Materiały źródłowe

• #1 Encopresis – Symptoms & causes – Mayo Clinic

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

  Encopresis can be caused by several factors, 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. […] Some causes of constipation include withholding stool due to fear of using the toilet, not wanting to interrupt play, eating too little fiber, not drinking enough fluids, and drinking too much cow’s milk. […] Emotional stress may trigger encopresis, with stressors including difficult toilet training, changes in the child’s life, and emotional stressors like parental divorce or the birth of a sibling.

• #2 Encopresis Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17849-encopresis-soiling

  Encopresis can be caused by: […] The most common cause of encopresis is constipation. When a child experiences constipation, its difficult to have a bowel movement because their stool is dry and hard inside their colon and it can be painful to pass. […] Encopresis could be a symptom of an underlying medical condition. Possible conditions that have encopresis as a symptom include: […] Encopresis could be the result of emotional stress, behavioral challenges or fear that affects the actions of your child. Psychological causes could include:

• #3 Encopresis – StatPearls – NCBI Bookshelf

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

  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. Other organic non-functional causes for encopresis include 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. […] Encopresis in children can also be subclassified into primary, in those children who have never been toilet trained, and secondary, where incontinence returns after successful toilet training. […] Risk factors for functional encopresis are low socioeconomic background, unhygienic toilets, living in an urban area or war-affected zone, hospitalization of the child for another illness, and bullying at school. Psychological and behavioral problems such as aggressive behavior, depression, social withdrawal, anxiety, disruptive and oppositional behavior, and poor school and social performances were noted in one-third of children with functional encopresis.

• #4 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. […] Encopresis is usually the result of chronic constipation, which can be easily overlooked in children. There’s often no clear cause although constipation sometimes does run in families. […] Certain foods, behaviors, and situations can contribute to constipation, including: A “junk-food” diet that is low in fiber, Lack of exercise, Stress in the family, with friends, or at school, Change in bathroom routine, such as when a child starts a new school year and bathroom breaks are less frequent, Being too busy to take time to use the bathroom, Painful bowel movements that make the child “hold it” in order to avoid further pain. […] Children who have never been toilet trained and refuse to have a bowel movement on the toilet are also at risk of developing encopresis.

• #5 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. […] In the great majority of cases, encopresis develops as a result of chronic (long-standing) constipation. […] In most children with encopresis, the problem begins with painfully passing very large stools. […] Over time, the child becomes reluctant to pass bowel movements and holds it in to avoid the pain. […] As more and more stool collects in the child’s lower intestine (colon), the colon slowly stretches (sometimes called megacolon). […] Some experts believe children become constipated when they do not eat enough fiber, which is available in fruits, vegetables, and whole-grain foods. […] Many doctors think that some children become constipated because they do not drink enough water.

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

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

  Constipation may run in certain families. […] In most cases, this is not the case. Children with encopresis are no more likely than other children to have major behavioral or emotional problems. […] More than 80% of children with encopresis have experienced constipation or painful defecation in the past. […] Soiling episodes usually occur during the day, while the child is awake and active. […] In many children with encopresis, their colon has become stretched out of shape, so they may intermittently pass extremely large bowel movements. […] Establishing regular soft and painless bowel movements is mostly a matter of helping your child to learn to give up the habit of retaining stool. […] The laxative must be given in doses large enough to produce one or two soft bowel movements every day. […] Many parents are reluctant to give their child laxatives because they have heard that laxatives are harmful or promote dependency. […] Most cases of encopresis respond to the treatment regimen outlined above. […] The best way to prevent encopresis is to prevent constipation in the first place.

• #6 Soiling (Encopresis) (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/encopresis.html

  If your child has bowel movements (BMs) in places other than the toilet, you know how frustrating it can be. […] But many kids beyond the age of toilet teaching (generally older than 4 years) who soil their underwear have a condition known as encopresis (en-kah-PREE-sis). They have a problem with their bowels that dulls the normal urge to go to the bathroom. So they can’t control the accidents that usually follow. […] Encopresis isn’t a disease. It’s a symptom that may have different causes. […] Most encopresis cases are due to constipation. Stool (poop) is hard, dry, and difficult to pass when a person is constipated. Many kids „hold” their BMs to avoid the pain they feel when they go to the bathroom, which sets the stage for having a poop accident. […] Causes of hard poop can include: diet, such as not eating enough fiber or having too much dairy; illness; not drinking enough liquids; fear of the toilet during potty training; limited access to a toilet or a toilet that’s not private (like at school); stress, or a change in schedule or routine; some medical conditions, like thyroid problems.

