Encopresis Health Article

Voluntary encopresis

A person with voluntary encopresis has control over when and where bowel movements occur and chooses to have them in inappropriate places. Constipation is not a factor, and the feces is usually a normal consistency. Often feces is smeared in an obvious place, although sometimes it is hidden around the house. The APA classifies voluntary encopresis as encopresis without constipation and overflow incontinence.

In young children, voluntary encopresis may represent a power struggle between the child and the caregiver doing the toilet training. In older children, voluntary encopresis is often associated with oppositional defiant disorder(ODD), conduct disorder, sexual abuse, or high levels of psychological stressors.

Demographics

Encopresis occurs in 1–3% of children and is seen more often in boys than in girls. The frequency of encopresis appears to be independent of social class, and there is no evidence that it runs in families.

Diagnosis

To receive an APAdiagnosisof encopresis, a child must have a bowel movement, either intentional or accidental, in an inappropriate place at least once a month for a minimum of three months. In addition, the child must be chronologically or developmentally at least four years old, and the soiling cannot be caused by illness, medical conditions (such as chronic diarrhea, spina bifida, anal stenosis, etc.), medications, or disabilities. However, it may be caused by constipation.

Treatments

Involuntary encopresis is treated by addressing the cause of the constipation and establishing soft, pain-free stools. This can include:

• increasing the amount of liquids a child drinks
• adding high-fiber foods to the diet
• short-term use of laxatives or stool softeners
• emptying the large intestine by using an enema
• establishing regular bowel habits

Once the constipation is resolved, involuntary encopresis normally stops.

Treatment of voluntary encopresis depends on the cause. When voluntary encopresis results from a power struggle between child and adult, it is treated with behavior modification. In addition to taking the steps listed above to ensure a soft, pain-free stool, the adult should make toileting a pleasant, pressure-free activity. Some experts suggest transferring the initiative for toileting to the child instead of constantly asking him/her to use the toilet. Others recommend toileting at scheduled times, but without pressure to perform. In either case, success should be praised and failure treated in a matter-of-fact manner. If opposition to using the toilet continues, the family may be referred to a child psychiatristor a pediatric psychologist.

With older children who smear or hide feces, voluntary encopresis is usually a symptom of another more serious disorder. When children are successfully treated for the underlying disorder with psychiatric interventions, behavior modification, and education, the encopresis is often resolved.