Functional encopresis is an uncommon disorder in which the child passes faeces in inappropriate places after the age at which bowel control is usual. The age at which control is reached varies, but at the age of 3–4 years 94 per cent of children have control with only occasional accidents.
Usually, encopresis would not be diagnosed in a child younger than 4, and it should have been taking place for at least once a month for at least 3 months.
Encopresis occurs in about 1 per cent of children aged 4 and upwards, but after 5–6 years is much rarer. The condition is more common in boys than girls, by a factor of 6 to 1.
It is unusual to be able to identify a cause of encopresis, but some are listed below:
- idiopathic primary encopresis is more common in children with learning disabilities
- chronic constipation and overflow incontinence
- structural malformations of the colon (e.g. Hirschsprung’s disease)
- anal fissures causing pain
- traumatic or unsettling events
- deliberate rebellion by the child against the parents (almost never the sole cause)
- associated with anxiety or mood disorder
- associated with physical, sexual, or emotional abuse (extremely rare).
- Treat any primary physical or psychiatric disorder
- Reassure the parents that the problem occurs in other children and will improve in time
- Avoid constipation with a high-fibre diet and adequate hydration. Empty the bowel with laxatives, and continue them as maintenance if necessary
- Encourage normal bowel habits, starting by asking the child to sit on the toilet for 5 minutes after each meal
- Encourage the parents to reward the child for opening his bowels in the appropriate place, and not to dwell on failure
- Modify any stressful circumstances if possible.
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