About Encopresis

Overview

Encopresis is a condition where children over the age of four soil their clothes with stool over and over. To diagnose encopresis, the stool soiling must happen at least once a month for three months or more. It’s not caused directly by other medical conditions or medications, and it is often referred to as fecal incontinence. This problem is usually related to chronic constipation, where bowel movements don’t happen often, and the stool is hard and dry. When the stool stays in the lower bowel (rectum) for too long without being passed, it stretches the bowel wall. This can weaken the muscle tone and reduce sensitivity, making it hard for the child to pass stool and to recognize when they need to go to the bathroom. Treating constipation can help relieve symptoms over time.

Causes and Risk Factors

The root causes of encopresis include:

Chronic constipation and withholding of bowel movements: The most common cause of encopresis is when stool becomes very hard and dry, making it difficult to pass. This can lead to a buildup of stool in the rectum and colon, causing accidental soiling.
Other physical causes: These include conditions like:
- Hypothyroidism: A health issue where the thyroid doesn’t make enough hormones, affecting digestion and other body functions
- Inflammatory bowel disease (IBD): Conditions that cause swelling and irritation in the digestive tract, affecting how it works
- Nerve damage: Injuries to the nerves that help control bowel movements
- Recta infections: Infections in the lower bowel that make controlling bowel movements painful
- Rectal tears: Small tears in the skin around the anus that can hurt during bowel movements and make it difficult to control when to go to the bathroom

Non-modifiable risk factors of encopresis cannot be changed or controlled. These include:

Gender: Boys are six times more likely to develop encopresis than girls.
Health conditions: Certain health problems, like diabetes or hypothyroidism, can make a person more likely to get constipated. Constipation increases the risk of encopresis because it can make bowel movements difficult.
Tissue tear in the rectum: Chronic constipation can cause a tear in the rectum. This can make it harder to control bowel movements, adding to encopresis.

Modifiable risk factors of encopresis can be influenced or changed. These include:

Eating habits: Not eating enough fiber can lead to constipation. Foods high in fiber help keep bowel movements regular, so having poor eating habits can increase the risk of encopresis.
Exercise: Not being active enough can also make constipation more likely. Regular physical activity helps improve digestion and can reduce the chances of becoming constipated.
Learning how to use the bathroom properly: Starting to learn how to use the bathroom too early or not having a regular routine can make it harder for children to learn to control their bowel movements, adding to encopresis.
Abuse: In some cases, encopresis not related to constipation might be seen in children who have been sexually abused or who are having emotional problems. However, it is important to know that just because a child has encopresis, it does not definitely mean they have been abused.

It's important to note that these risk factors may increase the chance of developing encopresis but do not mean it will happen It's always best to talk with a healthcare professional for the right diagnosis and advice.

Symptoms

The most common early symptoms of encopresis include:

Uncontrolled bowel movements: This is the most common symptom of encopresis. Children might soil their underwear without being able to stop it.
Constipation: This is often present but might not always be noticed right away. Constipation means not having a bowel movement for three days or more, which can make stool hard, dry and painful to pass later. This buildup of stool can lead to accidental soiling, as it becomes harder for the child to control when they go to the bathroom.
Lack of appetite: Some children with encopresis may have a decreased appetite.
Abdominal pain: Abdominal pain can happen in children with encopresis.
Urinary incontinence: In some cases, children with encopresis might also have trouble controlling their urine. This can happen especially if there are problems with the muscles or nerves in their pelvic floor, which help control both urine and stool.
Shame and guilt: Children with encopresis often feel really bad and embarrassed about soiling themselves. They might hide their dirty clothes or not want to talk about what’s happening because they are worried about what others think.

As encopresis becomes more severe or continues over time, additional symptoms may arise, including:

Becoming more secretive: As the problem continues, some children might try even harder to hide their soiled underwear and avoid talking about their bathroom troubles. They may feel more worried about others finding out.
Teasing at school: If classmates find out about the problem, children with encopresis may get teased at school.
Other emotional effects: Encopresis can lead to feelings of embarrassment, frustration, and low self-esteem in children.

Remember, it's important to talk with a healthcare professional to get the right help and advice.

Diagnosis

Encopresis can be diagnosed through various exams, tests, and procedures. Here is a list of commonly performed diagnostic measures:

Symptoms and medical history: The doctor will ask about the child's age, chronic constipation symptoms, and how long the problem has been going on.
Physical examination: The doctor will do a physical exam, including an exam of the rectum. They will look for signs of dried and hard fecal matter.
Abdominal X-ray: In some cases, an abdominal X-ray may be done to see how much fecal buildup there is, but this isn’t always needed.
Psychological evaluation: A psychological assessment may be done to find any emotional issues adding to the problem.

To determine the stage or severity of encopresis, additional exams and tests may include:

Barium enema: In this test, a special liquid called barium is used to help doctors see the inside of the large intestine on an X-ray. This helps them find any problems that might be causing trouble.
Rectal biopsy: A small piece of tissue from the rectum is taken and looked at under a microscope in the lab. This helps them check for any unusual changes in the tissue.
Blood tests: If the doctor thinks there might be an issue with the thyroid gland, like hypothyroidism, they may order a blood test to measure thyroid hormone levels.

It's important to talk with your child's doctor for the right diagnosis and check-up.

Treatment Options

The goals of treatment for encopresis are to fix the root causes, make it easier to pass stool, help create regular bowel movements. Here are the recommended treatments and how they work to reach these goals:

Psychological counseling: If a child is feeling very upset or has behavior problems, talking with a counselor can help. The counselor will work with the child to improve their coping skills (ways to handle and deal with feelings or difficult situations), boost their self-esteem, and help parents learn how to support their child better.
Removing impacted stool: Doctors may recommend enemas, laxatives, or rectal suppositories to clear out dry, hard stool from the colon. This makes it easier to go to the bathroom and helps prevent future constipation.
Encouraging regular bowel movements: Children need to learn healthy habits to help keep their bowel movements regular and prevent constipation from coming back. This may involve dietary changes, such as increasing fiber with foods like strawberries, bran cereal, beans, grapes, and broccoli. Drinking enough water and daily exercise also help keep stools soft and make going to the bathroom easier.
Lifestyle changes: Drinking less caffeine and spending less time on media can help the child stay hydrated and more active These habits are good for their overall bowel health.
Behavior changes: Using positive behaviors to encourage good bathroom habits can be helpful. Rewarding children for sitting on the toilet, eating high-fiber foods, and following treatment plans can make them more motivated. It’s important not to scold a child after an accident, as this can make them anxious about using the bathroom.

It's important to consult a healthcare professional before starting any medication or treatment.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.