Encopresis

DEFINATION: Encopresis occurs when children who are old enough to eliminate waste appropriately repeatedly defecate in inappropriate places such as inside clothing or on the floor.

EXPLANATION: majority of encopresis cases involve constipation, it is necessary that symptomatic child receive a thorough medical examination including a rectal examination to identify any physical or medical conditions that might be causing problems.

Information needs to be collected concerning the child’s toilet training history and his or her mastery of appropriate toilet skills

In addition, the child’s dietary and eating habits, and the pattern of soiling incidents including frequency of soiling, if soiling is in response to any stresses or issues, and how the child, parents and significant others respond to soiling incidents must be determined.

Knowledge of such information is necessary to demonstrate that diagnostic criteria are met, and may also shed light on environmental and emotional factors related to the disorder.

PREVALANCE: Encopresis is much less common than enuresis. According to the DSM, approximately 1% of 5-year old children meet the diagnostic criteria for Encopresis. About 3% of all children treated for a mental disorders meet criteria for the condition.

SEX BIAS: Encopresis is 3 to 6 times more common in males than in females.

AGE OF ONSET:  child must be at least 4 years old (or developmentally equivalent to a 4 year-old).

ETIOLOGY:

CLASSIFICATION: Two different varieties of Encopresis are seen:

  • With Constipation and Overflow Incontinence:
  • produce less than three bowel movements per week.
  • Due to constipation, only part of the total available stool is voided during each of these movements. Portions of the remaining stool then leak out of the bowel, often during the child’s daily activities.
  • When the child’s underlying constipation problem is treated, this form of encopresis generally resolves.

 

  • Without Constipation and Overflow Incontinence:
  • show no evidence of constipation.
  • Instead, the child’s feces are usually normal in form, and soiling is intermittent rather than regular.
  • Feces may be emitted in a prominent location (e.g., as an act of defiance) or may be an unintentional consequence of anal self-stimulation (e.g., a variety of masturbation).

Encopresis without Constipation and Overflow Incontinence is less common than the first type of Encopresis,

 

SIGNS AND SYMPTOMS: DSM criteria for encopresis state that the behavior must occur once a month for at least 3 months duration before the diagnosis applies. Generally, encopresis is an involuntary condition.

 

ASSOCIATED PROBLEMS:  associated with Oppositional Defiant Disorder and Conduct Disorder.