Encopresis - Counselor1Stop

BRIEF SUMMARY

Encopresis, also called fecal incontinence or soiling, occurs when constipation causes impacted stool to fill the colon, and liquid stool leaks out. It can also be caused by the inability to control the anal sphincter muscle or gastrointestinal problems, particularly chronic diarrhea and Crohn’s disease. Several neurological disorders, including Tourette syndrome and obsessive-compulsive disorder, are also occasionally associated with the symptom of encopresis, particularly in children. Far less frequently, encopresis occurs without constipation and may be the result of emotional issues. Preventive care for encopresis includes frequent scheduled toileting and the wearing of pads or diapers to prevent embarrassing soiling. Careful cleaning is important to prevent skin breakdown. Treatment of encopresis usually involves treatment of the underlying disorder; cognitive behavioral therapy or behavior modification is also sometimes helpful. Encopresis is one form of an elimination disorder in children. Encopresis usually occurs after age 4, when the child has already learned to use a toilet. Encopresis can be frustrating for parents — and embarrassing for the child. Social stigma and difficulty with peers may be an issue for encopretic children. However, with patience and positive reinforcement, treatment for encopresis is usually successful.

KEY POINTS

Encopresis has been defined as “the repetitive, voluntary or involuntary, passage of stool in inappropriate places by children 4 years of age and older, at which time a child may be reasonably expected to have completed toilet training and to exercise bowel control.”
Most studies indicate approximately 4% of all children 4-17 years of age will experience encopresis.
Most children with encopresis have underlying constipation.
Some children with encopresis may successfully stool every day, however, evacuation of their bowel is incomplete.
Encopretic children commonly “defecate in places inappropriate to the social context at least once a month” (for example, the classroom).
Children with encopresis may seem oblivious or nonchalant to either obvious stool staining of their clothes or the heavy stool odor they produce.
There is generally no underlying organic medical condition that explains the child’s encopretic pattern.
Emotional stress may trigger encopresis. A child may experience stress from:
- Premature, difficult or conflict-filled toilet training
- Changes in the child’s life, such as dietary changes, toilet training, starting school or schedule changes
- Emotional stressors, for example, the divorce of a parent or the birth of a sibling.
Encopresis is more common in boys. These risk factors may increase the chances of having encopresis:
- Using medications that may cause constipation, such as cough suppressants
- Attention-deficit/hyperactivity disorder (ADHD)
- Autism spectrum disorder
- Anxiety or depression
A child who has encopresis may experience a range of emotions, including embarrassment, frustration, shame and anger. If the child is teased by friends or criticized or punished by adults, he or she may feel depressed or have low self-esteem.
A child with encopresis often feels ashamed and may wish to avoid situations (such as camp or school) that might lead to embarrassment. The amount of impairment is a function of the effect on the child’s self-esteem, the degree of social ostracism by peers, and the anger, punishment, and rejection on the part of caregivers.
Generally, the earlier that treatment begins for encopresis, the better. The first step involves clearing the colon of retained, impacted stool. After that, treatment focuses on encouraging healthy bowel movements. In some cases, psychotherapy may be a helpful addition to treatment.

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SHARED WISDOM

BM issues reponses from Counselor Talk, February 2018

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