Materiały źródłowe

• #1 Encopresis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560560/

  Encopresis or fecal incontinence is defined as the involuntary passing of stool into inappropriate places such as the underwear in children older than four years of age. It represents severe psychological distress on children and their families. […] In the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), encopresis criteria consisted of the repeated passage of stool into inappropriate places, and it can be either voluntarily or involuntarily. These encopretic events should occur for at least three months. The diagnosis cannot be made below the age of four. […] Encopresis is mainly a clinical diagnosis, and the majority of patients do not need any further testing. […] The provider should perform a comprehensive assessment with an extensive medical history, including the history of rectal or anal surgery due to possible malformation or congenital disabilities.

• #1 Encopresis – Wikipedia

  https://en.wikipedia.org/wiki/Encopresis

  Encopresis is commonly caused by constipation in children, by reflexive withholding of stool, by various physiological, psychological, or neurological disorders, or from surgery (a somewhat rare occurrence). […] The psychiatric (DSM-5) diagnostic criteria for encopresis are: Repeated passage of feces into inappropriate places (e.g., underwear or floor) whether voluntary or unintentional; At least one such event a month for at least 3 months; Chronological age of at least 4 years (or equivalent developmental level); The behavior is not exclusively due to a physiological effect of a substance (e.g., laxatives) or a general medical condition, except through a mechanism involving constipation. […] The DSM-5 recognizes two subtypes: with constipation and overflow incontinence, and without constipation and overflow incontinence.

• #1 Encopresis DSM-5 307.7 (F98.1)

  https://www.theravive.com/therapedia/encopresis-dsm–5-307.7-(f98.1)

  Encopresis is essentially a repeated passage of feces into inappropriate places, such as on clothing or the floor. […] According to DSM-5, there are 4 features that must be present to support a diagnosis of encopresis: Patients chronological age must be at least 4 years; A repeated passage of feces into inappropriate places, e.g., clothing or floor. This can be either intentional or involuntary; At least one such event must occur every month for at least 3 months; The behavior is not attributable to the effects of a substance, e.g., laxative, or another medical condition, with the exception of a mechanism involving constipation. […] In making the diagnosis, it is critical that the clinician specify which of the following is present: With constipation and overflow incontinence: through physical examination or medical history, there is evidence of constipation.

• #1 Encopresis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/encopresis/diagnosis-treatment/drc-20354500

  To diagnose encopresis, your child’s doctor may: […] Conduct a physical exam and discuss symptoms, bowel movements and eating habits to rule out physical causes for constipation or soiling. […] Do a digital rectal exam to check for impacted stool by inserting a lubricated, gloved finger into your child’s rectum while pressing on his or her abdomen with the other hand. […] Recommend an abdominal X-ray to confirm the presence of impacted stool. […] Suggest that a psychological evaluation be done if emotional issues are contributing to your child’s symptoms.

• #1 Encopresis (Fecal Soiling) – Harvard Health

  https://www.health.harvard.edu/a_to_z/encopresis-fecal-soiling-a-to-z

  Encopresis is when a child who is toilet trained passes stool (bowel movements) into his or her underwear. […] In most cases, your doctor can diagnose encopresis based on your child’s: Age, History and symptoms of chronic constipation, Physical examination. […] The doctor will begin by asking about your child’s bowel habits, including: How often he or she has bowel movements, The size of your child’s bowel movements, Whether the outside of the stools have been streaked with blood. […] The doctor also will ask about your child’s diet, especially about: Foods that tend to cause constipation: Milk and other dairy products, white rice, white bread. […] Some doctors ask parents to keep a diary of the child’s diet and stools for a week. This can help to figure out how best to treat the child.

• #1 Encopresis DSM-5 307.7 (F98.1)

  https://www.theravive.com/therapedia/encopresis-dsm–5-307.7-(f98.1)

  Without constipation and overflow incontinence: through physical examination or medical history, there is no evidence of constipation. […] In order to make a definitive diagnosis, a complete medical examination must be conducted. […] Features of this exam must include: gait abnormalities; general strength; reflexes, coordination, abdomen for presence of stool masses/discomfort and rectal examination for tone and presence of impaction. […] In many cases, encopresis may be the result of anxiety. […] Cognitive Behavioral Therapy and psychotherapy can help decrease the symptoms of anxiety and/or depression associated with encopresis. […] No matter which treatment modality is chosen (dietary changes, behavioral strategies, biofeedback, psychotherapy or medications), it remains a fact that if the bowel is kept empty, soiling cannot occur.

• #1 Encopresis in Children | Causes, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/e/encopresis

  Children with encopresis, also called soiling, have bowel movements or leak a small amount of stool in their underclothes or on themselves. […] A doctor or nurse practitioner will examine your child and get a medical history. Testing is usually not required but might include: […] Abdominal X-ray to evaluate the amount of stool in the large intestine. […] Contrast enema to check the intestine for blockage, narrow areas and other abnormalities.

• #1 Encopresis Workup: Approach Considerations, Abdominal Radiography, Anorectal Manometry

  https://emedicine.medscape.com/article/928795-workup

  In most patients, the diagnosis of encopresis is established on the basis of the history and complete physical examination, including a rectal examination. […] Laboratory studies are rarely warranted, though radiography, manometry, and biopsy may be helpful. […] Plain abdominal radiography may be helpful in determining whether a soft fecal impaction is present. […] Anorectal manometry is sometimes helpful in delineating the child’s defecation dynamics. […] Anorectal manometry can also be helpful in excluding ultrashort-segment Hirschsprung disease, which is a rare cause of encopresis. […] Although Hirschsprung disease is rarely associated with encopresis, this diagnosis, if suspected, can be excluded by identifying ganglion cells in the submucosa and myenteric plexuses of the rectum.