• #6 Soiling (Encopresis) (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/encopresis.html

  Encopresis is not a behavioral issue or a simple lack of self-control. Punishing or humiliating a child with encopresis will only make matters worse. […] Treatment happens in three phases: Emptying the rectum and colon of the hard poop; Helping your child begin having regular BMs; Reducing use of the stool medicines. […] Diet and exercise are very important in keeping stools soft and BMs regular. Make sure your child gets plenty of fiber-rich foods. […] Successful treatment of encopresis depends on the support a child gets.

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

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

  Soiling is often the result of constipation. Constipation often begins when children hold back, or with-hold, their bowel movements. […] Some reasons that children start holding bowel movements include: Pain before, during or after pooping, Illnesses, Hot weather, Changes in diet, not drinking enough fluids, Travel, Diaper rashes that cause pain when the child has a bowel movement, Having to use bathrooms that offer less privacy than children are used to, Not taking the time out during play or other activities to go to the bathroom when children feel the urge to poop. […] There are more serious medical problems that children are born with that can cause encopresis, but these are rare.

• #8 Encopresis

  https://healthlibrary.overlakehospital.org/Library/Wellness/Nutrition/90,P01992

  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. […] In most cases, encopresis happens because a child has long-term (chronic) constipation. […] Other causes of encopresis include: Colonic inertia, a condition where the colon doesnt move stool along as it should; Nerve damage to the muscle at the end of the digestive tract (anal sphincter). This keeps it from closing correctly; Fear of using the toilet; Rectal infections or tears; Emotional stress. […] Other health problems may cause chronic constipation. These include diabetes, hypothyroidism, Hirschsprung disease, and inflammatory bowel disease. […] If your child’s encopresis is caused by another health problem, treating that condition may help. […] You can also help your child have regular bowel movements by making some diet and lifestyle changes. Give your child high-fiber foods and limit high-fat and high-sugar foods. Make sure your child drinks plenty of fluids, such as water. And keep your child physically active.

• #9 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. […] In most cases encopresis happens because a child has long-term (chronic) constipation. […] Other causes of encopresis include: Colonic inertia, a condition where the colon doesnt move stool along as it should. Nerve damage to the muscle at the end of the digestive tract (anal sphincter). This keeps it from closing properly. Fear of using the toilet. Rectal infections or tears. Emotional stress. […] Other health problems may cause chronic constipation. These include diabetes, hypothyroidism, Hirschsprung disease, and inflammatory bowel disease.

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

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

  Encopresis is not a disease but a symptom. Possible causes include chronic, or long-term, constipation, and emotional stress. […] Encopresis can result from biological, developmental, psychosocial, and environmental factors. Potential causes include: […] Doctors most commonly associate encopresis with chronic constipation and the withholding of a bowel movement. According to some research, 90-95% of children with the condition also experience constipation and stool retention. […] Other physical causes of chronic constipation and encopresis include: hypothyroidism, inflammatory bowel disease (IBD), nerve damage, so the anal sphincter cannot close correctly, and leakage occurs, rectal infections, rectal tears. […] Emotional issues can trigger encopresis. The condition is more common among children from homes where abuse is happening. However, any incident that a child perceives as stressful may trigger stool soiling.

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

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

  Research indicates that children with encopresis are more likely than others to have symptoms of anxiety and depression, more disruptive behavior, poor school performance, and social problems. […] Some other factors increase a child’s risk of developing encopresis and constipation. These include being male, having a neurodevelopmental disorder, taking certain medications, dietary habits, being inactive, and avoiding the passing of stool.

• #11 Encropresis – Conditions – Gastroenterology, Hepatology & Nutrition – Golisano Children’s Hospital – University of Rochester Medical Center

  https://www.urmc.rochester.edu/childrens-hospital/gastroenterology/conditions/encopresis.aspx

  Encopresis happens to children (generally 4 or older) who have already been toilet trained. […] In most cases encopresis happens because a child has long-term (chronic) constipation. […] Other causes of encopresis include: Colonic inertia, a condition where the colon doesn’t move stool along as it should. […] Other health problems may cause chronic constipation. These include diabetes, hypothyroidism, Hirschsprung disease, and inflammatory bowel disease. […] Any child who has long-term (chronic) constipation may develop encopresis. […] Encopresis affects boys more than girls. Experts don’t know why. […] If your child’s encopresis is caused by another health problem, treating that condition may help. […] You may help prevent stool soiling if you avoid any emotional upsets while your child is toilet training. […] Children who have a negative experience using the toilet may avoid going to the bathroom. This leads to constipation and, over time, encopresis.

