PARENT GUIDE

PARENT GUIDE

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.

 

 

 

 

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

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