• #1 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content?contenttypeid=90&contentid=P01992

  Colorectal transit study. This test shows how well food moves through your child’s colon. The child swallows pills (capsules) filled with small markers that can be seen on an X-ray. The child eats a high-fiber diet for the next few days. X-rays will be taken 3 to 7 days after your child takes the pills. The X-rays will show how the pills moved through the colon. […] Lab testing. Several tests may be done. These include tests to check for issues such as celiac disease, urinary tract infection, thyroid problems, metabolic problems, and blood lead level.

• #1 Managing Encopresis in Schools | Show Me School Health

  https://showmeschoolhealth.org/resources/managing-encopresis-in-schools/

  Students with encopresis should also be evaluated for psychological symptoms, including anxiety, depression, and behavioral symptoms. […] The management of encopresis depends on the type of fecal incontinence. For students with constipation-associated (retentive) functional fecal incontinence, management focuses on treating the underlying constipation using both behavioral modification and laxatives. For children with non-retentive fecal incontinence, management involves similar behavioral interventions, with particular attention to identifying the trigger for the episodes of incontinence but without laxative therapy. […] The goal of therapy is the passage of soft stools, ideally once per day and no less than every other day. This goal of frequent defecation is important to overcome constipation.

• #1 Encopresis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560560/

  The general symptoms of encopresis have been shown variably in children. The providers should always keep in mind the possibility of underlying organic causes as well. In general, encopresis is a clinical diagnosis that is primarily based on symptoms in the absence of red flag symptoms, and most patients do not need further testing. […] The treatment for encopresis relies on treating the root cause, which is chronic constipation. Management of constipation is covered in a different section in Statpearls, Pediatric Functional Constipation. […] The treatment of non-retentive encopresis has not been well defined. The treatment consists of education, keeping a bowel diary, and toilet training four times a day following meals and immediately after arriving home from school. […] The differential diagnosis for encopresis includes organic non-functional causes such as repaired anorectal malformation, postsurgical Hirschsprung disease, spinal dysraphism, spinal cord trauma, spinal cord tumor, cerebral palsy, and myopathies affecting the pelvic floor and external anal sphincter. […] Most children treated for retentive encopresis are eventually cured, although the time required for treatment varies, and relapses are frequent.

• #1 Encopresis | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688741/all/Encopresis?q=Rash

  Defined by DSM-5 and Rome IV diagnostic criteria as repetitive and inappropriate passage of feces. Diagnostic criteria: chronological and developmental age of at least 4 years; repeated passage of stool in inappropriate placesfloors, clothes; symptoms mostly involuntary but may be intentional; at least one event per month for 3 months; behavior cant be explained by other medical conditions or use of substances (e.g., laxatives); excludes mechanisms involving constipation. In 90% of cases, encopresis develops as a consequence of chronic constipation, with resulting overflow incontinence (retentive encopresis). The other 10% are caused by specific organic etiologies. Chronic constipation with irregular and incomplete evacuation results in progressive rectal distension and stretching of the internal/external anal sphincters. Chronic rectal distension causes habituation, leading to the loss of sensing the normal urge to defecate causing abdominal pain, nausea, and bloating. Eventually, soft or liquid stool leaks around the retained fecal mass. Transition of foods: breast milk to formula or cows milk or start of solid foods; parental conflicts or divorce; new sibling; history of constipation; painful defecation; difficulty with bowel training, including social pressure related to early daycare placement; organic/anatomic causes; anxiety and depression; insufficient fluid or fiber intake; fear of using bathrooms/public restrooms; attention deficit; history of abuse; medications (particularly opiates, ADD/ADHD medications, antidepressants).

• #1 Treatment Guidelines for Primary Nonretentive Encopresis and Stool Toileting Refusal | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0415/p2171.html

  The principal differential diagnoses of encopresis are listed in Table 2. […] Children with retentive encopresis often soil small quantities of loose fecal matter several times a day but periodically pass very large bowel movements. […] A complete history and physical examination revealed no significant medical findings or evidence of fecal impaction. […] The following illustrative case demonstrates the efficacy of these treatment guidelines in a child with nonretentive encopresis and toileting refusal.

• #1 Treatment Guidelines for Primary Nonretentive Encopresis and Stool Toileting Refusal | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0415/p2171.html

  Nonretentive encopresis refers to inappropriate soiling without evidence of fecal constipation and retention. This form of encopresis accounts for up to 20 percent of all cases. […] A full developmental and behavioral assessment should be made to establish that the child is ready for intervention to correct encopresis and to identify any barriers to success, particularly disruptive behavior problems. […] Encopresis affects 1 to 3 percent of children, with higher rates in boys than in girls. However, encopresis may go undetected unless health professionals directly inquire about toileting habits. […] A consistent soiling pattern characterized by stools that are normal in size and consistency and the absence of constipation usually suggests nonretentive encopresis. […] If the physician is unable to confirm the presence of constipation or impaction following the history and physical examination, a flat plate radiograph of the abdomen will aid in diagnosis.

• #1 Encopresis (faecal incontinence) :: Paediatric Portal

  http://paedsportal.com/referrals/pre-referral/encopresis

  Fecal incontinence (previously known as encopresis) is defined as involuntary leaking of feces. This is often associated with constipation. […] Encopresis is often the result of an inciting painful stool in toddler years that leads to retention behaviours (child not wanting to poo and holding on) and resultant rectal distention. Over time, with increased rectal distension, the message of rectal fullness is 'lost’ to the brain, so that children no longer feel the need to defecate. […] Always ask about associated daytime urinary incontinence or nocturnal enuresis symptoms, as they will also require management. […] The effect of dietary changes on constipation and encopresis in children remains controversial. […] Management centres around removal of faecal retention then reconditioning the bowel.