• #12 Encopresis (Fecal Incontinence) – MD Searchlight

  https://mdsearchlight.com/gut-health/encopresis-fecal-incontinence/

  Encopresis is a condition where a child has difficulties controlling their bowel movements. This can be categorised into two types: one that’s connected to constipation and one that isn’t. In the case linked to constipation, which can also be called overflow encopresis, the child struggles with stool leakage because of longstanding constipation. This kind is seen in more than 80% of the kids who have encopresis. […] There are also other physical causes for encopresis not tied to constipation. These can include issues that affect the rectum or anus, conditions involving the spine (like spinal cord injuries or tumors), cerebral palsy, and muscular conditions that impact the muscles controlling bowel movements. […] Encopresis can also be classified into two types based on a child’s toilet training history. Primary encopresis refers to the condition in kids who’ve never been successfully toilet trained, while secondary encopresis is when a child starts having bowel accidents again after they were successfully toilet trained.

• #13 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 children, encopresis is related to chronic constipation. […] Chronic constipation that turns into encopresis can have many different causes. These include: Tension and anxiety because of problems during toilet training, A diet that is low in fiber, found in: Fruits, Vegetables, Whole grains, A diet that is high in foods that tend to cause constipation, such as: Whole milk, Cheese, White rice, White bread, Not drinking enough liquids, An inactive lifestyle with too little exercise, Fear and anxiety about using an unfamiliar bathroom, Not paying attention to the feeling (urge) that it’s time to have a bowel movement, A fissure, Hypothyroidism. […] No matter what the initial cause of a child’s chronic constipation, the end result is the same. A large chunk of stool builds up and stretches the rectum until it loses its normal tone and feeling. […] In rare cases, encopresis is related to medical problems involving the nerves in the spine or the bowel wall, psychological issues, such as: Anger, Abnormally impulsive behavior, Grief over the death of a loved one, Some other stress or history of trauma.

• #14 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. […] As many as 95 percent of children referred for the treatment of encopresis present with functional constipation or constipation without identifiable cause (e.g., medical conditions or side effects of medication). […] Experiences such as painful defecation, psychosocial stressors (e.g., entering school or the birth of a sibling), and challenges during toilet training may predispose some children to functional constipation. […] The most serious and common health-based consequence of encopresis is urinary tract infections from the contamination of the urinary tract with feces from the child’s underwear. […] Studies have not found associations between encopresis and socioeconomic status, family size, child’s position in the family or parental age. […] The treatment approach with the best outcome data is usually referred to as Medical-Behavioral. […] Regardless of the treatment approach, there seems to be general agreement that treatment that prevents or quickly addresses the reappearance of constipation is necessary.

• #15 Encopresis: Practice Essentials, Background, Pathophysiology

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

  In most cases, encopresis is thought to develop as a consequence of chronic constipation with resulting overflow incontinence. Approximately 80-95% of children with encopresis have a history of constipation or painful bowel movements. The remaining 5-20% appear to have nonretentive encopresis and no history of constipation or painful defecation; they generally have no evidence of incomplete evacuation on physical evaluation or radiographic evaluation. […] No good prospective data suggest that encopresis, whether retentive or nonretentive, is primarily a behavioral or psychological disorder. Rather, most of the available evidence indicates that children with encopresis do not have an increased incidence of major behavioral or personality disorders when compared with age-matched peers. […] Overall, the evidence suggests that behavioral difficulties associated with encopresis may be the result of the encopresis rather than the cause.

• #15 Encopresis: Practice Essentials, Background, Pathophysiology

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

  No good evidence suggests that encopresis is an indicator of sexual abuse. […] Children with encopresis are significantly more likely to have attention-deficit disorder/hyperactivity (ADHD) than the general population. […] Low self-esteem or parent-child conflict as a result of the disorder is not uncommon. Embarrassed youngsters also frequently deny having the problem.

