PARENT GUIDE
PARENT GUIDE
Encopresis is a term used to describe children involuntarily or intentionally passing feces in unacceptable locations (for example, in undergarments or on the floor) on a minimum of one time per month for three months in a child over four years of age chronologically and/or developmentally (First & Tasman, 2004). This condition rarely occurs in isolation but more commonly accompanies chronic constipation with retention, resulting in large, infrequent stools passed less than three times per week, leading to overflow leakage, difficulty with voluntary defecation, and eventually, to stool incontinence.
ENCOPRESIS
By
Petty Regina
Espinosa Idalmis
Lashmann Oluseye
Onuora Vivien
SIGNS AND SYMPTOMS
Signs and Symptoms of Encopresis
· Leakage liquid stool on clothes that may happen due to fear of using the toilet or inadequate education about bowel emptying into the toilet (Andrews, C. N., & Storr, M. (2011).
· Premature and conflict-filled toilet training is also associated with stool staining on clothes.
· Constipation with dry, hard stool
· Passage of large stool that clogs or almost clogs the toilet
· Avoidance of bowel movements
· Long periods of time between bowel movements
· Lack of appetite
· Abdominal pain
· Problems with daytime wetting or bedwetting (enuresis)
· Repeated bladder infections, typically in girls
· Emotional stress may trigger encopresis. A child may experience stress from:
· Premature, difficult or conflict-filled toilet training
· Changes in the child’s life, such as dietary changes, toilet training, starting school or schedule changes
· Emotional stressors, for example, the divorce of a parent or the birth of a sibling
· Coprolalia (shouting or use of obscene words or phrases)
· Palilalia (repeating his or her own words)
· Echolalia (repetition of the last heard words of others)
Severe tic disorder is also known as Tourette disorder includes multiple motor tics, coprolalia, and echolalia. The initial tics are in the face and neck, over time it progresses to arm and hands, the body and lower extremities, and the respiratory, and alimentary system. It includes:
Tinsley Jesselin
OVERVIEW OF ENCOPRESIS INCLUDING SIGNS AND SYMPTOMS, AND MANAGEMENT.
PATHOPHYSIOLOGY
Once a child withholds stool rather than passing stool, the colon begins to distend. This distention gradually stretches nerve fibers, and over time, the child has less and less sensation of the urge to pass stool. The stools become larger and larger, and the child becomes less able to feel or pass the stool voluntarily. The large stool becomes impacted, with loose, watery stool leaking around the impaction, causing the appearance of uncontrollable diarrhea. Eventually, if left untreated, the child cannot control when the large, impacted stool is passed, resulting in incontinence or soiling of large stools in the toilet.
Encopresis in children is classified as organic (nonfunctional), which is related to an anatomic, neurologic, or metabolic cause, or nonorganic (functional), which is related to behavioral or psychological causes.
Causes of organic encopresis include post-surgical anal or rectal stricture, dehydration, megacolon, anorectal fissures or stenosis, laxative use, diarrhea, Hirschsprung disease, spina bifida, hypothyroidism, hypercalcemia, cerebral palsy, myelomeningocele, and adverse drug reactions.
Nonorganic encopresis can be caused by ineffective bowel training and psychosocial stressors (e.g., new school, birth of a sibling, repeated sexual abuse). Some children with nonorganic encopresis avoid defecating appropriately (e.g., in a bathroom using the toilet, painful or unpleasant bowel movement) because of fear or anxiety; others intentionally defecate inappropriately because of a mental disorder (e.g., conduct disorder, oppositional defiant disorder, obsessive compulsive disorder, and cognitive delays and learning disabilities).
Other risk factors include eating a high-fat diet, high intake of sugary fluids (such as soda pop, juices), low intake of dietary fiber, low activity level, and/or chronic and/or recurrent stress, specifically an unstable or unpredictable daily routine. Both organic and nonorganic encopresis can produce low self-esteem, aggression, and acting out. Children can fear rejection and social isolation by their peers, and angry and punitive reactions from their parents.
