Encopresis

Question 1

how many criteria are there for encopresis

Answer 1

4

Question 2

criteron A for encopresis

Answer 2

repeated passage of feces into inappropriate places (i.e clothing, floor) whether involuntary or intentional

Question 3

criterion B for encopresis

Answer 3

at least one such event occurs EACH MONTH for at least THREE MONTHS

Question 4

criterion C for encopresis

Answer 4

chronological age is at least 4 years (or equivalent developmental level)

Question 5

criterion D for encopresis

Answer 5

behaviour is not attributable to physiological effects of a substance (i.e laxatives) or another medical condition–> except through a mechanism involving CONSTIPATION

Question 6

what are the two specifiers for encopresis

Answer 6

1. with constipation and overflow incontinence (–> incontinence resolves after treatment of the constipation)
2. without constipation and overflow incontinence

Question 7

what other features are usually associated with the encopresis–without constipation subtype

Answer 7

stools usually normal form and consistency

feces may be deposited in a prominent location

usually associated with presence of ODD and conduct disorder

may be consequence of anal masturbation

Question 8

which subtype of encopresis is more common

Answer 8

soiling with constipation

Question 9

what other features are usually associated with the encopresis–with constipation subtype

Answer 9

if it is INvoluntary, it is usually related to constipation, impaction and retention with subsequent overflow

may develop for psychological reasons i.e anxiety about defecating in a particular place leading to avoidance of defecation

may also be associated with physiological predispositions to constipation i.e ineffectual straining or paradoxical defecation dynamics

Question 10

what is the prevalence of encopresis among five year olds

Answer 10

1%

Question 11

is encopresis more common in males or females

Answer 11

males

Question 12

name two possible predisposing factors in the environment for encopresis

Answer 12

inadequate, inconsistent toilet training

psychosocial stress i.e entering school, birth of a sibling

Question 13

define primary encopresis

Answer 13

person has never established fecal continence

Question 14

define secondary encopresis

Answer 14

encopresis develops after period of established fecal continence

Question 15

list genetic/physiological risk factors for encopresis

Answer 15

painful defecation–> can lead to constipation and withholding behaviours

Question 16

what medical condition should be considered in those with encopresis

Answer 16

Hirschprung’s disease

Question 17

treatment of retentive (constipation related) encopresis

Answer 17

treat the root cause–> chronic constipation

education + disimpaction + prevention of reaccumulation of feces + follow up

maintenance therapy usually takes 6-24 months

Question 18

options for pharmacologic disimpaction of feces

Answer 18

ie oral PEG–> effective and safe

Question 19

how do you prevent recurrence of fecal impaction

Answer 19

dietary changes (ie fiber, healthy balanced diet) + behavioural interventions (positive feedback and support from parents, address behvaioural problems, treat psychiatric conditions) + medication

Question 20

how do you treat non-retentive (i.e non constipation related) encopresis

Answer 20

not well defined–>

education

keeping bowel diary

toilet training four times a day following meals and immediately after arriving home from school

can consider antidiarrheal drugs like loperamide for those with fecal incontinence to reduce feal output

Question 21

what is the most critical step in treatment of non-retentive encipresis

Answer 21

behavioural therapy of toilet training + reward system