• #16 About Encopresis – Department of Pediatrics

  https://med.virginia.edu/pediatrics/clinical-and-patient-services/patient-tutorials/chronic-constipation-encopresis/about-encopresis/

  In most cases, encopresis develops as a result of long-standing constipation. The vast majority of children suffering from encopresis have a history of constipation or a history of passing large and/or painful bowel movements. […] With constipation and painful bowel movements, children may not completely empty themselves when they go to the bathroom. Over a long period of time the large intestine slowly fills with stool and stretches out of shape. […] In most cases, encopresis is not primarily a behavioral problem. Children do not have these accidents out of spite or because they are lazy. Instead, many behavioral problems develop because of the encopresis, and once the encopresis is treated, many of the behavioral problems may resolve.

• #17 Encopresis |Understanding & Managing Encopresis In Children

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

  Encopresis (or faecal soiling) is one of the most frustrating difficulties of middle childhood, affecting approximately 1.5% of young school children (von Gontard, 2013). […] Encopresis is a common complaint amongst parents who visit the Quirky Kid Clinic as it often occurs in the context of other behavioural issues such as oppositional defiant disorder (ODD) or separation anxiety. […] It is important to be aware of the many possible causes of this disorder. […] Biological factors: Functional constipation (persistent constipation with incomplete defecation without evidence of a structural or biochemical explanation) is one of the main causes of encopresis, accounting for 90% of cases amongst children (Har Croffle, 2010). […] Psychological factors: Overall 30-50% of children with encopresis have a comorbid emotional or behavioural disorder (von Gontard, 2012).

• #17 Encopresis |Understanding & Managing Encopresis In Children

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

  Family and social factors: Children may develop delays in toileting due to unsuccessful toilet training as a toddler and intrusive toilet training. […] Studies have shown that there are a number of risk factors, which are associated with the development of encopresis including: Gender: encopresis is five times more common in boys than girls. […] Encopresis can have a severe effect on the child, family and school environment. […] Studies have shown that encopresis children experience a greater amount of anxiety and depression symptoms, difficulties with attention, more social problems, disruptive behaviours and lower levels of academic performance (Mosca Schatz, 2014). […] The first step to treating encopresis is to identify the cause behind the condition and seek medical advice from a pediatrician or GP. […] Comorbid emotional and behavioural disorders should be treated separately according to evidence-based recommendations (von Gontard, 2013).

• #18 Encopresis: Symptoms, Mental Health, and Treatment

  https://psychcentral.com/disorders/encopresis-symptoms

  Encopresis refers to when a child empties their bowels anywhere but the toilet. It can be voluntary or involuntary. Your child may do this in their clothes, on the floor, or elsewhere. […] The root cause of encopresis is chronic constipation. Chronic constipation can happen for several reasons, including because a child holds their bowel movements in. They may hold their stool consciously or unconsciously. […] Some things that may cause encopresis include: having painful bowel movements, which might encourage children to hold it; stressful events, like going to a new school; having a tough time with toilet training. […] Other things that can make it more likely for a child to develop encopresis include: having a low socioeconomic background; experiencing trauma, such as abuse or neglect, which can cause children to regress to an earlier stage of development; having to defecate in unhygienic environments; living in a war zone; living in an urban area; being hospitalized for something other than encopresis; bullying. […] The age at which a child starts potty training doesn’t seem to impact the onset of encopresis. A 2016 study suggests that the approach to potty training is more likely to play a role in whether a child develops fecal incontinence.

• #19 Encopresis – Causes & Treatment | Atrium Health Wake Forest Baptist

  https://www.wakehealth.edu/condition/e/encopresis

  Encopresis, or stool accidents, can occur as a result of children resisting bowel movements and stool collecting in the colon. […] The child may have constipation. The stool is hard, dry, and stuck in the colon (called fecal impaction). The child then passes only wet or almost liquid stool that flows around the hard stool. It may leak out during the day or night. […] Other causes may include: Not toilet training the child, Starting toilet training when the child was too young, Emotional problems, such as oppositional defiant disorder or conduct disorder. […] Factors that may increase the risk of encopresis: Chronic constipation, Low socioeconomic status. […] For encopresis without constipation, the child may need a psychiatric evaluation to find the cause.

• #20 Encopresis and soiling – PubMed

  https://pubmed.ncbi.nlm.nih.gov/8596685/

  Constipation can have a variety of causes, such as organic and anatomic causes or intake of medication. […] Fecal incontinence is fecal soiling in the presence of an organic or anatomic lesion, such as Hirschsprung’s disease, anal malformation, anal surgery or trauma, meningomyelocele, and some muscle disease. […] Encopresis is the involuntary loss of formed, semiformed, or liquid stool into the child’s underwear in the presence of functional (idiopathic) constipation in a child 4 years of age or younger.

