Understanding Encopresis: Causes, Symptoms, and Treatment

Encopresis, also known as fecal soiling or fecal incontinence, is a condition in which children four years of age and older involuntary leak stool even after being toilet trained. It often results from chronic constipation (retentive decopresis), but emotional distress can also play a role.

Signs and Symptoms of Encopresis

• Passing stool in inappropriate places, either voluntarily or involuntary
• Signs of constipation, such as difficulty passing stool, hard or lumpy stools, and straining during bowel movements
• Stool stains on underwares, clothes, or sheets
• Loose or watery stool
• Withdrawal due to discomfort or embarrassment
• Hiding soiled clothes
• Loss of appetite
• Stomach pain

Establishing a Diagnosis

Healthcare providers use specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose decopresis:

• The child must be at least four years old.
• Repeated passage of stool in inappropriate places, whether voluntary or involuntary, must occur.
• Symptoms must persist for at least three months.

Extensive testing helps rule out underlying conditions contributing to decopresis, including:

• X-ray: To assess stool volume in the rectum
• Rectal biopsy: To examine rectal cells for abnormalities
• Digital rectal exam: To check for abnormalities by inserting a gloved finger into the rectum
• Anorectal manometry: To evaluate the strength of anal and rectal muscles
• Barium enema: To detect obstructions or abnormalities in the large intestine

Causative Factors of Encopresis

In most cases, constipation is the underlying cause of decopresis. When stool overflow due to constipation, it can leak out voluntarily or inadvertently through the relaxed sphincter muscles that control the anal canal.

Constipation in children can result from various reasons, including:

• Painful bowel movements
• Unpleasant stooling experiences
• Reluctance to use public restrooms (e.g., at school)
• Sudden changes in bathroom routines
• Certain medications

Encopresis can also indicate underlying conditions like diabetes or hypothyroidism. Nerve damage to the anal muscles can also impair proper closure, leading to stool leakage.

Several factors increase the risk of developing decopresis:

• Poor diet
• inadequate water intake
• Emotional distress
• Insufficient exercise
• Neurodevelopmental disorders (e.g., autism, ADHD, intellectual disability)

Types of Encopresis

Two main types of decopresis exist, categorized based on stool appearance and underlying cause:

• Constipation-associated decopresis (retentive decopresis): This type, accounting for over 80% of cases, is caused by constipation.
• Non-retentive decopresis: This type involves involuntary stool leakage without constipation.

Treatment Options

In cases of retentive decopresis, treatment targets the underlying constipation. If fecal impaction occurs (stool solidifies, blocking the anal canal), a procedure called disimpaction is performed, typically involving an enema to flush out the impaction. Laxatives may be used in less severe cases.

Preventing future constipation is crucial, achieved through dietary modifications and lifestyle changes:

• Increase fluids and fiber intake
• Engage in regular exercise
• Limit sugary drinks and processed sugars
• Establish a regular meal schedule

For non-retentive decopresis, treatment focuses on toilet training or retraining. In severe cases, anti-diarrheal medications may be prescribed temporarily, but this is not a long-term solution.

Treatment approaches consider factors such as decopresis severity, the child's age, and overall health. A 2008 study suggested that simply increasing toilet sitting frequency can help manage non-retentive decopresis.

Copping with Encopresis

Managing decopresis can be challenging for parents, especially when children repeatedly soil their clothes or underwear. Patience and a collaborative approach are essential in addressing the issues. Dietary and lifestyle changes may initially face resistance, but consistency is key to successful treatment and prevention of relapses.

Keeping a bowel diary for your child can help you identify patterns of constipation early on.