GI

Encopresis

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Encopresis, Stool Soiling

  • Epidemiology
  1. Children of at least 4 years old
  2. Affects 1-4% of school aged children
  3. Boys more affected than girls
  • 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
  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)
  • 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
  • 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
  • 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
  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
  • Management
  1. Evaluate and treat causes of Retentive Encopresis
  2. See Functional Encopresis