• #1 Encopresis

  https://www.massgeneral.org/condition/encopresis

  Symptoms of encopresis may look like other health conditions. Always see your child’s healthcare provider for a diagnosis. […] Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. […] Your child’s healthcare provider may prescribe an enema to help remove the impacted stool. An enema is a liquid that is placed in your child’s rectum. It helps loosen the hard, dry stool. […] Your child’s healthcare provider will likely prescribe medicines to help keep your child’s bowel movements soft for several months. This will help stop stool from getting impacted again. […] Encopresis can cause both physical and emotional problems. […] Children with encopresis often feel upset by the accidents they have when they soil their clothes. In most cases, they can’t control this stool leakage. This can affect how they feel about themselves, or their self-esteem.

• #1 Encopresis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/encopresis/symptoms-causes/syc-20354494

  Encopresis usually occurs after age 4, when a child has already learned to use a toilet. […] Call your doctor if your child is already toilet trained and starts experiencing one or more of the symptoms listed above. […] There are several causes of encopresis, including constipation and emotional issues. […] Most cases of encopresis are the result of chronic constipation. […] The longer the stool remains in the colon, the more difficult it is for the child to push stool out. […] When the colon becomes too full, soft or liquid stool may leak out around the retained stool or loss of control over bowel movements may occur. […] Emotional stress may trigger encopresis. […] Encopresis is more common in boys than in girls. […] Early treatment, including guidance from your child’s doctor or mental health professional, can help prevent the social and emotional impact of encopresis.

• #1 Faecal incontinence, soiling or encopresis | Raising Children Network

  https://raisingchildren.net.au/school-age/health-daily-care/toileting/faecal-incontinence

  Faecal incontinence is when children who are 4 years old or older cant control when and where they do a poo. This means that they regularly do poos in places other than the toilet, most often in their underwear. […] Faecal incontinence is also called encopresis or soiling. […] The most common cause of faecal incontinence in children is chronic constipation. […] The main symptom of faecal incontinence is pooing in places other than the toilet, usually in underwear. […] You should see your GP for advice about treatment and management if you think your child is constipated or if your child: is 4 years old and cant yet control when or where they poo. […] The treatment for faecal incontinence depends on its cause.

• #2 Encopresis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/encopresis/symptoms-causes/syc-20354494

  Encopresis usually occurs after age 4, when a child has already learned to use a toilet. […] Call your doctor if your child is already toilet trained and starts experiencing one or more of the symptoms listed above. […] There are several causes of encopresis, including constipation and emotional issues. […] Most cases of encopresis are the result of chronic constipation. […] The longer the stool remains in the colon, the more difficult it is for the child to push stool out. […] When the colon becomes too full, soft or liquid stool may leak out around the retained stool or loss of control over bowel movements may occur. […] Emotional stress may trigger encopresis. […] Encopresis is more common in boys than in girls. […] Early treatment, including guidance from your child’s doctor or mental health professional, can help prevent the social and emotional impact of encopresis.

• #2 Encopresis DSM-5 307.7 (F98.1)

  https://www.theravive.com/therapedia/encopresis-dsm–5-307.7-(f98.1)

  Encopresis is essentially a repeated passage of feces into inappropriate places, such as on clothing or the floor. […] According to DSM-5, there are 4 features that must be present to support a diagnosis of encopresis: Patients chronological age must be at least 4 years; A repeated passage of feces into inappropriate places, e.g., clothing or floor. This can be either intentional or involuntary; At least one such event must occur every month for at least 3 months; The behavior is not attributable to the effects of a substance, e.g., laxative, or another medical condition, with the exception of a mechanism involving constipation. […] In making the diagnosis, it is critical that the clinician specify which of the following is present: With constipation and overflow incontinence: through physical examination or medical history, there is evidence of constipation.

• #2 Encopresis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/928795-overview

  DSM-5 criteria for encopresis are as follows: Repeated passage of feces into inappropriate places, whether involuntary or intentional; One such event occurs each month for at least 3 months; Occurs in children at least age 4 years (or of equivalent developmental level); The behavior is not attributable to the physiologic effects of a substance or another medical condition except through a mechanism involving constipation.

• #2 Encopresis DSM-5 307.7 (F98.1)

  https://www.theravive.com/therapedia/encopresis-dsm–5-307.7-(f98.1)

  Without constipation and overflow incontinence: through physical examination or medical history, there is no evidence of constipation. […] In order to make a definitive diagnosis, a complete medical examination must be conducted. […] Features of this exam must include: gait abnormalities; general strength; reflexes, coordination, abdomen for presence of stool masses/discomfort and rectal examination for tone and presence of impaction. […] In many cases, encopresis may be the result of anxiety. […] Cognitive Behavioral Therapy and psychotherapy can help decrease the symptoms of anxiety and/or depression associated with encopresis. […] No matter which treatment modality is chosen (dietary changes, behavioral strategies, biofeedback, psychotherapy or medications), it remains a fact that if the bowel is kept empty, soiling cannot occur.

• #2 Encopresis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/79851

  Encopresis or fecal incontinence is defined as the involuntary passing of stool into inappropriate places such as the underwear in children older than four years of age. […] In the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), encopresis criteria consisted of the repeated passage of stool into inappropriate places, and it can be either voluntarily or involuntarily. These encopretic events should occur for at least three months. The diagnosis cannot be made below the age of four. […] Encopresis can be divided into constipation-associated encopresis or overflow encopresis, and non-retentive encopresis. More than 80% of the children with encopresis have retentive fecal incontinence. […] Encopresis is mainly a clinical diagnosis, and the majority of patients do not need any further testing.