• #21 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. An organic cause for nonretentive encopresis is rarely identified. […] From 80 to 95 percent of encopresis cases involve fecal constipation and retention. […] Although several excellent reviews cover retentive encopresis, encopresis in which fecal retention is not a primary etiologic component is under-represented in the literature. […] Various terms have been used to describe this problem, including functional encopresis, primary nonretentive encopresis and stool toileting refusal. […] Although the toileting dynamics and behavioral characteristics of children with nonretentive encopresis are well described, few specific treatment guidelines are available for family physicians.

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

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

  While the treatment of retentive encopresis has progressed substantially in the past 20 years, less attention has been paid to the 5 to 20 percent of cases in which constipation is not contributory, or where a child refuses the toilet-training process. […] However, many times the reason is not a lack of readiness skills, but a child who is behaviorally resistant or parents who need information on effective behavior management or toilet-training strategies. […] If the problem is related to a skill deficit (e.g., opening the bathroom door, disrobing, seating self on the toilet, wiping), then modeling, teaching and reinforcement are preferred to passive waiting. […] In either case, without active intervention, the strong-willed child may resist toilet training, create unnecessary stress on the parent-child relationship and increase the risk of abuse.

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

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

  Few cases of retentive encopresis and even fewer cases of nonretentive encopresis have an organic etiology. […] 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. […] Unrealistic expectations or family priorities (particularly the birth of another child) may prompt parents to begin toilet training before the child is developmentally prepared. […] Coexisting behavior problems are a predictor of poor outcome in toilet-training protocols. […] Many children with fecal soiling have a history of painful defecation, toilet phobia or toilet refusal behavior.

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

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

  It is critical to ensure that the child is having relatively frequent, soft and well-formed bowel movements before engaging in any intervention for soiling. […] If obtaining frequent, soft and well-formed bowel movements continues to be a problem, the addition of stool softeners or laxatives may be considered. […] Although ensuring frequent, soft and well-formed bowel movements should reduce the likelihood of a child withholding fecal material, a back-up plan is necessary.

• #22 Encopresis | Riley Children’s Health

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

  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. […] There are three main causes of encopresis: […] Constipation. Most cases of encopresis are the result of chronic constipation. In constipation, the child’s stool is hard, dry and may be painful to pass. As a result, the child avoids going to the toilet, making the problem worse. The longer the stool remains in the colon, the more difficult it is for the child to push out. The colon stretches, ultimately affecting the nerves that signal when it is time to go to the toilet. When the colon becomes too full, soft or liquid stool may leak out.

• #23 Possible Causes – UCanPoopToo

  http://www.ucanpooptoo.com/about-encopresis/possible-causes

  Chronic constipation in children often leads to large, hard, difficult to pass bowel movements. […] Since children with chronic constipation and encopresis almost always have some stool in their rectum, the nerves that send the signal to the brain are constantly being stimulated. […] As the colon gets more and more stretched out of shape, soft or liquid stool from higher up in the colon begins to leak around the hard stool. […] As the colon continues to stretch, the amount of leakage increases so that eventually children begin having poop accidents or encopresis, passing whole bowel movements in their pants.

• #24 Encopresis | 5-Minute Pediatric Consult

  https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617042/0.3/Encopresis

  Chronic constipation leads to a dilated rectum, decreased rectal sensation, shortening of the anal canal, and decreased anal sphincter tone in some patients. […] Findings on anorectal manometry include increased rectal sensory threshold and paradoxic contraction of the external anal sphincter during attempts at defecation (known as anismus). […] Nonretentive fecal incontinence occurs in children without constipation. The soiling may be a manifestation of an emotional disturbance. In some children, it can be associated with specific triggers (person or place) or may represent a voluntary impulsive action. Laboratory, imaging, and motility studies in these patients are normal, including normal anorectal manometry and normal colonic transit times.

• #25 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. […] Cow’s milk protein intolerance is a common precipitant of constipation and resultant encopresis. […] The effect of dietary changes on constipation and encopresis in children remains controversial. […] Explain that because of rectal hyposensitivity from stretching the child often has no warning of need to stool, or even intermittent warning.