DIAGNOSIS
To consider encopresis as a diagnosis, criteria should be met which includes age of least 4 years old, leakage of stool or feces into inappropriate places such as clothing or floor, and at least a monthly occurrence of symptoms for 3 consecutive months (American Psychiatric Association, 2013). Furthermore, the behavior is not related to another medical condition. This information is typically obtained by the practitioner through a clinical interview, health history, and physical examination. Before making a diagnosis of encopresis, your practitioner will rule out any other causes such as allergies or medications that may act as laxatives (Child Mind Institute, 2017). Furthermore, a digital rectal exam may be performed to rule out stool impaction and your practitioner may recommend an abdominal x-ray to confirm findings (Child Mind Institute, 2017). Encopresis may be diagnosed based on criteria and once physiological causes have been ruled out.
PARENTS REFERAL
Parents should seek help to understand the underlying cause of the illness since it can occur as a result of dietary issues or mental problems such as anxiety and depression. In cases where the child is mentally ill, parents care referred to a psychiatrist for further management. If it is a permanent disorder, parents are referred to a counselor who can help them cope with the disorder. Also, if organizations can help the mentally disadvantaged, the parents should be referred to them too. Besides, parents should search for a good approach to training their children on how to use toilets. In cases where nutrition is the major contributing factor, nutritionists should help the parents determine a proper diet, for instance, foods rich in fiber to prevent constipation. (“Encopresis – Symptoms and causes”, 2020)
“Just because you don’t understand it, doesn’t mean it isn’t so.”
– unknown –
REFERENCES
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Andrews, C. N., & Storr, M. (2011). The pathophysiology of chronic constipation. Canadian journal of gastroenterology = Journal Canadien de gastroenterology, 25 Suppl B (Suppl B), 16B–21B.
Child Mind Institute. (2017). Encopresis basics. Retrieved from https://childmind.org/guide/guide-to-encopresis/
Coehlo, D.P., (2011). Encopresis: A Medical and Family Approach. In: Pediatric Nursing; May/Jun2011; v.37. n.3, 107-112. 6p. (Case Study – case study, CEU, exam questions, tables/charts) ISSN: 0097-980
Cox, D.J., Ritterband, L.M., Quillian, W., Kovatchev, B., Morris, J., Sutphn, J., & Borowitz, S. (2003). Assessment of behavioral mechanisms maintaining encopresis: Virginia Encopresis-Constipation Apperception Test. Journal of Pediatric Psychology, 28, 375- 382.
Gibas-Dorna, M., & Piątek, J. (2014). Functional constipation in children – evaluation and management. Przeglad gastroenterology, 9(4), 194–199. https://doi.org/10.5114/pg.2014.45099
Heron, J., Grzeda, M., Tappin, D., von Gontard, A., & Joinson, C. (2018). Early childhood risk factors for constipation and soiling at school age: An observational cohort study. BMJ Paediatrics Open, 2(1), e000230. doi:10.1136/bmjpo-2017-000230
Koppen, I. J., Lammers, L. A., Benninga, M. A., & Tabbers, M. M. (2015). Management of Functional Constipation in Children: Therapy in Practice. Pediatric drugs, 17(5), 349–360. https://doi.org/10.1007/s40272-015-0142-4
Koppen, I. J., Lammers, L. A., Benninga, M. A., & Tabbers, M. M. (2015). Management of Functional Constipation in Children: Therapy in Practice. Pediatric drugs, 17(5), 349–360. https://doi.org/10.1007/s40272-015-0142-4
MANAGEMENT
• Clean-out (if necessary): This approach often begins with clearing the bowel of rock-like stool. Usually, it can be done with oral laxatives (e.g., polyethylene glycol). Sometimes, other therapeutic agents such as stimulant laxatives or lubricants may be useful as additional or second-line therapy if adequate treatment with oral laxatives is insufficient (Koppen, Lammers, Benninga, & Tabbers, 2015).
• Nutritional changes: To prevent the return of constipation, begins with eating healthy. Plan a balanced diet that includes whole grains, fruits, high-fiber, and vegetables in your daily meals and snacks. Also, promote drinking plenty of water throughout the day. Fluids such as (prune, pear, and apple juices) have a natural stool softening effect you can incorporate. Dietary changes should accompany regular physical activity a maximum of 2 h/day (Gibas-Dorna & Piątek, 2014).