• #2 Encopresis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560560/

  The general symptoms of encopresis have been shown variably in children. The providers should always keep in mind the possibility of underlying organic causes as well. In general, encopresis is a clinical diagnosis that is primarily based on symptoms in the absence of red flag symptoms, and most patients do not need further testing. […] The treatment for encopresis relies on treating the root cause, which is chronic constipation. Management of constipation is covered in a different section in Statpearls, Pediatric Functional Constipation. […] The treatment of non-retentive encopresis has not been well defined. The treatment consists of education, keeping a bowel diary, and toilet training four times a day following meals and immediately after arriving home from school. […] The differential diagnosis for encopresis includes organic non-functional causes such as repaired anorectal malformation, postsurgical Hirschsprung disease, spinal dysraphism, spinal cord trauma, spinal cord tumor, cerebral palsy, and myopathies affecting the pelvic floor and external anal sphincter. […] Most children treated for retentive encopresis are eventually cured, although the time required for treatment varies, and relapses are frequent.

• #2 Encopresis (Fecal Soiling) – Harvard Health

  https://www.health.harvard.edu/a_to_z/encopresis-fecal-soiling-a-to-z

  Encopresis is when a child who is toilet trained passes stool (bowel movements) into his or her underwear. […] In most cases, your doctor can diagnose encopresis based on your child’s: Age, History and symptoms of chronic constipation, Physical examination. […] The doctor will begin by asking about your child’s bowel habits, including: How often he or she has bowel movements, The size of your child’s bowel movements, Whether the outside of the stools have been streaked with blood. […] The doctor also will ask about your child’s diet, especially about: Foods that tend to cause constipation: Milk and other dairy products, white rice, white bread. […] Some doctors ask parents to keep a diary of the child’s diet and stools for a week. This can help to figure out how best to treat the child.

• #2 Encopresis | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688741/all/Encopresis?q=Rash

  Defined by DSM-5 and Rome IV diagnostic criteria as repetitive and inappropriate passage of feces. Diagnostic criteria: chronological and developmental age of at least 4 years; repeated passage of stool in inappropriate placesfloors, clothes; symptoms mostly involuntary but may be intentional; at least one event per month for 3 months; behavior cant be explained by other medical conditions or use of substances (e.g., laxatives); excludes mechanisms involving constipation. In 90% of cases, encopresis develops as a consequence of chronic constipation, with resulting overflow incontinence (retentive encopresis). The other 10% are caused by specific organic etiologies. Chronic constipation with irregular and incomplete evacuation results in progressive rectal distension and stretching of the internal/external anal sphincters. Chronic rectal distension causes habituation, leading to the loss of sensing the normal urge to defecate causing abdominal pain, nausea, and bloating. Eventually, soft or liquid stool leaks around the retained fecal mass. Transition of foods: breast milk to formula or cows milk or start of solid foods; parental conflicts or divorce; new sibling; history of constipation; painful defecation; difficulty with bowel training, including social pressure related to early daycare placement; organic/anatomic causes; anxiety and depression; insufficient fluid or fiber intake; fear of using bathrooms/public restrooms; attention deficit; history of abuse; medications (particularly opiates, ADD/ADHD medications, antidepressants).

• #2 Encorpresis Treatment in Kids: Facts on Potty Training

  https://www.emedicinehealth.com/encopresis/article_em.htm

  Encopresis Diagnosis Your child’s health care professional will ask many questions about the child’s medical history, toilet training history, diet, lifestyle, habits, medications, and behaviors. A thorough physical examination will be done to assess the child’s general health as well as the status of the colon, rectum, and anus. The health care professional may insert a gloved finger into the child’s rectum to feel for stool and make sure the anal opening and rectum are of normal size and that the anal muscles are of normal strength. […] In most cases, blood tests are not part of the evaluation of constipation and/or encopresis. In some cases, an X-ray of the child’s abdomen or pelvis may be performed to determine how much stool is present in the colon and to assess if the colon and rectum are enlarged. Occasionally, a contrast barium enema is performed. This is a special type of X-ray in which a small tube is inserted into the child’s rectum, and the colon is slowly filled with a radiopaque dye (barium or hypaque). X-rays are taken throughout the procedure to see if there are any areas of narrowing, twisting, or kinking in the lower intestine that might cause the child’s symptoms.

• #2 Encopresis in Children | Causes, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/e/encopresis

  Children with encopresis, also called soiling, have bowel movements or leak a small amount of stool in their underclothes or on themselves. […] A doctor or nurse practitioner will examine your child and get a medical history. Testing is usually not required but might include: […] Abdominal X-ray to evaluate the amount of stool in the large intestine. […] Contrast enema to check the intestine for blockage, narrow areas and other abnormalities.

• #2 Encopresis in Children | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/encopresis

  Encopresis is the involuntary leaking of feces, most often caused by chronic constipation. An estimated 1 to 3 percent of children have this problem at one time or another in childhood. […] Diagnosis starts with a complete medical history that includes questions about the child’s toilet training and a physical exam. This often provides enough information to diagnose encopresis. In some cases, doctors obtain an abdominal X-ray to evaluate the amount of stool in the large intestine. […] Treatment for encopresis depends on the root cause. If encopresis is caused by constipation, treatment may include: laxatives to help the child pass the impacted stool, medication to keep bowel movements soft so the stool will pass easily, and 5 to 10 minutes sitting on the toilet at home after breakfast and dinner.

• #2 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content?contenttypeid=90&contentid=P01992

  Barium enema. This is an X-ray exam of the rectum, the large intestine, and the lower part of the small intestine. Your child will be given a metallic fluid called barium. Barium coats the organs so they can be seen on an X-ray. The barium is put into a tube and inserted into your child’s rectum as an enema. An X-ray of the belly will show if your child has any narrowed areas (strictures), blockages (obstructions), or other problems. […] Anorectal manometry. This test checks the strength of the muscles in the anus and the nerve reflexes. It also checks your child’s ability to sense that the rectum is full (rectal distension) and a bowel movement is needed. And it looks at how well the muscles work together during a bowel movement. […] Rectal biopsy. This test takes a sample of the cells in the rectum. They are checked under a microscope for any problems.

