Encopresis

definition,causes ,diagnosis ,managment

1. Encopresis
Prof. Saad S Al-Ani
Senior Pediatric Consultant
Head of Pediatric Department
Khorfakkan Hospital
Sharjah ,UAE

2. 08/08/10 Prof.Saad S AlAni Khorfakkan Hospital2
Encopresis
Refers to the passage of feces into inappropriate
places after a chronologic age of 4 yr (or
equivalent developmental level).
Subtypes include:
1. Retentive encopresis:
Encopresis with constipation and overflow
incontinence
2. Nonretentive encopresis:
Encopresis without constipation and overflow
incontinence

3. 08/08/10 Prof.Saad S AlAni Khorfakkan Hospital3
Encopresis (cont.)
Encopresis may be:
1.Primary: persist from infancy onward
2.Secondary : may appear after successful
toilet training
 About two thirds of encopresis cases are of
the retentive type and associated with
chronic constipation;

4. 08/08/10 Prof.Saad S AlAni Khorfakkan Hospital4
Encopresis (cont.)
In children younger than 4 yr of age, the
male: female ratio for chronic constipation is
1:1.
In the school-aged child, however,
encopresis is more common in males

5. 08/08/10 Prof.Saad S AlAni Khorfakkan Hospital5
Clinical Manifestations
The first consideration in managing encopresis is
assessment of fecal retention.
Rectal examination
* A positive rectal examination is sufficient to
document fecal retention
* A negative rectal examination in the presence of
encopresis requires plain abdominal
roentgenograms.
The presence of fecal retention is evidence of chronic
constipation

6. 08/08/10 Prof.Saad S AlAni Khorfakkan Hospital6
Clinical Manifestations (cont.)
Many children with encopresis present with
abnormal anal sphincter physiology as
documented either by electromyography or
difficulty in defecating a rectal balloon.
 The inability to defecate a balloon at
presentation is associated with poorer
response to treatment

7. 08/08/10 Prof.Saad S AlAni Khorfakkan Hospital7
Clinical Manifestations (cont.)
 Abnormal anal sphincter function is a marker for
chronic constipation; children with this pathology do
not appear to have a higher incidence of behavioral
or psychiatric disorders than those without. However,
a chart review study suggests that
Primary encopresis in boys is associated with global
developmental delays and enuresis,
Secondary encopresis is associated with high levels
of psychosocial stressors and conduct disorder

8. 08/08/10 Prof.Saad S AlAni Khorfakkan Hospital8
Clinical Manifestations (cont.)
Associated behavioral or psychiatric problems
obviously may complicate the treatment of
encopresis,especially when parents respond to
soiling with retaliatory, punitive measures and
children become angry, ashamed, and resistant to
intervention.
 School performance and attendance may be
secondarily affected as the child becomes the target
of scorn and derision from schoolmates because of
the offensive odor

9. 08/08/10 Prof.Saad S AlAni Khorfakkan Hospital9
Treatment
The standard treatment approach to encopresis begins with
1. Clearance of impacted fecal material
2. Short-term use of mineral oil or laxatives to
prevent further constipation.
Concomitant behavioral management is also indicated.
The focus of behavioral treatment should be on compliance
with:
1. Regular postprandial toilet sitting and
2. adoption of a high-fiber diet.

10. 08/08/10 Prof.Saad S AlAni Khorfakkan Hospital10
Treatment (cont.)
 On some occasions, manual disimpaction is
required before the treatment can begin; rarely
megacolon is observed and referral to a
gastroenterologist is required.
Once impacted stool is removed, the combination of
constipation management and simple behavior
therapy is successful in the majority of cases, though
it is often a period of months before soiling stops
completely

11. 08/08/10 Prof.Saad S AlAni Khorfakkan Hospital11
Treatment (cont.)
Parents should be actively encouraged to
issue rewards for compliance to the child
from the outset of treatment and to avoid
power struggles with the child.
 Keeping records of the child's progress is
necessary
Long-term laxative use is contraindicated.

12. 08/08/10 Prof.Saad S AlAni Khorfakkan Hospital12
Treatment (cont.)
Improvement in some children on tricyclic
antidepressants
Tricyclic antidepressants often cause or
exacerbate constipation and should be
avoided in children with retentive encopresis
Encopresis eventually resolves in most
children, regardless of treatment approach.

13. 08/08/10 Prof.Saad S AlAni Khorfakkan Hospital13
Summary
Encopresis refers to the passage of feces
into inappropriate places after a chronologic
age of 4 yr
Subtypes include: Retentive encopresis and
Nonretentive encopresis
Encopresis may be: Primary or Secondary
The first consideration in managing
encopresis is assessment of fecal retention.

14. 08/08/10 Prof.Saad S AlAni Khorfakkan Hospital14
Summary (cont.)
Primary encopresis in boys is associated with
global developmental delays and enuresis,
Secondary encopresis is associated with
high levels of psychosocial stressors and
conduct disorder
the combination of constipation management
and simple behavior therapy is successful in
the majority of cases

15. 08/08/10 Prof.Saad S AlAni Khorfakkan Hospital15
References
Mikkelsen EJ: Enuresis and encopresis: Ten years of progress. J Am
Acad Child Adolesc Psychiatry 2001;40:1146. Medline Similar articles
Schum TR, McAuliffe TL, Simms MD, et al: Factors associated with
toilet training in the 1990s. Ambulatory Pediatrics 2001;1:79. Medline
Similar articles
Youssef NN, Di Lorenzo C: Childhood constipation: Evaluation and
treatment. J Clin Gastroenterol 2001;33:199-205. Medline
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Gereige RS, Frias JL: Is it more than just constipation? Pediatrics
2001;109:961-65.
Penning C, Gielkens HA, Hemelaar M, et al: Prolonged ambulatory
recording of antroduodenal motility in slow-transit constipation. Br J
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