Encopresis

Encopresis: Excerpt from In A Page: Pediatric Signs and Symptoms

Encopresis refers to the repeated voluntary or involuntary passage of quantitative normal feces into inappropriate places (usually clothing or floor) after the age of 4 years. Subtypes include encopresis with constipation and overflow incontinence, defective neuromuscular control, and functional nonretentive fecal soiling. Encopresis affects about 1% of school-age children, and it is more common in males in this age group.

Differential Diagnosis

• Functional constipation (accounts for 66%)
  –Chronic constipation with fecal impaction results in a functional megacolon and overflow incontinence
  –Repeated soiling of underpants
  –Involuntary passage of loose feces around large balls of impacted feces
  –Child is unaware of “accidents” and odor

• Functional nonretentive fecal soiling
  –Rome II criteria: Inappropriate defecation in the absence of constipation and structural or inflammatory disease
  –May be the manifestation of an emotional disturbance in a child
  –Affects 2% of school-age children
  –Male-to-female ratio of 4:1

• Spina bifida
  –Incidence is 1/1,000 live births
  –Myelomeningocele is the most common
  –Bladder and bowel dysfunction is usual

• Anorectal malformations
  –Incidence is 1/4,000 live births
  –Anal stenosis with overflow incontinence
  –Imperforate anus with perineal fistula
  –Vestibular fistula: Most frequent defect seen in females, rectum opens into the vaginal vestibule
  –Rectovaginal fistula: Can result from pressure necrosis with obstructed labor
  –Persistent cloaca: The rectum, vagina, and urinary tract meet and fuse into a single common channel

• Postsurgical repair
  –Common sequela of the repair of high imperforate anus and Hirschsprung
• Inflammatory bowel disease (IBD)
  –Perianal fistulas or sinuses (Crohn disease)
• Diarrheal disease: Transient fecal soiling resolves with cessation of diarrhea
• Intestinal neuronal dysplasia
• Spinal tumors
• Tethered cord
• Diastematomyelia
  –Difficulty in walking, dribbling of urine, and fecal incontinence
• Organic constipation
  –Hypothyroidism, celiac disease, amyloid neuropathy, and endocrine disorders

Workup and Diagnosis

• Encopresis is often a clinical diagnosis
• History
  –Age of onset, duration, frequency
  –Stool-withholding behavior
  –Chronic abdominal pain, anorexia
  –Passive-aggressive relationship with caregiver
  –Chronic constipation
  –Prior anorectal malformations and corrective surgeries
  –Growth failure, developmental delay
  –History of depression and low self-esteem
  –Urinary incontinence and frequent urinary infections
• Physical exam
  –Abdominal distension
  –Bimanual abdominal palpation for fecal mass
  –Rectal examination to palpate fecal mass
  –Signs of spinal dysraphism: Motor and sensory deficit, absent cremasteric reflex, patulous anus, urinary incontinence, hair tufts in sacrococcygeal region
• KUB demonstrates fecal mass in the uncooperative child
• Labs: In non-straightforward cases
  –Serologic assay for celiac, thyroid function tests, serum electrolytes, calcium, and lead
• Colonic manometry
  –Differentiates between neuropathy and myopathy
• Spinal MRI for sacral anomalies

Treatment

• Functional constipation
  –Disimpaction (manual or with laxatives/enemas)
  –Maintenance therapy (stool softeners and laxatives)
  –Dietary manipulation (increase fluid and fiber)
• Surgical correction of anorectal anomalies

• Spina bifida
  –Behavioral modification techniques
  –Biofeedback training
  –Large-volume enemas with enema incontinence catheter
  –Continent appendicostomy (Malone procedure): Appendix is connected to the umbilicus, an antegrade colonic enema is given while the patient is sitting on the toilet
  –Cecostomy tube inserted percutaneously via interventional radiology or endoscopically; can also be used for antegrade colonic enema
• Bowel management program

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

More About Encopresis

• Back to disease: Encopresis: Introduction
• Next Book Extract About Encopresis: Encopresis (The 5-Minute Pediatric Consult)
• More Book Extracts: All Online Books for Encopresis

More Medical Textbooks Online about Encopresis

Review other book chapters online related to Encopresis:

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Encopresis (The 5-Minute Pediatric Consult)
• Surveys relating to Encopresis
• Ask Question about Encopresis

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City