Encopresis Prof. Saad S Al-Ani Senior Pediatric Consultant  Head of Pediatric Department  Khorfakkan Hospital  Sharjah ,UAE
Encopresis <ul><li>Refers to the  passage of feces into inappropriate places after a chronologic age of 4 yr  (or equivale...
Encopresis  (cont.) <ul><li>Encopresis may be: </li></ul><ul><li>1.Primary:  persist from infancy onward  </li></ul><ul><l...
Encopresis  (cont.) <ul><li>In children  younger than 4 yr  of age, the  male: female ratio  for  chronic constipation  is...
Clinical Manifestations  <ul><li>The first consideration in managing encopresis is  assessment of fecal retention .  </li>...
Clinical Manifestations  (cont.) <ul><li>Many children with encopresis present with  abnormal anal sphincter physiology  a...
Clinical Manifestations  (cont.) <ul><li>Abnormal anal sphincter function  is  a marker for chronic constipation ; childre...
Clinical Manifestations  (cont.) <ul><li>Associated behavioral or psychiatric problems  obviously may  complicate the trea...
Treatment  <ul><li>The  standard treatment  approach to encopresis begins with </li></ul><ul><li>1.  Clearance of impacted...
Treatment  (cont.) <ul><li>On some occasions,  manual disimpaction  is required before the treatment can begin; rarely meg...
Treatment  (cont.) <ul><li>Parents  should be  actively encouraged to issue rewards   for compliance to the child  from th...
Treatment  (cont.) <ul><li>Improvement  in some  children on  tricyclic antidepressants  </li></ul><ul><li>Tricyclic antid...
Summary <ul><li>Encopresis refers to the  passage of feces into inappropriate places after a chronologic age of 4 yr </li>...
Summary  (cont.) <ul><li>Primary encopresis  in boys is  associated with   global developmental delays and enuresis ,  </l...
References <ul><li>Mikkelsen EJ: Enuresis and encopresis: Ten years of progress.  J Am Acad Child Adolesc Psychiatry  2001...
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Encopresis

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Encopresis

  1. 1. Encopresis Prof. Saad S Al-Ani Senior Pediatric Consultant Head of Pediatric Department Khorfakkan Hospital Sharjah ,UAE
  2. 2. Encopresis <ul><li>Refers to the passage of feces into inappropriate places after a chronologic age of 4 yr (or equivalent developmental level). </li></ul><ul><li>Subtypes include: </li></ul><ul><li>1. Retentive encopresis: </li></ul><ul><li>Encopresis with constipation and overflow </li></ul><ul><li>incontinence </li></ul><ul><li>2. Nonretentive encopresis: </li></ul><ul><li>Encopresis without constipation and overflow </li></ul><ul><li>incontinence </li></ul>
  3. 3. Encopresis (cont.) <ul><li>Encopresis may be: </li></ul><ul><li>1.Primary: persist from infancy onward </li></ul><ul><li>2.Secondary : may appear after successful toilet training </li></ul><ul><li>About two thirds of encopresis cases are of the retentive type and associated with chronic constipation; </li></ul>
  4. 4. Encopresis (cont.) <ul><li>In children younger than 4 yr of age, the male: female ratio for chronic constipation is 1:1 . </li></ul><ul><li>In the school-aged child , however, encopresis is more common in males </li></ul>
  5. 5. Clinical Manifestations <ul><li>The first consideration in managing encopresis is assessment of fecal retention . </li></ul><ul><li>Rectal examination </li></ul><ul><li>* A positive rectal examination is sufficient to </li></ul><ul><li>document fecal retention </li></ul><ul><li>* A negative rectal examination in the presence of </li></ul><ul><li>encopresis requires plain abdominal </li></ul><ul><li>roentgenograms . </li></ul><ul><li>The presence of fecal retention is evidence of chronic constipation </li></ul>
  6. 6. Clinical Manifestations (cont.) <ul><li>Many children with encopresis present with abnormal anal sphincter physiology as documented either by electromyography or difficulty in defecating a rectal balloon. </li></ul><ul><li>The inability to defecate a balloon at presentation is associated with poorer response to treatment </li></ul>
