Encopresis

Encopresis, also known as fecal incontinence or soiling, is the frequent flow of feces into clothing—usually involuntarily. The colon gets too full and liquid feces escapes around the retained stool, staining underpants. This is what often happens when impacted stool gathers in the colon and rectum. Stool retention may eventually result in bowel stretching (distention) and a lack of control over bowel movements.

Encopresis often happens once a child reaches the age of four and has mastered using the toilet. Most often, soiling is a sign of chronic constipation. It happens much less frequently without constipation and might be brought on by mental problems.

Encopresis may be humiliating for the youngster as well as frustrating for the parents. Nonetheless, encopresis therapy is typically effective with persistence and encouragement.

Encopresis: Causes

Encopresis can have several reasons, such as mental problems and constipation.

Chronic constipation is the cause of the majority of encopresis patients. The youngster with constipation passes firm, dry, and perhaps painful feces. The issue gets worse as a result of the youngster refusing to use the restroom. The youngster finds it more challenging to get the feces out the longer it stays in the colon.

The nerves that indicate when it's time to use the restroom are eventually impacted by the colon's stretching. When the colon is overstuffed, soft or liquid feces may leak out around the trapped feces, or bowel motions may become uncontrollable.

Constipation has several reasons, such as −

• Withholding stools because they are uncomfortable to pass or they are afraid to use the toilet (particularly when they are away from home).

• Avoiding interfering with gaming or other activities

• Eating insufficient fiber

• Not enough liquids consumed.

• Excessive consumption of cow's milk or, less frequently, an intolerance to it, while the study on both topics has shown mixed findings.

• Mood disorders

Encopresis may be brought on by emotional stress. Stress in children can result from −

• Early, challenging, or contentious potty training

• A child's life may alter due to nutritional adjustments, potty training, entering school, or scheduling adjustments.

• Emotional pressures, such as a parent's divorce or a sibling's birth

Encopresis: Symptoms

The patient with encopresis mainly presents with the following symptoms that include −

• Stool leakage or liquid stools on underpants that resemble diarrhea.

• Diarrhoea accompanied by dry, firm stools.

• The passing of big feces that partially or completely block the toilet

• Delaying bowel movements

• A protracted interval between bowel motions

• Having no appetite

• Continent pain

• Issues with night-time or daytime urination (enuresis)

• Bladder infections that recur often, usually in girls

Encopresis: Risk Factors

Several factors play an important role in the development of encopresis which includes −

Boys experience encopresis more frequently than girls. Several potential risk factors might raise the likelihood of developing encopresis −

• Using drugs that might make you constipated, such as cough suppressants

• Hyperactive/attention-deficit disorder (ADHD)

• Autism spectrum condition

• Depression or anxiety

Encopresis: Diagnosis

The diagnosis of the encopresis is mainly done based on history and some of the tests may be required for confirmation and to rule out underlying causes −

• To rule out physical causes for constipation or soiling, perform a physical examination, and talk about the symptoms, bowel motions, and dietary habits.

• Insert a finger into your child's rectum while pressing on his or her belly to do a digital rectal exam to look for any impacted stools.

• Encourage an abdominal X-ray to see whether impacted stools are present.

• If your child's symptoms are being exacerbated by emotional problems, recommend that they get a psychiatric examination.

Encopresis: Treatment

The treatment is based on the severity of the symptoms. Your doctor may advise conservative or surgical treatment.

In general, the earlier encopresis therapy starts, the better. Getting rid of impacted, retained feces is the first step. The focus of therapy then shifts to promoting regular bowel motions. Psychotherapy may occasionally be a beneficial supplement to treatment.

Removing Affected Stools from the Colon

There are various techniques for constipation relief and colon cleansing. The doctor of your child will probably suggest one or more of the following −

• A few laxatives

• Reproductive suppositories

• Enemas

The doctor treating your child could advise frequent follow-up visits to see how the colon is cleaning up.

• Promoting regular, healthy bowel movements

• Encourage your youngster to have frequent bowel movements once the colon has been cleaned. The pediatrician may advise −

• Dietary adjustments that include consuming more fiber and getting enough water

• Laxatives, gradually stopping them once the bowels are functioning normally

Your youngster should be taught to use the restroom as soon as the desire to urinate strikes.

Alteration of Behavior

The doctor or mental health specialist who cares for your kid might go over teaching methods for educating them to have regular bowel movements. This is sometimes referred to as bowel retraining or habit modification. If the doctor determines that the encopresis may be caused by emotional problems, she may advise treatment with a mental health specialist for your kid. 

Encopresis: Prevention

Some of the measures that can help to prevent encopresis include the following −

Eliminate Constipation

By giving your kid a balanced diet that is high in fiber and encouraging them to drink enough water, you may help them prevent constipation.

Discover the best methods for toilet training

Learn about successful potty training methods. Avoid getting started too soon or using overly aggressive tactics. Provide supportive encouragement and positive reinforcement once your child is ready to help them grow. Inquire with your doctor about training toilet resources.

Early encopresis therapy is advised

Encopresis can have a negative social and emotional impact, but early treatment, including advice from your child's physician or mental health specialist, can help prevent this. To change therapy as necessary, persistent or reoccurring issues might be found through regular follow-up appointments with your doctor.

Conclusion

Family members, medical professionals, and the patient must collaborate to successfully treat encopresis to get better treatment outcomes. Constipation frequently causes a vicious cycle that ends in stool withholding, fecal retention, and ultimately fecal incontinence, the physicians must explain.

It is crucial to make it clear to the family that the kid has no control over rectal impaction, which is the primary cause of fecal incontinence.

Parents also need to be aware that there is no fast fix for this problem. Parents should be reassured, nonetheless, that recovery is feasible with sufficient, frequently prolonged treatment.

Therapy programs ought to contain directions for initial management, ongoing care, how to deal with relapses at home, and when and how to follow up for more assistance and inquiries; behavioral remedies such as waiting five to ten minutes before using the restroom after eating the same thing every day (for toilet-trained children); and scheduled follow-up visits, often every three to four weeks until bowel motions returned to normal, then every three to six months and as necessary.