• #2 Encorpresis Treatment in Kids: Facts on Potty Training

  https://www.emedicinehealth.com/encopresis/article_em.htm

  In some cases, anorectal manometry may be performed. For this test, a small tube with several pressure sensors is inserted into the child’s rectum. During the test, the doctor can determine how the child is using his or her abdominal, pelvic, and anal muscles during defecation. Many children who have chronic constipation and/or encopresis do not use their muscles in a coordinated fashion when trying to pass stools. […] The main objective of manometry is to determine whether there is normal pressure within the anus. Manometry can also show whether the nerves controlling the anal sphincter, anus, and rectum are present and working by measuring reflexes in this area. Manometry can measure how far the rectum is distended and whether sensation in this area is normal. Abnormal contractions of the muscles in the pelvic floor can be documented by using manometry.

• #2 Encorpresis Treatment in Kids: Facts on Potty Training

  https://www.emedicinehealth.com/encopresis/article_em.htm

  Anorectal manometry can also be helpful to rule out Hirschsprung’s disease, a very rare cause of constipation without encopresis. If Hirschsprung’s disease is being seriously considered as a cause of your child’s encopresis, a biopsy of the rectum may be necessary. A biopsy is the removal of a very tiny piece of tissue for examination under a microscope. This is done to look for characteristic signs of Hirschsprung’s disease in the tissues.

• #2 Encopresis (Fecal Soiling) – Harvard Health

  https://www.health.harvard.edu/a_to_z/encopresis-fecal-soiling-a-to-z

  If the doctor thinks the problem may be related to abnormalities in your child’s lower digestive tract, he or she may order additional tests. These may include an X-ray procedure called a barium enema or a procedure called a rectal biopsy. […] In a biopsy, a small piece of tissue from the rectum is removed to be examined in a laboratory. […] If your child has signs of hypothyroidism, your doctor may order blood tests to measure thyroid hormone levels.

• #2 Encopresis in Children and Adolescents – Society of Pediatric Psychology

  https://pedpsych.org/fact_sheets/encopresis/

  Encopresis is the voluntary or involuntary passage of stool in places other than toilets. To receive a diagnosis of encopresis, the child must pass feces into inappropriate places (such as clothing or on the floor) at least once per month for three months or more. […] Assessment and treatment of encopresis is based on a biobehavioral model. […] Assessment of encopresis should include a thorough medical and psychosocial evaluation. Medical evaluation of encopresis includes a history and physical, review of symptoms and stooling history, physical examination, and possibly blood work if symptoms suggesting medical causes of constipation are present. […] Psychosocial assessment including behavioral screening using parent and teacher rating scales (e.g., BASC, CBCL, Connors CBRS), is recommended to identify comorbidities such as Oppositional Defiant Disorder, Anxiety and Attention-Deficit/Hyperactivity Disorder which may impact implementation of treatment recommendations.

• #2 Encopresis |Understanding & Managing Encopresis In Children

  https://www.childpsychologist.com.au/resources/encopresis-soiling-in-school-aged-children

  Medical treatments: The first step to treating encopresis is to identify the cause behind the condition and seek medical advice from a pediatrician or GP. Medical examinations are important in order to rule out the existence of organic causes. Initially, a doctor may prescribe a laxative to ease the passage of the hardened stool through the rectum. […] Behavioural modification with the assistance of a Psychologist is an integral treatment component for encopresis. […] Treat other co-morbidities: Comorbid emotional and behavioural disorders should be treated separately according to evidence-based recommendations (von Gontard, 2013). If your child is presenting with anxiety, depression, or oppositional defiant disorder, these associated co-morbidities should be treated concurrently to reduce symptoms of encopresis.

• #2 Encopresis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/79851

  The provider should perform a comprehensive assessment with an extensive medical history, including the history of rectal or anal surgery due to possible malformation or congenital disabilities. […] The treatment for encopresis relies on treating the root cause, which is chronic constipation. […] The recently published NASPGHAN guidelines include four important phases in the treatment of chronic constipation: (1) education, (2) disimpaction, (3) prevention of reaccumulation of feces, and (4) follow-up. […] The treatment of non-retentive encopresis has not been well defined. The treatment consists of education, keeping a bowel diary, and toilet training four times a day following meals and immediately after arriving home from school. […] The differential diagnosis for encopresis includes organic non-functional causes such as repaired anorectal malformation, postsurgical Hirschsprung disease, spinal dysraphism, spinal cord trauma, spinal cord tumor, cerebral palsy, and myopathies affecting the pelvic floor and external anal sphincter.

• #2 Encopresis | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688741/all/Encopresis

  Defined by DSM-5 and Rome IV diagnostic criteria as repetitive and inappropriate passage of feces. […] Diagnostic criteria: chronological and developmental age of at least 4 years; repeated passage of stool in inappropriate placesfloors, clothes; symptoms mostly involuntary but may be intentional; at least one event per month for 3 months; behavior cant be explained by other medical conditions or use of substances (e.g., laxatives); excludes mechanisms involving constipation. […] In 90% of cases, encopresis develops as a consequence of chronic constipation, with resulting overflow incontinence (retentive encopresis). The other 10% are caused by specific organic etiologies. […] Chronic constipation with irregular and incomplete evacuation results in progressive rectal distension and stretching of the internal/external anal sphincters.

• #2 Quick Facts on Encopresis – Child Mind Institute

  https://childmind.org/article/quick-facts-on-encopresis/

  In the case of deliberate passing of feces, symptoms of oppositional defiant disorder and conduct disorder may also be present. Enuresis, which is a repeated passage of urine in inappropriate places such as beds or clothes, over the mental age of five, also tends to appear in children with encopresis.

