Encopresis Flashcards
how many criteria are there for encopresis
4
criteron A for encopresis
repeated passage of feces into inappropriate places (i.e clothing, floor) whether involuntary or intentional
criterion B for encopresis
at least one such event occurs EACH MONTH for at least THREE MONTHS
criterion C for encopresis
chronological age is at least 4 years (or equivalent developmental level)
criterion D for encopresis
behaviour is not attributable to physiological effects of a substance (i.e laxatives) or another medical condition–> except through a mechanism involving CONSTIPATION
what are the two specifiers for encopresis
- with constipation and overflow incontinence (–> incontinence resolves after treatment of the constipation)
- without constipation and overflow incontinence
what other features are usually associated with the encopresis–without constipation subtype
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
which subtype of encopresis is more common
soiling with constipation
what other features are usually associated with the encopresis–with constipation subtype
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
what is the prevalence of encopresis among five year olds
1%
is encopresis more common in males or females
males
name two possible predisposing factors in the environment for encopresis
inadequate, inconsistent toilet training
psychosocial stress i.e entering school, birth of a sibling
define primary encopresis
person has never established fecal continence
define secondary encopresis
encopresis develops after period of established fecal continence
list genetic/physiological risk factors for encopresis
painful defecation–> can lead to constipation and withholding behaviours
what medical condition should be considered in those with encopresis
Hirschprung’s disease
treatment of retentive (constipation related) encopresis
treat the root cause–> chronic constipation
education + disimpaction + prevention of reaccumulation of feces + follow up
maintenance therapy usually takes 6-24 months
options for pharmacologic disimpaction of feces
ie oral PEG–> effective and safe
how do you prevent recurrence of fecal impaction
dietary changes (ie fiber, healthy balanced diet) + behavioural interventions (positive feedback and support from parents, address behvaioural problems, treat psychiatric conditions) + medication
how do you treat non-retentive (i.e non constipation related) encopresis
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
what is the most critical step in treatment of non-retentive encipresis
behavioural therapy of toilet training + reward system
