Encopresis in Children
Definition
Encopresis, also known as functional fecal incontinence, is the repetitive passage of stools in inappropriate places. This can be voluntary or involuntary. It occurs in children 4 years and older who have already acquired toilet training.
Etiology
- Retentive Encopresis
- Associated with functional constipation.
- Signs: Retentive posturing, hard or painful stools, volitional stool retention, presence of large fecal mass, history of passing large-diameter stools.
- Non-Retentive Encopresis
- Occurs without signs of constipation.
- Diagnostic Criteria:
- More than 1 month of inappropriate defecation.
- No evidence of fecal retention upon medical evaluation.
Clinical Features
- Passing hard stools in inappropriate places.
- Soiling of clothes, abdominal pain, and fecal incontinence.
- Associated anxiety and social stigma.
- 25-30% of cases show co-existing urinary incontinence.
Diagnosis
- Exclude organic causes by history and examination.
- Diagnostic Tools:
- X-ray spine for suspected spinal or neurological causes.
- Ultrasonography, contrast studies, or MRI in select cases.
- Rule out hypothyroidism, celiac disease, cow’s milk intolerance, etc.
- Anorectal manometry for intractable symptoms or poor response to treatment.
Treatment
- Bowel Retraining
- Step 1: Disimpaction.
- Step 2: Achieve regular bowel movements and avoid recurrent constipation with laxatives and behavioral therapy.
- Step 3: Stool softening through increased fiber intake.
- Behavioral Therapy
- Positive reinforcement to support new bowel habits.
- Dietary Management
- Promote balanced diets rich in fruits, vegetables, and whole grains. Limit excessive milk consumption. Ensure adequate fiber and fluid intake.
- Medication
- Polyethylene Glycol (PEG): Safe and effective for children to maintain regular bowel movements.
- In severe cases, enemas or laxatives are needed during the disimpaction phase.
Conclusion
Early diagnosis and treatment of encopresis can prevent long-term complications like social anxiety, stigma, and coexisting urinary incontinence. A multidisciplinary approach involving dietary management, behavioral therapy, and appropriate medications can help achieve regular bowel habits in affected children.