Encopresis

Symptoms Symptoms include: Accidental passage of stool, usually into the underwearLow self-esteemFeelings of embarrassment, shame, or guilt DiagnosisThe doctor will ask about symptoms and medical history, and perform a physical exam. Most children with encopresis have no physical problem. While parents are often unaware that their child is constipated, they may see their child forcibly holding stool when he or she experiences the urge to defecate. The description of stool holding is quite important for making the diagnosis of constipation. The exam may include a rectal exam, which may reveal the presence of a large quantity of hard, dry stool in the rectum. An x-ray of the abdomen may also show stool in the rectum. TreatmentThe doctor will explain to the parents and the child why encopresis is occurring. The parents should be encouraged not to shame the child. Bowel Clean-OutIf constipation is a problem, enemas and mineral oil or other laxatives may be used short-term to clean out the bowel.If symptoms are not improving rapidly or if your child is passing blood with stools, then further testing may be needed to exclude other very rare disorders that may have different treatments. Dietary Changes To help prevent the return of constipation, the child should:

Eat a healthy diet, high in fiber.Drink plenty of liquids. Behavioral TherapyHelp your child learn when to use the toilet. Give rewards for success in keeping clothes clean and passing a bowel movement into the toilet. Counseling This may be needed if: There were severe problems with toilet training.The child has emotional problems.There are family problems contributing to the child's encopresis.The child is experiencing shame, guilt, or low self-esteem due to encopresis. PreventionFollowing reasonable guidelines for toilet training may help prevent encopresis. A healthy, high-fiber diet and adequate liquid intake may also help prevent encopresis. RESOURCES: American Academy of Family Physicianshttp://www.aafp.org University of Michigan Health Centerhttp://www.med.umich.edu/ CANADIAN RESOURCES: About Kids Healthhttp://www.aboutkidshealth.ca Alberta Health and Wellnesshttp://www.health.gov.ab.ca/ References: Kleigman RM, Jensen HB, Behrman RE, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, PA: Saunders Elsevier; 2007. Kuhn BR, Marcus BA, Pitner SL. Treatment guidelines for primary nonretentive encopresis and stool toileting refusal. Am Fam Physician . 1999;59(8). Available at: http://www.aafp.org/afp/990415ap/2171.html.

Last reviewed November 2007 by Kari L. Kassir, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.