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
Primary encopresis in boys is associated with global developmental delays and enuresis ,
Secondary encopresis is associated with high levels of psychosocial stressors and conduct disorder
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.
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
On some occasions, manual disimpaction is required before the treatment can begin; rarely megacolon is observed and referral to a gastroenterologist is required.
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