Diagnosis of Encopresis
Encopresis Diagnosis: Book Excerpts
Diagnostic Tests for Encopresis: Online Medical Books
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Encopresis:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- 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
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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
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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
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KUB demonstrates fecal mass in the uncooperative child
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Labs: In non-straightforward cases
–Serologic assay for celiac, thyroid function tests, serum electrolytes, calcium, and lead
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Colonic manometry
–Differentiates between neuropathy and myopathy
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Spinal MRI for sacral anomalies
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
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