Encopresis

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Encopresis is involuntary "fecal soiling" in children who have usually already been toilet trained. Children with encopresis often leak stool into their underwear.

Prevalence
The estimated prevalence of encopresis in 5-year-olds is ~1%. The disorder is thought to be more common in males.

Causes
Encopresis is commonly caused by constipation, various physiological, psychological, or neurological disorders, or from surgery.

Typically, a child with encopresis has a long-standing history of constipation. The pain of moving his/her bowels leads to the child avoiding moving his/her bowels, which leads to hard stools which are even more difficult to pass. Eventually, the bowel is so full of stool, it starts to leak out. The child typically has no control over these accidents.

Encopresis may also be due to psychological problems, such as oppositional defiant disorder or conduct disorder.

Diagnosis
The psychiatric (DSM-IV) diagnostic criteria for encopresis are:
 * 1) Repeated passage of feces into inappropriate places (e.g., clothing or floor) whether voluntary or intentional
 * 2) At least one such event a month for at least 3 months
 * 3) Chronological age of at least 4 years (or equivalent developmental level)
 * 4) The behavior is not exclusively due to a physiological effect of a substance (e.g., laxatives) or a general medical condition, except through a mechanism involving constipation.

The DSM-IV recognizes two subtypes: with constipation and overflow incontinence, and without constipation and overflow incontinence. In the subtype with constipation, the feces are usually poorly formed and leakage is continuous, and occurs both during sleep and waking hours. In the type without constipation, the feces are usually well-formed, soiling is intermittent, and feces are usually deposited in a prominent location. This form may be associated with oppositional defiant disorder or conduct disorder, or may be the consequence of anal masturbation.

Treatment
There is a 3-pronged approach to the treatment of encopresis associated with constipation:
 * 1) cleaning out
 * 2) using laxatives to soften the stool
 * 3) scheduled sitting times, typically after meals

The initial clean-out is achieved with laxatives, enemas, or both. Following that, laxatives are used daily to keep the stools soft.

Next, the child must try to use the toilet regularly to retrain his/her body. It is recommended that a child be required to sit on the toilet and 'try' to go for 10-15 minutes immediately after eating. Children are more likely to go to the bathroom immediately after eating. Creating a regular schedule of bathroom time will allow the child to achieve a proper elimination pattern.