Encopresis

Question 1

Encopresis - background

Answer 1

1. Def = soiling due to overflow incontinence
2. In most children - caused by underlying constipation
3. Painful or distressing experience with defecation leads to stool-withholding behaviour, which further contributes to constipation
4. Constipation -> large bolus of faeces which the child cannot shift. Rectum dilates and habituates to distension -> child becomes unaware of the need to empty it
5. Stool may seep out beyond child’s control. Soiling in child’s pants

Question 2

Encopresis - causes of stool-withholding

Answer 2

1. Constipation, possibly following dehydration during an illness
2. Inhibition of defecation because of pain from a fissure
3. Anxieties about using the toilet

Question 3

Encopresis - mx

Answer 3

1. Discuss the condition with child and parents - let them know that retention is present and that it has lead to incontinence
2. Empty rectum as soon as possible. Stool softener (e.g. macrogo) given for several weeks, followed by stimulant laxative (docusate, sodium picosulphate or senna) + osmotic laxative (lactulose) if necessary. Sometimes an enema is required
3. Maintenance laxative therapy once rectum disimpacted
4. Child encouraged to defecate regularly in the toilet - stars on a star chart
5. Identify and treat underlying reasons for fecal retention (e.g. anal fissure)

Mx anal fissures in children?
- In adults, tx constipation, then +/- NTG ointment (adverse effects), then botox, then internal anal sphincterotomy