Pediatrics Book

Behavioral Disorders


Functional Encopresis

Aka: Functional Encopresis, Primary Nonretentive Encopresis, Stool Toileting Refusal, Nonretentive Fecal Incontinence
  1. Types
    1. Failed initial bowel training
    2. Toilet phobia
    3. Manipulative soiling
    4. Irritable Bowel Syndrome
  2. Epidemiology
    1. Ages 4 to 18 years old
  3. Signs
    1. Fecal Incontinence without stool impaction or Constipation
    2. Normal stool number and normal colonic transit
  4. Evaluation
    1. See Encopresis
  5. Associated Conditions
    1. Psychosocial disorders
    2. Neurologic Disorders
  6. Management: Address Toilet refusal behavior
    1. Positive toilet sits
      1. Start with short sits on toilet
        1. Sit 3-5 times per day for 30 seconds
        2. Increase to 5 minutes each (timer signals end)
      2. Leave on diapers and pants
      3. Provide relaxing, enjoyable activity
    2. Gradual shaping procedure (if above fails)
      1. Parent models toileting behavior for 2 weeks
        1. Male caretakers should sit while urinating
      2. Play games and read books in or near bathroom
      3. Gradually progress to positive toilet sits above
  7. Management: Ensure soft, well-formed stools
    1. Adjust diet to ensure frequent well-formed stool
    2. Short-term supplements (flavored fiber drink, bran)
    3. Consider short-term daily Laxative
      1. Milk of Magnesia 1-3 ml/kg/day
      2. Mineral Oil 1-5 ml/kg/day (avoid if aspiration risk)
      3. Sorbitol 1-3 ml/kg/day
    4. Soiling may be more frequent with these regimens
      1. Prepare a matter-of-fact neutral clean-up procedure
  8. Management: Schedule prompt toilet sits
    1. Establish toilet sits when child most likely to stool
      1. Schedule up to 5 per day for 3-5 minutes each
      2. Consider sit 5-20 minutes after each meal
      3. Use daily toileting diary to set up other sit times
      4. Use a timer to signal end of toilet sit
    2. Once achieved, hold a graduation ceremony
      1. Declare the child a "big" girl or boy
      2. Completely switch from diapers to pants
  9. Management: Provide incentives for stools in toilet
    1. Reward child when stools in toilet
      1. Avoid rewarding clean pants (Stool Withholding)
    2. Incentives might vary
      1. Candy
      2. Star chart
      3. Dot-to-dot
      4. Special activities
    3. Gradually reduce verbal prompts to toilet
      1. Allow child to recognize urge to urinate and defecate
      2. Reward child for requests to use bathroom
  10. Management: Physician Contact for Stool Withholding
    1. See also Pediatric Constipation Management
    2. No stool for 4 days
      1. Try one of stool softening regimens above
    3. Impaction (may require inpatient management)
      1. Hypertonic phosphate enemas 1-2/day x1-3 days OR
      2. Mineral Oil
        1. Daily Dose: 15-30 ml per year of age
        2. Maximum: 8 ounces
  11. References
    1. Kuhn (1999) Am Fam Physician 59(8): 2171-8 [PubMed]

Functional encopresis (C0014089)

Definition (MSHCZE) Neschopnost udržet stolici. (cit. Velký lékařský slovník online, 2013 )
Definition (NCI) An elimination disorder characterized by fecal incontinence, whether involuntary or intentional, which is not due to a medical condition and which occurs at an age of at least 4 years.
Definition (MSH) Incontinence of feces not due to organic defect or illness.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D004688
ICD9 307.7
ICD10 F98.1
SnomedCT 302752001, 192026001, 192023009, 192629009, 25378008
English Encopresis, Non-organic encopresis NOS, Nonorganic encopresis, Non-organic encopresis NOS (disorder), Functional encopresis (finding), encopresis, functional encopresis, encopresis (diagnosis), Psychogenic encopresis, Incontinence of feces of nonorganic origin, Functional encopresis, Non-organic encopresis (finding), Non-organic encopresis (disorder), Functional encopresis (disorder), Non-organic encopresis NOS (finding), Faecal incontinence not due to organic disease, Fecal incontinence not due to organic disease, Non-organic encopresis, encopresis; functional, encopresis; nonorganic origin, feces; incontinence, functional, feces; incontinence, nonorganic origin, functional; encopresis, incontinence; fecal, nonorganic origin, nonorganic origin; encopresis, Encopresis, NOS, Functional encopresis, NOS, Functional encopresis (disorder) [Ambiguous], Encopresis of nonorganic origin
Spanish encopresis funcional (hallazgo), encopresis no orgánica, SAI (trastorno), incontinencia fecal no causada por enfermedad orgánica, encopresis no orgánica, SAI (hallazgo), encopresis no orgánica, encopresis no orgánica (hallazgo), encopresis no orgánica, SAI, encopresis funcional (trastorno), encopresis funcional (concepto no activo), encopresis funcional, incontinencia fecal funcional, incontinencia fecal no debida a enfermedad orgánica, Encopresis
Swedish Tarmtömning, ofrivillig
Czech enkopréza
Finnish Tuhriminen
German Nichtorganische Enkopresis, Einkoten, Enkopresis, Einstuhlen
Korean 비기질성 유분증
Polish Zanieczyszczanie się kałem, Popuszczanie kału, Zanieczyszczanie się kałem nieorganiczne
Norwegian Enkoprese, Funksjonell enkoprese, Ikke-organisk enkoprese, Psykogen enkoprese
Dutch encopresis; functioneel, encopresis; niet-organische oorsprong, faeces; incontinentie, functioneel, faeces; incontinentie, niet-organische oorsprong, functioneel; encopresis, incontinentie; faeces, niet-organische oorsprong, niet-organische oorsprong; encopresis, Niet-organische encopresis, Encopresis
French Encoprésie
Italian Encopresi
Portuguese Encoprese
Derived from the NIH UMLS (Unified Medical Language System)

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