What is Encopresis?
Encopresis is an involuntary soiling of the underpants with faeces in children above the age of 4. It is a result of a faulty bowel movement, loss of urge to defecate that leads to the accidental leak of the stools. It is also called as faecal incontinence. Around 1.5% of the school going children experience encopresis. More boys than girls suffer from encopresis.
Encopresis is caused primarily due to chronic constipation. Infrequent bowel movements lead to accumulation of stools in the rectum. The wall of the rectum remains stretched for longer periods, losing its tone and feeling. As newer stool get collected in the rectum, the watery faecal matter often leaks through the hard stools. The soiling of the underwear is always during the day when the child is active and awake, but unaware of the leakage.
A child may develop chronic constipation due:
- Inactive lifestyle
- Eating junk food
- Drinking less water
- Being too busy in playing
- Painful bowel movement
In few cases, it may be as a result of emotional problems, fear of using an unfamiliar toilet or anxiety related to using the toilet. Very rarely, an issue in the spinal cord or nerves of the bowel wall could be a reason for faecal incontinence.
Risk factors that increase the chances of developing encopresis are:
- Infrequent bowel movement
- A change in the routine
- Poor toilet training
- Health issues such as diabetes and hypothyroidism
- Rectal injury due to painful bowel movement
- Sexual abuse
Symptoms and signs
Some of the symptoms of encopresis are:
- Dirty underwear
- Very foul body odour
- Chronic constipation
- Passing of very large bowel movement in between the episodes of constipation
- Abdominal pain
- Spotting of blood during bowel movement
- Bedwetting in few cases
- Irritation in the anal area, scratching of the anal area
Encopresis can be either:
- Primary encopresis: Children who experience encopresis throughout their lives, without being successfully toilet trained ever.
- Secondary encopresis: Children who experience a phase of encopresis, which can develop after being toilet trained.
Your doctor will diagnose encopresis based on the:
- Age of your child
- Medical history
- Duration of the constipation episode
- Physical examination
In some case, a rectal biopsy, x-ray of the lower abdominal region might be recommended. You might be asked to maintain a diary with the details of the bowel movements and other symptoms.
Your doctor might run few other tests to rule out any other health issues that might be causing the problem.
Based on the diagnosis of the condition, there are different treatments that can include:
- Encopresis due to physiological problems: It will be addressed by a neurologist or gastroenterologist.
- Encopresis due to psychological problems: It will be addressed by a psychiatrist for counselling and other therapies.
- Treating chronic constipation: This will include:
- Emptying the bowel by use of oral laxatives, enema or rectal suppositories.
- A stool softener like lactulose or mineral oil helps for a smooth bowel movement.
- Adopting a healthy toilet routine for your child.
- Follow a proper toilet routine for your child. Let them take their own time in the toilet.
- Ensure that your child’s diet has high fibre content for easy bowel movement.
- Let your child drink enough water throughout the day
- Your child should be physically active; it aids proper bowel movement.
Encopresis may lead to a feeling of shame and guilt, forcing a child to resort to secretive behaviour. It may lead to low self-esteem, and the child ultimately starts avoiding friends and school.
If your child is above the age of 4 and you are troubled by his/her faecal incontinence, consult a paediatrician and discuss the treatment options available for your child.
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