Encopresis (Involuntary Defecation)

Almost 1.5% of young children face encopresis disorder. Furthermore, a report suggests that 1.4% of people face encopresis, which includes 0.9% of adults aged 40-64 years old and 2.3% of adults aged 65 years and above. It affects people of all ages, from children to adults, and it is more common in women and older adults and is not only a part of aging or childhood.

What is Encopresis (Involuntary Defecation)?

Encopresis is also known as fecal incontinence or soiling. This disorder is defined as when someone unintentionally passes stool in their clothes. Typically, it occurs when impacted stool is collected in the colon and rectum, and during this time, the colon becomes full, and the liquid stool leaks around the retained stool staining in the clothes. Rarely it occurs without constipation and results in embarrassment with emotional issues. It was mainly common among children and older people. However, positive reinforcement and treatment for curing encopresis are usually successful.

There are two types of encopresis−

• Retentive encopresis, i.e., type encopresis caused by constipation.
• Non-retentive encopresis, i.e., involuntary leaking of stool without constipation.

Symptoms of Encopresis

There are several symptoms of encopresis. Those are −

• Leakage of stool or liquid stool on clothes which can be thought of as diarrhea

• Hard and dry stool due to constipation

• Passage of large stool that clogs the toilet

• Avoiding movements of bowel

• A long period between bowel movements

• Lack of appetite

• Pain in the abdomen

• Continuous infection in the bladder

• Secretive behavior from the terror of embarrassment

• Enlargement of the colon. Colon gets out of shape, which leads to periodically passing extremely large bowel movements

Causes of Encopresis

Several factors in individuals cause encopresis. Those factors are −

Constipation − The most common cause of encopresis is constipation. In constipation, the stool of the individual becomes hard, dry, and very much painful to pass it out. This leads to the avoidance of the toilet due to fear of worsening the condition. Due to this, the colon starts stretching and affects the nerves that signal when it is time to go to the toilet. After this, stool may leak when the colon becomes full, soft, or liquid due to the lack of control of bowel movements. Causes of constipation are −

• Withholding stool due to the fear of using the toilet or because it will be painful to pass it out

• Do not want to interfere in other activities

• Too little fiber intake

• Drinking too much cow milk which sometimes leads to intolerance to cow's milk

Underlying Medical Conditions − This disorder may occur due to some medical conditions. Possible conditions are −

• Colonic inertia - Does not move stool as needed.

• Nerve damage in the digestive tract - Muscles at the end of the digestive tract do not close properly.

• Hirschsprung disease - Missing nerve ending in the bowel, which leads to blockage of the intestine to disrupt the passage of the stool.

• Infection in rectum

• Malnutrition or a diet composed of too much fat and sugar

• Dehydration

Psychological Causes − Emotional stress, behavioral challenges, or fear can be considered a cause of encopresis. Psychological causes involve −

• Does not want to go to the washroom due to interference in the current activities.

• Fear of using the toilet

• Oppositional defiant disorder, i.e., disobedience toward authority figures.

• Behavioral or psychological problems.

Diagnosis of Encopresis

Doctors may suggest some processes for the diagnosis of encopresis. Those are −

• Conduct a Physical Exam − After this exam, the doctor discusses the individual's symptoms, bowel movements, and eating habits to identify the physical causes of encopresis.

• Digital Rectal Exam − Doctors go through this exam to look at the impacted stool by inserting a lubricated, gloved finger into a person's rectum and pressing on his/he abdomen with the other hand.

• Abdominal X-Ray − Doctors recommended this to confirm the presence of the impacted stool.

• Psychological Evaluation − Sometimes, doctors suggest a psychological evaluation of the patient by a psychiatrist to identify any emotional issue or mental illness contributing to the encopresis disorder.

• Anorectal Manometry − This test is done to check the strength of the anal and rectal muscles.

• Barium Enema − This test is done to check if there is any obstruction or abnormality in the large intestine.

Other than these, doctors may suggest a urine test find similar conditions that will help them diagnose the encopresis of a person.

Treatment of Encopresis

Treatment of encopresis involves cleaning the retained and impacted stool from the colon; after that, treatment moves toward encouraging healthy bowel movements. In addition, in some cases, psychotherapy can help cure this disorder.

Cleaning the Colon of Impacted Stool − There are various procedures for cleaning the colon and relieving constipation. A doctor will suggest the following processes −

• Certain laxatives
• Rectal suppositories
• Enemas

Encouraging Healthy Bowel Movement − Once the colon is cleaned, it is important to encourage the patient to have a regular bowel movement. Doctors may suggest −

• Changes in the diet by including more fiber and drinking enough fluid.

• Laxatives must be stopped after the bowel movement becomes normal.

• Training must be given to a child to use the washroom when there is an urge to do bowel movements occurs.

• Trial of going off cow's milk or checking for cow's milk intolerance, if indicated.

Behavior Modification − To regularize the bowel movement of an individual, a mental health professional can suggest psychotherapy if the encopresis is connected to emotional issues. This is known as bowel retraining. Psychotherapy can also help an individual overcome the problem of shame, guilt, and depression related to encopresis.

Conclusion

From the above discussion, it can be concluded that encopresis, i.e., involuntary defecation, can occur among people of all ages, but it is most common among children and older adults. This eliminating disorder involves symptoms like leaking of stool or liquid stool in cloth, lack of appetite, abdominal pain, and many more. The main reasons for this disorder are constipation, psychological problem, and medication. There is some treatment for this disorder, which can be understood by the doctor after diagnosing the disorder with several tests. Treatment of this disorder involves behavioral changes, colon cleaning, and healthy movements of bowel.