Encopresis

Overview

Encopresis is a condition in which a person involuntarily passes stool into their clothing, typically due to impacted stool collecting in the colon and rectum. This usually occurs after age 4 in children who have already learned to use the toilet. It is often a symptom of long-standing constipation but can also result from emotional issues. Encopresis can cause frustration and embarrassment for both parents and children, but with patience and positive reinforcement, treatment is usually successful.

Understanding the disease

Symptoms

The symptoms of encopresis include repeated passing of stool (usually involuntarily) into clothing, abdominal pain and gastrointestinal bleeding, weakness, fatigue or a general feeling of being unwell, and rash or skin sores. Other symptoms may include pain, numbness, and tingling in the hands and feet, loss of appetite and weight loss, and difficulty with bowel movements. Encopresis typically occurs in children after age 4 and is often caused by long-standing constipation, although it can also be the result of emotional issues in some cases. If encopresis is not treated, it can lead to further complications such as bowel dysfunction and stool retention. If you or your child is experiencing these symptoms, it is important to see a healthcare provider for proper diagnosis and treatment.

Development

Encopresis develops when a child has long-standing constipation, which causes stool to become hard, dry, and painful to pass. As a result, the child avoids going to the toilet, making the problem worse. The longer the stool remains in the colon, the more difficult it becomes for the child to push stool out. The colon stretches, ultimately affecting the nerves that signal when it's time to go to the toilet. When the colon becomes too full, soft or liquid stool may leak out around the retained stool, or loss of control over bowel movements may occur. In some cases, encopresis can occur without constipation and may be the result of emotional issues, such as stress from premature toilet training, changes in the child's life, or emotional stressors.

Assessment and Diagnosis

Triage

You should see a doctor if encopresis is suspected if you or your child experiences the following symptoms: chronic or severe constipation, rectal prolapse, or if there is a change in bowel habits that lasts longer than a week. Additionally, it is recommended to consult a doctor if there are any signs of liver disease, easy bleeding or bruising, fluid buildup in the abdomen, or if you experience vomiting with large amounts of blood, black, tarry or bloody stools, lightheadedness due to blood loss, or loss of consciousness in severe cases.

Diagnosis

To diagnose encopresis, a child's doctor may conduct a physical exam, discuss symptoms, bowel movements, and eating habits to rule out physical causes for constipation or soiling. The doctor may also perform a digital rectal exam to check for impacted stool by inserting a lubricated, gloved finger into the rectum while pressing on the abdomen with the other hand. In some cases, an abdominal X-ray may be recommended to confirm the presence of impacted stool. If emotional issues are contributing to the symptoms, a psychological evaluation may be suggested.

Management and Treatment

Complications

Encopresis can lead to several complications, including:

1. Emotional issues: Encopresis can cause embarrassment, frustration, shame, and anger in children. If they are teased by friends or criticized by adults, they may experience depression or low self-esteem.
2. Soiling accidents: The repeated passing of stool into clothing can result in soiling accidents, which may impact a child's self-confidence and social interactions.
3. Impacted stool: The retained stool in the colon can lead to further complications such as bowel obstruction or fecal impaction.
4. Constipation: Encopresis is typically a symptom of long-standing constipation, which can lead to further complications like abdominal pain, fecal incontinence, or chronic constipation.
5. Stretching of the bowels: The stretching (distention) of the bowels due to stool retention can cause loss of control over bowel movements and make the problem more difficult to resolve. While these complications are not as common as the emotional issues and soiling accidents, it is essential to address encopresis promptly and seek professional help to prevent potential complications.

Prevention

encopresis can be prevented by taking certain measures to reduce constipation and promote healthy bowel habits. Some preventive strategies include:

1. Providing a balanced diet high in fiber to help regulate bowel movements.
2. Encouraging your child to drink enough water to stay hydrated.
3. Avoiding starting toilet training too early or being too forceful in the methods used.
4. Using positive reinforcement and encouragement during toilet training.
5. Addressing emotional issues, such as stress or anxiety, that may contribute to encopresis. Early treatment and consultation with a doctor or mental health professional can also help prevent the social and emotional impact of encopresis. Regular follow-up visits with your doctor can help identify any ongoing or recurring problems, allowing for adjustments in treatment as needed. Remember that encopresis is typically a symptom of long-standing constipation, so promoting healthy bowel habits and addressing any underlying issues can help prevent encopresis and its complications.

Home Remedies

Home remedies for encopresis may include:

1. Increasing fiber intake: Encourage your child to eat high-fiber foods like fruits, vegetables, and whole grains to help prevent constipation.
2. Drinking plenty of fluids: Ensure your child stays well-hydrated, especially with water, to promote regular bowel movements.
3. Gentle exercise: Encourage your child to engage in physical activities like walking, biking, or swimming to promote regular bowel movements and improve overall health.
4. Maintaining a healthy weight: Help your child maintain a healthy weight through a balanced diet and exercise to avoid constipation.
5. Toileting schedule: Encourage your child to use the bathroom at regular intervals, such as after meals or before bedtime, to establish a routine.
6. Warm baths: Give your child a warm bath to help relax the muscles and facilitate bowel movements.
7. Avoiding constipation triggers: Identify and avoid triggers that may cause constipation, such as dehydration, stress, or certain medications.
8. Practicing pelvic floor exercises: Encourage your child to practice pelvic floor exercises to strengthen the muscles involved in bowel movements. Remember that it's essential to consult with your child's doctor for proper diagnosis and treatment recommendations, as encopresis may have underlying medical causes that require professional attention.

Treatment

The treatments for encopresis typically involve addressing the underlying cause, which is often constipation. The following strategies can help treat and manage encopresis:

1. Encourage a high-fiber diet: Provide your child with a balanced diet that's high in fiber, including fruits, vegetables, and whole grains. This can help soften stools and make them easier to pass.
2. Increase fluid intake: Ensure that your child drinks enough water to ensure proper hydration, as dehydration can contribute to constipation.
3. Toilet training techniques: Use positive reinforcement and encouragement when helping your child learn proper toileting habits. Wait until your child is ready, and avoid being too forceful in your methods.
4. Exercise: Encourage regular physical activity, which can help promote healthy digestion and prevent constipation.
5. Medications: In some cases, your doctor may recommend laxatives or stool softeners to help alleviate constipation.
6. Behavioral therapy: If emotional issues are contributing to encopresis, your child may benefit from behavioral therapy or counseling to address any underlying anxieties or stressors.
7. Regular follow-up visits: Consult with your child's doctor regularly to monitor progress and make adjustments to the treatment plan as needed. Remember that patience and understanding are essential when dealing with encopresis. With the right approach and support, your child can overcome this issue and regain control over their bowel movements.

Preparing for medical consultation