Encopresis

Aka: Encopresis, Stool Soiling, Stool Incontinence in Children

advertisement

II. Epidemiology

  1. Children of at least 4 years old
  2. Affects 1-4% of school aged children
  3. Boys more affected than girls

III. History

  1. Stool pattern
    1. Stool size
    2. Stool consistency
    3. Interval between stools
  2. History of Constipation (Age of onset)
  3. History of Stool Soiling
    1. Age of onset
    2. Type and amount of material
  4. Diet history
    1. Type and amount of food
    2. Changes in diet
  5. Associated symptoms
    1. Abdominal Pain
    2. Decrease in appetite
    3. Urinary symptoms
      1. Enuresis
      2. Dysuria or Urinary Tract Infection
  6. Medications
  7. Family History of Constipation

IV. Diagnosis: DSM 5

  1. Elimination disorder that occurs with or without stool retention
  2. Soiling as a key feature, with repeated passage of feces in inappropriate places (on the floor, inside clothing)
  3. One or more events each month for 3 or more months

V. Assessment: Readiness for Toilet Training

  1. Usually occurs between 24-30 months
  2. Physical Readiness
    1. Sphincter control (usually by time of walking)
    2. Bladder and bowel readiness
      1. Remains dry for several hours at a time
      2. Fully empties Bladder on Vomiting
  3. Developmental readiness
    1. Awareness of stooling time
      1. Facial expressions or squatting with stooling
      2. Go to specific or private location to stool
    2. Motor skills
      1. Walk to bathroom
      2. Undress
      3. Sit on toilet
      4. Flush
    3. Cognitive skills
      1. Understanding toileting words (wet, bathroom)

VI. Assessment: Behavioral

  1. Disruptive behavior problems
    1. Aggression
    2. Oppositional behavior
    3. Temper tantrums
  2. Child compliance with adult instructions
    1. Bedtime, Bath-time, and Dressing
    2. Child should follow 7 of 10 instructions
  3. Daily diary of toileting habits

VII. Examination

  1. Growth Curve plotted
    1. Pediatric Height
    2. Pediatric Weight
  2. Abdomen
    1. Abdominal Distention
    2. Abdominal mass (suprapubic)
  3. Rectum
    1. Sacral dimple
    2. Position of anus
    3. Anal Fissure
    4. Anal Wink
    5. Sphincter tone
    6. Rectal vault size
    7. Presence or absence of stool in Rectum
    8. Pelvic mass
  4. Neurological exam

VIII. Differential Diagnosis: Retentive Encopresis

  1. Functional Constipation (95%)
    1. Typically related to stool witholding
  2. Anal causes
    1. Anal Fissure
    2. Anal stenosis or anal atresia with fistula
    3. Anterior displacement of anus
    4. Anal Trauma
    5. Postsurgical repair
  3. Neurogenic causes
    1. Hirschsprung's Disease
    2. Chronic intestinal pseudo-obstruction
    3. Spinal cord disorders (e.g. Spinal Dysraphism)
    4. Cerebral Palsy or hypotonia
    5. Pelvic mass
  4. Neuromuscular disease
  5. Endocrine causes
    1. Hypothyroidism
    2. Hypercalcemia
    3. Lead Intoxication
  6. Medications
    1. Codeine or other Narcotics
    2. Antacids

IX. Differential Diagnosis: Functional Encopresis

  1. Functional Encopresis (99%)
  2. Severe Ulcerative Colitis
  3. Acquired spinal cord disease
    1. Sacral Lipoma
    2. Spinal cord tumor
  4. Rectoperineal fistula with imperforate anus
  5. Postsurgical damage to anal sphincter

X. Management

  1. Evaluate and treat causes of Retentive Encopresis
  2. See Functional Encopresis

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Encopresis." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Studies

Related Topics in Gastroenterology

advertisement