•Bowel training: Design a toileting regimen that dedicates regular “toilet sitting times.” Assist the child in sitting on the toilet for a few minutes, 10-15 minutes after each main meal, and after school should be sufficient. Use a child-size toilet seat and place a small stool under their feet to push if they need to; teach the proper position and relaxation techniques for comfort.
•Behavior management: Behavior correction helps the child understand and realize that defecation is a routine activity and encourages the child to stop stool holding. Decrease toileting stress by considering reading a book to the child or permitting games when on the toilet. Praising successful progress is the best practice to improve things.
PARENT GUIDE
ENCOPRESIS
B
y
Petty
Regina
Espinosa Idalmis
Lashmann Oluseye
Onuora Vivien
Tinsley Jesselin
OVERVIEW O
F
ENCOPRESIS
INCLUDING SIGNS AND SYMPTOMS,
AND MANAGEMENT
.
OVERVIEW
Encopresis is a term used to describe children
involuntarily or intentionally passing feces in unacceptable
locations (for example, in undergarments or on the floor) on a
minimum of one time per month for three months in a child
over four
years of age chronologically and/or developmentally
(First & Tasman, 2004). This condition rarely occurs in
isolation but more commonly accompanies chronic
constipation with retention, resulting in large,
infrequent
stools passed less than three times per
week, leading to
overflow leakage, difficulty with voluntary defecation, and
eventually, to stool incontinence.
PATHOPHYSIOLOGY
Once a child withholds stool rather than passing
stool, the colon begins to distend. This
distention gradually
stretches nerve fibers, and over time, the child has less
and less sensation of the urge to pass stool. The stools
become larger and larger, and the child becomes less
able to feel or pass the stool voluntarily. The large stool
becomes
impacted, with loose, watery stool leaking
around the impaction, causing the appearance of
uncontrollable diarrhea. Eventually, if left untreated, the
child cannot control when the large, impacted stool is
passed, resulting in incontinence or soiling of l
arge stools
in the toilet.
Encopresis in children is classified as organic
(nonfunctional), which is related to an anatomic,
neurologic, or metabolic cause, or nonorganic (functional),
which is related to behavioral or psychological causes.
Cau
ses of organic encopresis include post
–
surgical anal or rectal stricture, dehydration, megacolon,
anorectal fissures or stenosis, laxative use, diarrhea,
Hirschsprung disease, spina bifida, hypothyroidism,
hypercalcemia, cerebral palsy, myelomeningocele, a
nd
adverse drug reactions.
Nonorganic encopresis can be caused by
ineffective bowel training and psychosocial stressors (e.g.,
new school, birth of a sibling, repeated sexual abuse).
Some children with nonorganic encopresis avoid
defecating appropriately
(e.g., in a bathroom using the
toilet, painful or unpleasant bowel movement) because of
fear or anxiety; others intentionally defecate
inappropriately because of a mental disorder (e.g.,
conduct disorder, oppositional defiant disorder, obsessive
compulsiv
e disorder, and cognitive delays and learning
disabilities).
Other risk factors include eating a high
–
fat diet,
high intake of sugary fluids (such as soda pop, juices), low
intake of dietary fiber, low activity level, and/or chronic
and/or recurrent stress
, specifically an unstable or
unpredictable daily routine. Both organic and nonorganic
encopresis can produce low self
–
esteem, aggression, and
acting out. Children can fear rejection and social isolation
by their peers, and angry and punitive reactions fro
m their
parents.
SIGNS AND SYMPTOMS
Signs and Symptoms of
Encopresis
·
Leakage liquid stool on clothes that may happen due
to fear of using the toilet or inadequate education
about bowel emptying into the toilet (Andrews, C. N.,
& Storr, M. (2011).
·
Premature and conflict
–
filled toilet training
is also
associated with stool staining on clothes.
