Encopresis is the passing of stool into the clothing. It often occurs in the children over the age of 4. It happens when the bowel movement impacts the stool to collect in the rectum and colon. When the colon becomes too full of solid stool and the retained liquid stool will leak into the clothing. The retention of stool can cause swelling of the bowels and it lose the control of bowel movements. It is the symptoms of chronic constipation or it may be due to emotional issues that result in encopresis.
Although few prospective studies have been conducted to examine the prevalence of encopresis in childhood, it is estimated that 1-2% of children younger than 10 years have encopresis. In a study of 482 children aged 4-17 years who were observed over a 6-month period in a primary care pediatric clinic in Iowa, 4.4% of the subjects experienced fecal incontinence at least once per week.
Nearly all of the few published population-based studies examining the prevalence of encopresis have been conducted in North America and Europe. In one such study conducted in the Netherlands, 4.1% of children aged 5-6 years and 1.6% of children aged 11-12 years experienced fecal soiling at least once per month. Studies conducted in Sweden and the United Kingdom reported similar numbers.
In nearly all published series, boys are much more commonly affected than girls. In most series, approximately 80% of affected children are boys.
There are two types of encopresis such as primary and secondary.
Primary encopresis: children with primary encopresis will have continuous soiling throughout their lives. This can be trained successfully without any period of time.
Secondary encopresis: The secondary encopresis may develop this condition after they have been toilet trained; such as upon entering school or encountering other experiences that might be stressful.
Some of the risk factors include:
- Lack of exercise
- Not taking enough water and fiber foods
- Emotional stress with friends, families or at school
- Being busy and taking long time to use the bathroom
- Having a change in bathroom routine
- Eating high sugar, high fat, and junk foods
- Drinking soft drinks and sugary drinks
- Refused to use public toilets
There are two main causes of encopresis are constipation and emotional stress.
Constipation: Sometimes prolonged or chronic constipation may also cause encopresis. The irregular bowel movements will harden the stool and leads to pain during excretion. A lack of fiber content, poor hydration, and some food allergies can also cause constipation.
Emotional stress: Some factors may cause emotional stress or anxiety may interrupt the bowel movement and cause constipation. Other known childhood/adolescence emotional disorders that can cause encopresis include oppositional defiant disorder and conduct disorder. Sometimes changes in the children’s lifestyle such as toilet training, starting school or schedule changes.
Symptoms of encopresis include:
- Poor appetite
- Abdominal pain
- Avoidance bowel movement
- Hard stool and constipation
- Unintentional soiling of clothes (loose liquid stool)
- Regular urinary infection mostly in girls
- Long periods of time between bowel movement
- Large stools that block the rectum
- Encopresis may cause both physical and emotional stress
- Children may feel upset due to soiling in their clothes, in many cases, they can’t control stool leakage. This affects their self-esteem or feel depressed themselves
- The part of the colon may stretch under double the volume and pressure of impacted stools. It is called megacolon. This abnormal colon holds more feces than normal and leads to leakage.
- Ignorance of defecation signal leads to encopresis. The rectum contains some stretch receptors when the stools move into the rectum area of the colon; the receptors send signals to our brain and triggers to urge to do the toilet. When the rectum is constantly full then the receptors will be overstimulated and leads to encopresis
Diagnosis and test
Diagnosis starts with a physical exam and tests such as:
Digital rectal exam: Doctor will check the compacted stool by inserting the lubricated, gloved finger into the rectum while pressing his or her abdomen.
X-ray: X-ray of the abdominal area is used to find the amount of compacted stools in the intestine and rectum. A contrast barium enema is performed. This is a special type of X-ray in which a small tube is inserted into the child’s rectum, and the colon is slowly filled with a radiopaque dye (barium or hypaque). X-rays are taken throughout the procedure to see if there are any areas of narrowing, twisting, or kinking in the lower intestine that might cause the child’s symptoms.
Physiological evaluation: It is done to identify the emotional stress that may play a role.
Treatment and medications
The main goal of the treatment is to clear the colon and to help the child to adopt healthy bowel routine. Treatment depends on factors such as child age, toilet training status and other factors.
Colon emptying: Varieties of the method are used to clear the colon. Enemas or laxatives (oral or rectal suppository) will induce the bowel movement and make the stools to come out. Other methods to soften the stools are stool softeners or lubricating the stool points in the wall of the colon using mineral oils.
Diet: Once the colon is relieved from constipation, the change in diet will maintain the regularity. Foods such as fruits, vegetables, whole grains, other high-fiber foods and proper hydration will produce the soft bowel movement.
Toilet routine: Train your child to go to the toilet at regular intervals as soon as possible when they urge to have bowel movements.
Psychotherapy: In some child, encopresis may occur due to emotional causes. Psychotherapy help children to cope up with depression, anger, and other negative psychological thoughts.
There are some preventive measures to follow such as:
- Do regular exercise or outside play can prevent encopresis
- Avoid fast foods and processed food
- Drinking plenty of fluids, especially water, helps keep stool soft
- Avoid fatty and dairy foods
- Eat healthy diet rich in fruits, vegetables, whole grains and fiber
- Train your children to do toilet at regular intervals