Tags

Type your tag names separated by a space and hit enter

Encopresis

Encopresis is a topic covered in the 5-Minute Clinical Consult.

To view the entire topic, please or purchase a subscription.

Medicine Central™ is a quick-consult mobile and web resource that includes diagnosis, treatment, medications, and follow-up information on over 700 diseases and disorders, providing fast answers—anytime, anywhere. Explore these free sample topics:

Medicine Central

-- The first section of this topic is shown below --

Basics

Description

  • Voluntary or involuntary fecal soilage in a (typically) previously toilet-trained child
    • Age may be chronologic or developmental.
    • No underlying organic disease
    • At least one event per month for 3 months
    • Classified into functional constipation (retentive encopresis) and functional nonretentive fecal incontinence (FNRFI); both cause fecal incontinence. There is no constipation in FNRFI. Functional constipation is more common.
  • System(s) affected: GI; psychological
  • Synonyms(s): fecal incontinence, soiling

Epidemiology

Incidence
Predominant sex: male > female (4 to 6:1) Constipation accounts for 3% of general pediatric referrals; up to 84% of constipated children have fecal incontinence at some point.

Prevalence
Occurs in 1–3% of children 4 years of age

Etiology and Pathophysiology

  • In 90% of cases, encopresis develops as a consequence of chronic constipation, with resulting overflow incontinence (retentive encopresis). The other 10% are caused by specific organic etiologies.
  • Chronic constipation with irregular and incomplete evacuation results in progressive rectal distension and stretching of the internal/external anal sphincters.
  • As a child habituates to chronic rectal distension, they may no longer sense the normal urge to defecate. Eventually, soft or liquid stool leaks around the retained fecal mass.
  • Many children voluntarily withhold stool in response to the urge to defecate for fear of pain or a preoccupation with not interrupting social activities.
  • Psychological
    • Stool withholding, fear, anxiety
    • Difficulty with toilet training, including unusual anxiety or conflict with parent
    • Resistance to using public toilet facilities, such as school bathrooms or outdoor toilets
    • Known association with sexual abuse in boys; likely similar association in girls
    • Developmental delay
  • Anatomic
    • Rectal distension and desensitization
    • Anal fissure or painful defecation
    • Muscle hypotonia
    • Slow intestinal motility
    • Hirschsprung disease
    • Cystic fibrosis
    • Spinal cord defects (e.g., spina bifida)
    • Congenital anorectal malformations
    • Anal stenosis
    • Anterior displacement of the anus
    • Postoperative stricture of anus or rectum
    • Pelvic mass
    • Neurofibromatosis
  • Dietary or metabolic
    • Inadequate dietary fiber
    • Excessive protein or milk intake
    • Inadequate water intake
    • Hypothyroidism
    • Hypercalcemia
    • Hypokalemia
    • Diabetes insipidus; diabetes mellitus
    • Food allergy
    • Gluten enteropathy
  • Medication side effects

Genetics
None known; although incidence may be higher in children with family history of constipation

Risk Factors

  • Male gender
  • Constipation
  • Very low birth weight
  • Painful defecation
  • Difficulty with bowel training, including social pressure related to early daycare placement
  • Organic/anatomic causes
  • Anxiety and depression
  • Insufficient fluid or fiber intake
  • Refusal to use public restrooms
  • Attention deficit
  • History of abuse

General Prevention

Family education: toilet training when ready; optimize fluid and fiber intake.

Commonly Associated Conditions

  • Constipation, Hirschsprung disease
  • Cerebral palsy, cystic fibrosis
  • Developmental and behavioral diagnoses, urinary incontinence

-- To view the remaining sections of this topic, please or purchase a subscription --

Citation

Stephens, Mark B., et al., editors. "Encopresis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116204/all/Encopresis.
Encopresis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116204/all/Encopresis. Accessed June 27, 2019.
Encopresis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116204/all/Encopresis
Encopresis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 June 27]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116204/all/Encopresis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Encopresis ID - 116204 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116204/all/Encopresis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -