The Problems
Soiling / Encopresis
POSSIBLE CAUSES -

ASSESSMENT AND MANAGEMENT - q
NEW STUDIES - q

RESULTS- q

 

Soiling, or Encopresis, is the involuntary passing of formed or semi-formed bowel motion into the clothing, in children over 4 years of age, for a period of greater than 1 month.
The child's plight is that they did not create the problem, have little control over yet suffer the social and emotional consequence. This little known problem is common, causes much anguish in the family and child, and has a high incidence of emotional and social problems as a consequence.

Frequency
Approx. 1.5% in second graders
Approx. 0.8% in 5 to 6 graders
3 to 6 times more common in boys
Approximately half of the children have never achieved control, the other achieved then lost it, frequently around starting kindergarten or primary school.

Appearance
Sometimes the problem is "unmasked" by a doctors visit for related problems.
Parents may not volunteer the problem feeling it is a sign of the child's laziness or bad parenting.

Mostly combinations of:

- Soiling the pants
- Abdominal pains
- Day or night wetting

Features
The features may be variable with periods of soiling and pains, then apparent improvement with the passage of large stools, only to have the cycle repeat again. Many children do not seem to be bothered by their soiling, others become quite secretive, or deny the problem.

Emotional and social problems can develop with children becoming withdrawn, fearful of exposure, and plummeting self esteem.  Punitive or derogatory measures by parents or others can only make the problem worse.
All this for a young child who is unaware of the soiling until it actually occurs and has little control over it.

Development of control of bowel movements is a complex process involving the recognition of signals from the muscles of the pelvic floor and anus, as well as recognition of distension of the rectum when the stool enters the rectum. Any processes that interfere with the development can lead to a retention of faeces and a loaded bowel. Stool eventually leaks out and soiling occurs. Most often the children do not know it is happening until it has happened.

Behavioural factors can interfere with the development and maintenance of control of bowel motions. These include :

 
Toilet Routine Problems Correct routine allows the child to "perform" on recognition of the stool in rectum. Difficulties can lead to retention.
Oppositional Behaviours The bowel may become an "issue" with a battle between the parents. It is one thing the child can control ie: hold on.
Harsh Toilet Training May occasionally interfere with development of control.
Short Attention Span / Hyperactivity Child may be "too busy to perform". This is especially true with commencement with kindergarten and school.
Constipation Painful passage of stool may lead to holding on and result in retention of faeces.
Most children with encopresis are not constipated in the sense of hard dry large stools but more have trouble with clearance or evacuation of stool.


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Last Updated  Sunday, 01. May 2016