Encopresis

Question 1

Encopresis Definition

Answer 1

Faecal incontinence in a child >4 yrs old, at least once per month for 3 months

Question 2

Encopresis Epidemiology

Answer 2

1-1.5% of school-aged children (rare in adolescence);

M:F = 6:1 in school-aged children

Question 3

Encopresis Clinical Presentation

Answer 3

Faecal incontinence usually associated with chronic constipation

Question 4

Encopresis Aetiology

Answer 4

Consider medical causes (e.g. Hirschsprung disease, hypothyroidism, hypercalcemia, spinal cord lesions, anorectal malformations)

Question 5

Retentive Encopresis causes

Answer 5

• physical: anal fissure (painful stooling)

* emotional: disturbed parent-child relationship, coercive toilet training, social stressors

Question 6

Retentive Encopresis history

Answer 6

• child withholds bowel movement, develops constipation, leading to fecal impaction and seepage of soft or liquid stool (overflow incontinence)
  
  • crosses legs or stands on toes to resist urge to defecate
  • distressed by symptoms, soiling of clothes
  • toilet training coercive or lacking in motivation
  • may show oppositional behaviour

Question 7

Retentive Encopresis physical exam

Answer 7

• digital rectal exam: large fecal mass in rectal vault

* anal fissures (result from passage of hard stools)

Question 8

Retentive Encopresis treatment

Answer 8

• complete clean-out of bowel
  
  • maintenance of regular bowel movements
  • assessment and guidance regarding psychosocial stressors behavioural modification

Question 9

Retentive Encopresis complications

Answer 9

• continuing cycle
  
  • toxic megacolon (requires >3-12 months to treat)
  • bowel perforation