Encopresis Flashcards
Define encopresis.
Voluntary or involuntary passing of faeces in inappropriate places after the age at which faecal continence is considered normal (>4 years).
What are the three categories for encopresis?
Retentive encopresis
Non-retentive fecal soiling
Emotional
Explain the aetiology for retentive encopresis.
Most common: Secondary to functional constipation.
Constipation causes progressive rectal distension and stretching of the internal/external anal sphincters (IAS/EAS). This leads to rectal distension and loss of normal defecation sensation.
Explain the aetiology for non-retentive fecal soiling.
Occurs without constipation.
Explain the aetiology for emotional encopresis.
May have an impact although not primarily a behavioural problem. Low self-esteem, parent–child conflict results from the disorder rather than being causative.
What are risk factors for encopresis?
Surgical interventions for Hirschsprung’s disease and anorectal malformations
Neuropathy
Enuresis
Summarise the epidemiology of encopresis.
Up to 3%. Most commonly under 4. Males more affected than females.
What are the presenting symptoms of encopresis?
Constipation
What are the clinical signs of encopresis?
Abdominal: Distension or palpable stool.
Digital rectal examination: Anal fissures or tears. Stool around perianal region. Anal sphincter may appear lax secondary to massive rectal distension and relaxation of the internal anal sphincter. Normal anal wink and sensation. Rectum normally filled with soft stool.
What are appropriate investigations for encopresis?
Anorectal manometry: Delineating child’s defecation dynamics, evidence of megarectum, exclusion of ultrashort segment Hirschsprung’s disease.
Radionuclear transit scintography: Identifies slow colonic transit. May also be done with plain AXR after ingestion of different shaped markers.
What is the management plan for encopresis?
Constipation: Diet control, colonic evacuation, oral laxatives (polyethene glycol), enema, surgery.
Without constipation: Bowel re-training programme, behavioural medicine evaluation, anorectal feedback, loperamide.
What are complications associated with encopresis?
Low self-esteem. Psychological issues.
What is the prognosis of encopresis?
Usually good as it is unusual for encopresis to persist beyond teenage years.