  7. 7. Clinical Manifestations (cont.) <ul><li>Abnormal anal sphincter function is a marker for chronic constipation ; children with this pathology do not appear to have a higher incidence of behavioral or psychiatric disorders than those without. However, a chart review study suggests that </li></ul><ul><li>Primary encopresis in boys is associated with global developmental delays and enuresis , </li></ul><ul><li>Secondary encopresis is associated with high levels of psychosocial stressors and conduct disorder </li></ul>
  8. 8. Clinical Manifestations (cont.) <ul><li>Associated behavioral or psychiatric problems obviously may complicate the treatment of encopresis,especially when parents respond to soiling with retaliatory, punitive measures and children become angry , ashamed , and resistant to intervention. </li></ul><ul><li>School performance and attendance may be secondarily affected as the child becomes the target of scorn and derision from schoolmates because of the offensive odor </li></ul>
  9. 9. Treatment <ul><li>The standard treatment approach to encopresis begins with </li></ul><ul><li>1. Clearance of impacted fecal material </li></ul><ul><li>2. Short-term use of mineral oil or laxatives to </li></ul><ul><li>prevent further constipation. </li></ul><ul><li>Concomitant behavioral management is also indicated. </li></ul><ul><li>The focus of behavioral treatment should be on compliance with: </li></ul><ul><li>1. Regular postprandial toilet sitting and </li></ul><ul><li>2. adoption of a high-fiber diet . </li></ul>
  10. 10. Treatment (cont.) <ul><li>On some occasions, manual disimpaction is required before the treatment can begin; rarely megacolon is observed and referral to a gastroenterologist is required. </li></ul><ul><li>Once impacted stool is removed, the combination of constipation management and simple behavior therapy is successful in the majority of cases , though it is often a period of months before soiling stops completely </li></ul>
  11. 11. Treatment (cont.) <ul><li>Parents should be actively encouraged to issue rewards for compliance to the child from the outset of treatment and to avoid power struggles with the child. </li></ul><ul><li>Keeping records of the child's progress is necessary </li></ul><ul><li>Long-term laxative use is contraindicated . </li></ul>
  12. 12. Treatment (cont.) <ul><li>Improvement in some children on tricyclic antidepressants </li></ul><ul><li>Tricyclic antidepressants often cause or exacerbate constipation and should be avoided in children with retentive encopresis </li></ul><ul><li>Encopresis eventually resolves in most children, regardless of treatment approach . </li></ul>
  13. 13. Summary <ul><li>Encopresis refers to the passage of feces into inappropriate places after a chronologic age of 4 yr </li></ul><ul><li>Subtypes include: Retentive encopresis and Nonretentive encopresis </li></ul><ul><li>Encopresis may be: Primary or Secondary </li></ul><ul><li>The first consideration in managing encopresis is assessment of fecal retention . </li></ul>
  14. 14. Summary (cont.) <ul><li>Primary encopresis in boys is associated with global developmental delays and enuresis , </li></ul><ul><li>Secondary encopresis is associated with high levels of psychosocial stressors and conduct disorder </li></ul><ul><li>the combination of constipation management and simple behavior therapy is successful in the majority of cases </li></ul>
  15. 15. References <ul><li>Mikkelsen EJ: Enuresis and encopresis: Ten years of progress. J Am Acad Child Adolesc Psychiatry 2001;40:1146. Medline Similar articles </li></ul><ul><li>Schum TR, McAuliffe TL, Simms MD, et al: Factors associated with toilet training in the 1990s. Ambulatory Pediatrics 2001;1:79. Medline Similar articles </li></ul><ul><li>Youssef NN, Di Lorenzo C: Childhood constipation: Evaluation and treatment. J Clin Gastroenterol 2001;33:199-205. Medline Similar articles </li></ul><ul><li>Gereige RS, Frias JL: Is it more than just constipation? Pediatrics 2001;109:961-65. </li></ul><ul><li>Penning C, Gielkens HA, Hemelaar M, et al: Prolonged ambulatory recording of antroduodenal motility in slow-transit constipation. Br J Surg 2000;87:211-17. Medline Similar articles </li></ul>
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