• #2 Encopresis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/79851

  Most children treated for retentive encopresis are eventually cured, although the time required for treatment varies, and relapses are frequent. […] Successful treatment of encopresis requires a team approach; family members, health care providers, and the patient work as a team for better treatment outcomes.

• #2 Encopresis – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/topic/default?id=encopresis-90-P01992

  Encopresis is when your child leaks stool into his or her underwear. It is also called stool soiling. It is most often because of long-term (chronic) constipation. Encopresis happens to children ages 4 and older who have already been toilet trained. […] Symptoms of encopresis may look like other health conditions. Always see your child’s healthcare provider for a diagnosis. […] Your child’s healthcare provider will give your child an exam and take a health history. Imaging tests may also be done to check the intestine and rule out other health problems. These tests may include: […] Treatment for encopresis may include: Removing the impacted stool, Keeping bowel movements soft so the stool will pass easily, Retraining the intestine and rectum to gain control over bowel movements. […] Talk with your child’s healthcare provider if your child has hard, painful stools or soils his or her underwear.

• #2 Encopresis | Phoenix Children’s Hospital

  https://phoenixchildrens.org/specialties-conditions/encopresis

  Your child’s healthcare provider will likely prescribe medicines to help keep your child’s bowel movements soft for several months. This will help stop stool from getting impacted again. […] If your child’s encopresis is caused by another health problem, treating that condition may help. […] Talk with your child’s healthcare provider if your child has hard, painful stools or soils their underwear. Also call your provider right away if your child doesn’t have a bowel movement for 3 or 4 days in a row or complains of abdominal pain.

• #2 Managing Encopresis in Schools | Show Me School Health

  https://showmeschoolhealth.org/resources/managing-encopresis-in-schools/

  Fecal incontinence due to overflow does not constitute willful and defiant behavior by the child but actually represents physiologic loss of continence. The child should therefore not be scolded or otherwise punished for episodes of incontinence. Both behavioral interventions and laxatives are important parts of treatment. The process of bowel retraining, with readjustment of the nerves and muscles in the rectum, can take as long as six months to several years. Relapse is not uncommon.

• #3 Stool Incontinence in Children – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/stool-incontinence-in-children/stool-incontinence-in-children

  Encopresis is a common childhood problem; it occurs in approximately 2 to 5% of 4-year-old children and decreases in frequency with age. […] Most cases of encopresis can be diagnosed with a thorough history and physical examination. […] Any organic process that results in constipation can result in encopresis. […] Treatment is through education, relief of stool impaction, maintenance of proper stooling, and slow withdrawal of laxatives with continued behavioral and dietary intervention.

• #3 Encopresis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32809395/

  Encopresis or fecal incontinence is defined as the involuntary passing of stool into inappropriate places such as the underwear in children older than four years of age. It represents severe psychological distress on children and their families. In the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), encopresis criteria consisted of the repeated passage of stool into inappropriate places, and it can be either voluntarily or involuntarily. These encopretic events should occur for at least three months. The diagnosis cannot be made below the age of four. The encopresis of fecal incontinence also called soiling or fecal overflow incontinence.

• #3

  https://www.bionity.com/en/encyclopedia/Encopresis.html

  The psychiatric (DSM-IV) diagnostic criteria for encopresis are: […] The DSM-IV recognizes two subtypes: with constipation and overflow incontinence, and without constipation and overflow incontinence.

• #3 Encopresis | Psychology Today

  https://www.psychologytoday.com/us/conditions/encopresis

  For a diagnosis of encopresis, according to the DSM-5: […] A health care provider will perform a physical examination and perhaps run additional tests to help make a diagnosis of encopresis. […] Encopresis can be further classified according to two subtypes: with constipation and overflow incontinence and without them. […] Painful defecation and some medications (such as anticonvulsants or cough suppressants) may contribute to the development of encopresis, according to the DSM-5. […] In the absence of constipation, a psychiatric evaluation may help identify an underlying cause for the behavior.

• #3 Encopresis Workup: Approach Considerations, Abdominal Radiography, Anorectal Manometry

  https://emedicine.medscape.com/article/928795-workup

  In most patients, the diagnosis of encopresis is established on the basis of the history and complete physical examination, including a rectal examination. […] Laboratory studies are rarely warranted, though radiography, manometry, and biopsy may be helpful. […] Plain abdominal radiography may be helpful in determining whether a soft fecal impaction is present. […] Anorectal manometry is sometimes helpful in delineating the child’s defecation dynamics. […] Anorectal manometry can also be helpful in excluding ultrashort-segment Hirschsprung disease, which is a rare cause of encopresis. […] Although Hirschsprung disease is rarely associated with encopresis, this diagnosis, if suspected, can be excluded by identifying ganglion cells in the submucosa and myenteric plexuses of the rectum.

• #3 Encopresis Symptoms, Causes, Treatments, & More

  https://www.webmd.com/digestive-disorders/encopresis

  Encopresis is the soiling of underwear with stool by children who are past the age of toilet training. […] To diagnose encopresis, your child’s health care provider will ask many questions about their medical history, toilet training history, diet, lifestyle, habits, medications, and behavior. […] In some cases, an exam called an anorectal manometry test may be performed. […] The main objective of a manometry test is to confirm increased pressure within the anus. […] Most cases of encopresis respond to the treatment regimen outlined above. […] If the soiling does not resolve, your child’s health care provider may refer you to a specialist in digestive and intestinal disorders (pediatric gastroenterologist), a behavioral psychologist, or both. […] The best way to prevent encopresis is to prevent constipation in the first place. […] If your child is consistently struggling with constipation, see their pediatrician.

