Encopresis
Definition
Encopresis is defined as the repeated passage or
leaking of feces in inappropriate places in a child over
4 years of age that is not caused by a physical illness or
disability.
Description
Over 80% of cases of encopresis begin with the
child’s experience of a painful bowel movement or
passing a very large bowel movement. Over time, the
child comes to associate using the toilet with pain and
begins to hold in, or retain, his or her bowel move-
ments to avoid the pain. The child may occasionally
try to pass some of the hardened stool and develop a
crack in the skin surrounding the anus known as an
anal fissure. Anal fissures cause additional pain and
usually reinforce the child’s habit of retaining feces. As
the mass of stool grows, the colon stretches to many
times its normal diameter—a condition known as
megacolon. The child also loses the natural urge to
have a bowel movement because the muscles in the
wall of the colon cannot contract and push the stool
out.
Encopresis is thought to affect between 1–2% of
children in the United States below the age of 10. Boys
are six times as likely to develop encopresis. It is not
known to be related to race or social class, the size of
the family, the child’s birth order, or the age of the
parents.
Treatment
There is no universal agreement among doctors as
to the best method of treatment for encopresis, includ-
ing dietary recommendations. It is a disorder resulting
from the interaction of bodily, psychological, and
social factors in the child’s life. As a result, there
have been no large-scale controlled studies of different
treatment methods.
Dietary treatment
Dietary treatment of encopresis is intended to
help the child develop regular bowel habits after dis-
impaction and to minimize the risk of recurrentcon-
stipation. Dietary modifications usually include:
Reducing the child’s intake of milk and other dairy
products that tend to cause constipation. Some
pediatricians recommend soy milk as a substitute
for cow’s milk during maintenance treatment.
Adding dietary fiber to the child’s diet in the form of
high-fiber breads and cereals, vegetables and fruits
that are high in fiber, or over-the-counter fiber
supplements.
Increasing the child’s water intake, particularly dur-
ing warm weather.
Encouraging the child to participate in vigorous
physical activity. Exercise helps to move food
through the digestive system.
Increasing the child’s intake of fruit and fruit juices.
Fruit juices, particularly prune juice, have a laxative
effect. Fruit and fruit juices cannot be used by them-
selves as maintenance treatment for encopresis
because few children are able to drink or eat the
amounts required for laxative treatment. Fruit is
recommended over fruit juice since it has more
nutrients.KEY TERMS
Anal fissure—A crack or slit that develops in the
mucous membrane of the anus, often as a result of a
constipated person pushing to expel hardened
stool. Anal fissures are quite painful and difficult
to heal.
Biofeedback—A technique for improving aware-
ness of internal bodily sensations in order to gain
conscious control over digestion and other proc-
esses generally considered to be automatic.
Constipation—Abnormally delayed or infrequent
passage of feces. It may be either functional (related
to failure to move the bowels) or organic (caused by
another disease or disorder).
Enema—The injection of liquid through the anus
into the rectum in order to soften hardened stools.
Impaction—The medical term for a mass of fecal
matter that has become lodged in the lower diges-
tive tract. Removal of this material is called
disimpaction.
Laxative—A drug usually administered by mouth to
produce a bowel movement. Laxatives are also
known as cathartics.
Megacolon—A condition in which the colon
becomes stretched far beyond its usual size. Chil-
dren with long-term constipation may develop
megacolon.
Suppository—A tablet or capsule, usually made of
glycerin, inserted into the rectum to stimulate the
muscles to contract and expel feces.Encopresis