Overview:
Encopresis or fecal incontinence is the involuntary passage of stool into inappropriate locations, such as underwear, in children older than four years. The disease is more likely in males than females. It causes significant emotional suffering for children and their families. This exercise addresses the evaluation and management of encopresis. It emphasizes the importance of inter-professional team management comprising physicians, child psychiatrists, and pediatric gastroenterologists in evaluating and treating children with this condition.
What Is Encopresis?
Encopresis, also called "soiling," is a disorder in which a child over the age of four poops repeatedly in places other than the toilet, like their clothes or the floor. Some kids with encopresis have trouble going to the bathroom normally, like having constipation or worrying about going to the bathroom, so they try to hold it. In either case, when a child has not pooped for a long time, they cannot control it, and when they do, thereby pass stools in inappropriate locations. Sometimes, it may be a sign of some other psychiatric condition.
What Are the Causes of Encopresis?
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The common cause of encopresis in children is long-term constipation, often known as chronic constipation.
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A child who is constipated has fewer bowel movements than usual. Bowel movements may become stiff, dry, and difficult to pass; as a result, it aches, and the child may postpone using the restroom. Liquid stool may begin to flow around the hard, dry, impacted stool over time. This spoils the child's clothing.
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When children withhold stools, the lower colon swells, this can cause the lower colon to lose its typical shape over time. The more stool a child retains, the more the colon expands, and the stool becomes larger and firmer. This makes pooping much more painful. When this occurs repeatedly, the colon becomes so stretched and floppy that the muscles children need to expel stool become ineffective. Solid stools can become trapped, and only liquid can pass around them. As the child's stretched nerves become less sensitive, they cannot feel the leaking stool.
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Other causes of encopresis are:
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Colonic inertia is when the colon fails to transport feces as it should.
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Those with emotional or behavioral difficulties may have difficulty with soiling.
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Nerve injury or damage to the muscle near the end of the digestive system (anal sphincter). This prevents it from properly closing.
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Fear of using the restroom.
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Genital ulcers or tears.
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Other health conditions that contribute to chronic constipation, like diabetes, hypothyroidism, Hirschsprung disease, and inflammatory bowel disease, can cause encopresis.
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What Symptoms Does Encopresis Cause?
More than 80 percent of children with encopresis have previously suffered from painful defecation or constipation at some point in their lives. In many situations, the symptoms of encopresis, such as constipation or pain, do not present themselves until years after the condition has already been present. The majority of children who suffer from encopresis report that they do not experience any urge to poop before they dirty their underwear. Soiling incidents tend to occur throughout the day while the child is awake and engaged in activities. It is not very common to soil oneself at night. However, each child's symptoms might differ from one another, and possible symptoms include the following:
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Having loose, watery stools.
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The need for a bowel movement with little or no notice is known as involuntary stooling.
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If the child is unable to reach the bathroom in a timely manner, he or she may soil his or her underpants.
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Itching or massaging the anal region because loose stools inflame it.
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Distancing oneself from friends, school, or family.
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Hiding dirty underwear.
What Are the Risk Factors for Encopresis?
The risk factors that can lead to encopresis include:
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Long-term (chronic) constipation.
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Eating junk food, high-fat, high-sugar diet.
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Mostly consuming soft drinks and sugary drinks.
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Drinking too little water.
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Lack of physical activity.
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Refusing to use public restrooms.
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Feeling anxious at home, at work, or at school.
How Is Encopresis Diagnosed?
Their healthcare provider will take a health history on the child's medical history, potty training history, diet, lifestyle, habits, medications, and behavior. The child will get a comprehensive physical examination to evaluate overall health and the colon, rectum, and anus condition. Imaging studies may also be used to examine the intestine and rule out other health issues. These tests consist of the following:
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Abdominal X-ray: The amount of stool in the large intestine is analyzed during this examination.
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Barium Test: This examination looks for obstructions, strictures, blockages, and other issues in the intestine. It makes use of barium fluid, which is visible on X-rays. A tube is filled with barium. As an enema, it is inserted into the child's rectum. After that, an X-ray is used to examine the gut.
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Psychological Testing: To determine if it is caused by emotional stress, fear, or problems with behavior.
How Is Encopresis Treated?
The ways to treat the child will depend on his or her symptoms, age, and overall health. Also, it will depend on how severe the problem is. Some of the treatments that are provided are:
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Removing the stool that was impacted.
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Maintaining regular, soft bowel motions to facilitate easy passage of feces.
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Retraining the colon and rectum to improve bowel movement control.
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The child's doctor may recommend an enema for impacted stool. A child's rectum receives an enema. It softens dry, hard feces. Never give the child an enema without medical consent.
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The child's doctor may prescribe medications to keep bowel motions smooth for months. This prevents impacted stool. Never give the child stool softeners without medical advice.
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Diet and lifestyle modifications are recommended.
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If the child has feelings of embarrassment or guilt due to their encopresis, a therapist can assist them in overcoming these emotions and teach them how to defecate regularly.
When Should One Get in Touch with the Doctor?
If one notices any of the signs and symptoms of encopresis, one should take the patient to a doctor. Encopresis and constipation can be easier to treat if they are caught early. If the child does not have bowel movements, is in pain, or will not eat because of pain, they should see the doctor right away.
How to Prevent Encopresis?
Constipation and good toileting experiences help prevent encopresis. Here's how:
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Take a high-fiber diet.
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Drinking lots of water.
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Getting good active time.
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Planning after-meal bathroom breaks.
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Positive encouragement to the child while potty training.
Conclusion:
Even though one could notice some improvement early along the treatment, it will likely be several months before the child is completely free of encopresis. Along the road, there will be a number of mishaps. The proper response for parents in an accident is to remain calm and continue supporting their children. Most children who undergo treatment for encopresis eventually no longer suffer from constipation as they grow older. Bowel training programs have been shown to work about 75 percent of the time, while the other 25 percent still have functional constipation. If the child's encopresis does not get better after the primary care practitioner tries to help, he or she may be advised to see a gastroenterologist. Sometimes, encopresis results from something more serious, like sexual abuse, and needs more intensive mental health treatment. In such cases, immediate therapy is advised.