• #3 Encopresis | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688741/all/Encopresis

  Defined by DSM-5 and Rome IV diagnostic criteria as repetitive and inappropriate passage of feces. […] Diagnostic criteria: chronological and developmental age of at least 4 years; repeated passage of stool in inappropriate placesfloors, clothes; symptoms mostly involuntary but may be intentional; at least one event per month for 3 months; behavior cant be explained by other medical conditions or use of substances (e.g., laxatives); excludes mechanisms involving constipation. […] In 90% of cases, encopresis develops as a consequence of chronic constipation, with resulting overflow incontinence (retentive encopresis). The other 10% are caused by specific organic etiologies. […] Chronic constipation with irregular and incomplete evacuation results in progressive rectal distension and stretching of the internal/external anal sphincters.

• #3 Encopresis | Paradoxical Diarrhea – Causes, Symptoms and Signs, Diagnosis and Management

  https://www.medindia.net/health/conditions/encopresis-paradoxical-diarrhea.htm

  Parents may seek medical advice due to problems with child’s bowel habits and episodes of fecal soiling. […] The doctor will obtain a detailed history including occurrence of constipation, diet history, details of toilet training and conduct a thorough physical examination to identify cause of constipation and rule out other causes of fecal soiling. […] The doctor gently introduces a lubricated, gloved finger into the anal opening while gently pressing the lower part of the belly with the other hand and checks for presence of hard impacted fecal mass. […] Abdominal x-ray to check the amount of stool in the large intestine and demonstrate hard fecal mass. […] Contrast enema, a test that gives a clearer picture of the bowel to check for blockage of intestine, any abnormal narrowing or other conditions that may be causing constipation. […] If the doctor suspects emotional disturbances as the possible cause of fecal soiling, he may recommend a psychological evaluation.

• #3 Encopresis | Riley Children’s Health

  https://www.rileychildrens.org/health-info/encopresis

  Encopresis (soiling) occurs when a child resists having bowel movements, causing impacted stool to collect in the colon and rectum. When a child’s colon is full of impacted stool, liquid stool can leak around the impacted stool and then out of the anus, staining a child’s underwear. […] Encopresis may also be called stool withholding. In most cases, encopresis is not a disease but rather a symptom of chronic constipation. Less frequently, it may be related to developmental or emotional issues. Encopresis usually occurs more commonly in boys after age 4, when a child has already learned to use a toilet. […] If your child is experiencing symptoms of encopresis, a pediatric gastroenterologist can perform the following exams and tests to help make a diagnosis: Physical exam. A pediatric gastroenterologist will ask about your child’s symptoms and complete a general examination of your child’s body. Rectal exam. A physical exam may include a rectal exam to check for impacted stool. During this exam, the doctor inserts a lubricated, gloved finger into your child’s rectum. X-ray. The pediatric gastroenterologist may recommend an abdominal X-ray to confirm the presence of impacted stool. Psychological evaluation. If the cause of encopresis is unclear, the doctor may recommend a psychological evaluation to help determine the cause. Motility test. A motility test called anorectal manometry uses small balloons to test the function of the anal muscles. The test can be conducted under general anesthesia. More extensive studies can be conducted in cooperative children while they are awake.

• #3 Encopresis: Definition, causes, symptoms, and treatments

  https://www.medicalnewstoday.com/articles/encopresis

  Encopresis is repeated episodes of stool soiling in children who are more than 4 years old. […] For a diagnosis of encopresis, stool soiling must occur at least once a month for a minimum of 3 months. It must not be the direct result of a medical condition, or substance usage, such as medication. […] A doctor can diagnose encopresis and recommend a course of treatment. Diagnosis may involve: a physical examination plus description of symptoms, a full medical and family history, an abdominal X-ray, to see stool volume in the intestine, a barium enema to check for blockages or other intestinal problems, a psychological evaluation if emotions are triggering physical symptoms.

• #3 Encopresis | ABC Medical Center

  https://centromedicoabc.com/en/padecimientos/encopresis/

  Once the doctor reviews your childs symptoms and medical history, they will perform a physical examination, including the rectum, and order an abdominal x-ray and a barium enema to check the amount of stool in the large intestine and whether there is a blockage or obstruction. […] They may suggest a psychological evaluation to find out if there is an emotional reason that triggers the problem. […] Treatment will be based on the symptoms, severity, and general condition of the child, but generally includes: […] Elimination of retained feces through: […] Enemas […] Laxatives. […] Suppositories. […] Medications that help keep stools soft for several months. […] Diet and lifestyle changes: […] High fiber foods. […] Drink more liquids. […] Increased consumption of fruits and vegetables. […] Physical activity. […] Psychotherapy to retrain or stimulate bowel movements healthily, as well as to treat any emotional problems.

• #3 What Is Encopresis?

  https://www.icliniq.com/articles/parenting-and-childrens-health/encopresis

  Encopresis is the involuntary passage of stool or feces in children. […] Diagnosis is generally made clinically by the doctor after a thorough physical examination and the history obtained from their parents. However, some investigations may be required to confirm the diagnosis of encopresis. […] 1. Imaging Tests: Checks the intestines to rule out health conditions. […] 2. Abdominal X-Ray: This rules out only the amount of stool present in the large intestine. […] 3. Barium Enema: The barium fluid that shows up clearly in the X-ray. The fluid is put into a tube and inserted into the child’s rectum as an enema. Then the X-ray is taken. It rules out the presence of any obstructions or narrowed parts of the intestines (strictures). […] 4. Anorectal Manometry: This is a beneficial tool for diagnosing chronic constipation. It analyses the anal pressure and the rectal sensation.