·
Constipation with dry, hard stool
·
Passage of large stool that clogs or almost clogs the
toilet
·
Avoidance of bowel movements
·
Long periods of time between bowel movements
·
Lack of appetite
·
Abdominal pain
·
Problems with daytime wetting or bedwetting
(enuresis)
·
Repeated bladder infections, typically in girls
·
Emotional stress may trigger encopresis. A child may
experience stress from:
·
Premature, difficult or conflict
–
filled toilet training
·
Changes in the child
‘s life, such as dietary changes,
toilet training, starting school or schedule changes
·
Emotional stressors, for example, the divorce of a
parent or the birth of a sibling
PARENT GUIDE
ENCOPRESIS
By
Petty Regina
Espinosa Idalmis
Lashmann Oluseye
Onuora Vivien
Tinsley Jesselin
OVERVIEW OF ENCOPRESIS
INCLUDING SIGNS AND SYMPTOMS,
AND MANAGEMENT.
OVERVIEW
Encopresis is a term used to describe children
involuntarily or intentionally passing feces in unacceptable
locations (for example, in undergarments or on the floor) on a
minimum of one time per month for three months in a child
over four years of age chronologically and/or developmentally
(First & Tasman, 2004). This condition rarely occurs in
isolation but more commonly accompanies chronic
constipation with retention, resulting in large, infrequent
stools passed less than three times per week, leading to
overflow leakage, difficulty with voluntary defecation, and
eventually, to stool incontinence.
PATHOPHYSIOLOGY
Once a child withholds stool rather than passing
stool, the colon begins to distend. This distention gradually
stretches nerve fibers, and over time, the child has less
and less sensation of the urge to pass stool. The stools
become larger and larger, and the child becomes less
able to feel or pass the stool voluntarily. The large stool
becomes impacted, with loose, watery stool leaking
around the impaction, causing the appearance of
uncontrollable diarrhea. Eventually, if left untreated, the
child cannot control when the large, impacted stool is
passed, resulting in incontinence or soiling of large stools
in the toilet.
Encopresis in children is classified as organic
(nonfunctional), which is related to an anatomic,
neurologic, or metabolic cause, or nonorganic (functional),
which is related to behavioral or psychological causes.
Causes of organic encopresis include post-
surgical anal or rectal stricture, dehydration, megacolon,
anorectal fissures or stenosis, laxative use, diarrhea,
Hirschsprung disease, spina bifida, hypothyroidism,
hypercalcemia, cerebral palsy, myelomeningocele, and
adverse drug reactions.
Nonorganic encopresis can be caused by
ineffective bowel training and psychosocial stressors (e.g.,
new school, birth of a sibling, repeated sexual abuse).
Some children with nonorganic encopresis avoid
defecating appropriately (e.g., in a bathroom using the
toilet, painful or unpleasant bowel movement) because of
fear or anxiety; others intentionally defecate
inappropriately because of a mental disorder (e.g.,
conduct disorder, oppositional defiant disorder, obsessive
compulsive disorder, and cognitive delays and learning
disabilities).
Other risk factors include eating a high-fat diet,
high intake of sugary fluids (such as soda pop, juices), low
intake of dietary fiber, low activity level, and/or chronic
and/or recurrent stress, specifically an unstable or
unpredictable daily routine. Both organic and nonorganic
encopresis can produce low self-esteem, aggression, and
acting out. Children can fear rejection and social isolation
by their peers, and angry and punitive reactions from their
parents.
SIGNS AND SYMPTOMS
Signs and Symptoms of Encopresis
Leakage liquid stool on clothes that may happen due
to fear of using the toilet or inadequate education
about bowel emptying into the toilet (Andrews, C. N.,
& Storr, M. (2011).
Premature and conflict-filled toilet training is also
associated with stool staining on clothes.
Constipation with dry, hard stool
Passage of large stool that clogs or almost clogs the
toilet
Avoidance of bowel movements
Long periods of time between bowel movements
Lack of appetite
Abdominal pain
Problems with daytime wetting or bedwetting
(enuresis)
Repeated bladder infections, typically in girls
Emotional stress may trigger encopresis. A child may
experience stress from:
Premature, difficult or conflict-filled toilet training
Changes in the child’s life, such as dietary changes,
toilet training, starting school or schedule changes
Emotional stressors, for example, the divorce of a
parent or the birth of a sibling