• #3 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content?contenttypeid=90&contentid=P01992

  Barium enema. This is an X-ray exam of the rectum, the large intestine, and the lower part of the small intestine. Your child will be given a metallic fluid called barium. Barium coats the organs so they can be seen on an X-ray. The barium is put into a tube and inserted into your child’s rectum as an enema. An X-ray of the belly will show if your child has any narrowed areas (strictures), blockages (obstructions), or other problems. […] Anorectal manometry. This test checks the strength of the muscles in the anus and the nerve reflexes. It also checks your child’s ability to sense that the rectum is full (rectal distension) and a bowel movement is needed. And it looks at how well the muscles work together during a bowel movement. […] Rectal biopsy. This test takes a sample of the cells in the rectum. They are checked under a microscope for any problems.

• #3 Managing Encopresis in Schools | Show Me School Health

  https://showmeschoolhealth.org/resources/managing-encopresis-in-schools/

  Students with encopresis should also be evaluated for psychological symptoms, including anxiety, depression, and behavioral symptoms. […] The management of encopresis depends on the type of fecal incontinence. For students with constipation-associated (retentive) functional fecal incontinence, management focuses on treating the underlying constipation using both behavioral modification and laxatives. For children with non-retentive fecal incontinence, management involves similar behavioral interventions, with particular attention to identifying the trigger for the episodes of incontinence but without laxative therapy. […] The goal of therapy is the passage of soft stools, ideally once per day and no less than every other day. This goal of frequent defecation is important to overcome constipation.

• #3 Encopresis | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688741/all/Encopresis

  Chronic rectal distension causes habituation, leading to the loss of sensing the normal urge to defecate causing abdominal pain, nausea, and bloating. Eventually, soft or liquid stool leaks around the retained fecal mass. […] Transition of foods: breast milk to formula or cows milk or start of solid foods; parental conflicts or divorce; new sibling; history of constipation; painful defecation; difficulty with bowel training, including social pressure related to early daycare placement; organic/anatomic causes; anxiety and depression; insufficient fluid or fiber intake; fear of using bathrooms/public restrooms; attention deficit; history of abuse; medications (particularly opiates, ADD/ADHD medications, antidepressants).

• #3 Encopresis – UF Health

  https://ufhealth.org/conditions-and-treatments/encopresis

  If a child over 4 years of age has been toilet trained, and still passes stool and soils clothes, it is called encopresis. The health care provider may feel the stool stuck in the child’s rectum (fecal impaction). An x-ray of the child’s belly may show impacted stool in the colon. The provider may perform an examination of the nervous system to rule out a spinal cord problem. Most children respond well to treatment. Encopresis often recurs, so some children need ongoing treatment. Contact your provider for an appointment if a child is over 4 years old and has encopresis. […] For encopresis without constipation, the child may need a psychiatric evaluation to find the cause.

• #3 Encopresis in Children and Adolescents – Society of Pediatric Psychology

  https://pedpsych.org/fact_sheets/encopresis/

  Encopresis is the voluntary or involuntary passage of stool in places other than toilets. To receive a diagnosis of encopresis, the child must pass feces into inappropriate places (such as clothing or on the floor) at least once per month for three months or more. […] Assessment and treatment of encopresis is based on a biobehavioral model. […] Assessment of encopresis should include a thorough medical and psychosocial evaluation. Medical evaluation of encopresis includes a history and physical, review of symptoms and stooling history, physical examination, and possibly blood work if symptoms suggesting medical causes of constipation are present. […] Psychosocial assessment including behavioral screening using parent and teacher rating scales (e.g., BASC, CBCL, Connors CBRS), is recommended to identify comorbidities such as Oppositional Defiant Disorder, Anxiety and Attention-Deficit/Hyperactivity Disorder which may impact implementation of treatment recommendations.

• #3 Encopresis | Phoenix Children’s Hospital

  https://phoenixchildrens.org/specialties-conditions/encopresis

  Your child’s healthcare provider will likely prescribe medicines to help keep your child’s bowel movements soft for several months. This will help stop stool from getting impacted again. […] If your child’s encopresis is caused by another health problem, treating that condition may help. […] Talk with your child’s healthcare provider if your child has hard, painful stools or soils their underwear. Also call your provider right away if your child doesn’t have a bowel movement for 3 or 4 days in a row or complains of abdominal pain.

• #3 Encopresis | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/e/encopresis.html

  Encopresis is when your child leaks stool into their underwear. It’s also called stool soiling. It’s most often because of long-term (chronic) constipation. Encopresis happens to children ages 4 and older who have already been toilet trained. […] Symptoms of encopresis may look like other health conditions. Always see your child’s healthcare provider for a diagnosis. […] Your child’s healthcare provider will give your child an exam and take a health history. Imaging tests may also be done to check the intestine and rule out other health problems. These tests may include: […] Abdominal X-ray. This test checks how much stool is in the large intestine. […] Barium enema. This test checks the intestine for blockages or obstruction, narrow areas called strictures, and other problems. It uses a fluid called barium that shows up well on X-rays. Barium is put into a tube. It’s inserted into your child’s rectum as an enema. Then the intestine is looked at with an X-ray. […] Talk with your child’s healthcare provider if your child has hard, painful stools or soils their underwear. Also call your provider right away if your child doesn’t have a bowel movement for 3 or 4 days in a row or complains of abdominal pain.

• #3 Encopresis |Understanding & Managing Encopresis In Children

  https://www.childpsychologist.com.au/resources/encopresis-soiling-in-school-aged-children

  There are two basic categories of encopresis i) primary encopresis-which refers to children who have never attained bowel control, ii) secondary encopresis-which refers to soiling after successfully attaining toilet control usually brought upon by entering a stressful environment (such as family conflict). […] While encopresis is a chronic and complex problem amongst many families, it is treatable. As a parent, it is important to be aware that there is no quick fix for encopresis, the process might take months and relapse is very common. Sixty-five per cent of patients are almost completely cured in 6-months and 30% show improvement (Har Coffle, 2010). The majority of children with encopresis can be effectively treated with a combination of medical, psychological and dietary interventions.

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