• #26 Encopresis | Psychology Today United Kingdom

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

  Encopresis can take a heavy toll on a child’s mental health. […] In cases where the passage of feces is not intentional, it often results from constipation, which may, in turn, stem from the avoidance of defecation due to anxiety or other forms of psychopathology. […] Painful defecation and some medications (such as anticonvulsants or cough suppressants) may contribute to the development of encopresis, according to the DSM-5. Inadequate toilet training and stress may also make encopresis more likely. […] Scientists have found a second or „backup brain” in the gut that can influence people’s moods and behavior. […] Encopresis can be both a contributing factor and a symptom of depression in childhood and adolescence. […] Sometimes, children may deliberately soil themselves. This occurs more frequently with children who have a co-occurring disorder, like conduct disorder or oppositional defiant disorder (ODD).

• #27

  https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Soiling-Encopresis.aspx

  Encopresis is not a disease but rather a symptom of a complex relationship between the body and psychological/environmental stresses. […] Some youngsters are predisposed from birth to early colonic inertia – that is, a tendency toward constipation because their intestinal tracts lack full mobility. […] Some children develop constipation and encopresis because of unsuccessful toilet training as toddlers. […] A number of other factors can also contribute to the eventual development of encopresis. […] While most children with encopresis are also constipated, some are not. […] Psychological counseling for these children helps them deal with issues like peer conflicts, academic difficulties, and low self-esteem, all of which can contribute to encopresis. […] One of the most important tasks of parents is to seek early treatment for this problem. […] The treatment goals will probably be four fold: To establish regular bowel habits in the child, To reduce stool retention, To restore normal physiological control over bowel function, To defuse conflicts and reduce concerns within the family brought on by the child’s symptoms.

• #28 Encopresis | University Hospitals

  https://www.uhhospitals.org/health-information/health-and-wellness-library/article/diseases-and-conditions—pediatrics/encopresis

  Encopresis can cause both physical and emotional problems. […] If your child’s encopresis is caused by another health problem, treating that condition may help. […] You can also help your child have regular bowel movements by making some diet and lifestyle changes. Give your child high-fiber foods and limit high-fat and high-sugar foods. Make sure your child drinks plenty of fluids, such as water. And keep your child physically active.

• #29 Encopresis: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/encopresis

  Just because encopresis is associated with psychological causes doesnt mean that the symptoms are under your childs control. Theyre most likely not soiling themselves on purpose. The problem may begin because of controllable situations, such as fear of using a public toilet or not wanting to be toilet trained, but it becomes involuntary over time.

• #30 Understanding Encopresis | Serin Center

  https://serincenter.com/conditions-we-treat-at-serin-center/encopresis/?srsltid=AfmBOopkc7FCZ34WsA1FTzObnc0a8j10M_3upb-ObVZQlLmFBmL021nd

  Encopresis is often caused by chronic constipation, which can lead to the impaction of stool in the rectum. This can cause the muscles of the rectum to stretch and weaken, making it difficult for the person to control bowel movements. Other possible causes of encopresis may include: […] For some, encopresis is a result of trauma or emotional dysregulation. Encopresis is seen in boys more than girls. Children with ADHD, Autism spectrum disorder, anxiety, or depression are at increased risks of experiencing encopresis.

• #31 Encopresis – symptoms, Definition, Description, Demographics, Causes and symptoms, Diagnosis, Treatment

  http://www.healthofchildren.com/E-F/Encopresis.html

  Encopresis can be one of two types, nonretentive encopresis and retentive encopresis. […] About 80 to 95 percent of all cases are retentive encopresis. Children with this disorder have an underlying medical reason for soiling. […] Retentive encopresis is most often the result of chronic constipation and fecal impaction. […] A child may exhibit nonretentive encopresis, or functional encopresis, for several reasons. […] These children often have other serious behavioral problems. […] If no fecal impaction is found, the pediatrician works with a counselor or psychiatrist to analyze the variables that characterize the encopresis. […] In the remainder of nonretentive encopresis cases, treatment should then center on making sure the child has comfortable bowel movements, since some cases of nonretentive encopresis involve some level of discomfort associated with constipation.

• #32 Encopresis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001570.htm

  If a child over 4 years of age has been toilet trained, and still passes stool and soils clothes, it is called encopresis. The child may have constipation. The stool is hard, dry, and stuck in the colon (called fecal impaction). The child then passes only wet or almost liquid stool that flows around the hard stool. It may leak out during the day or night. […] Other causes may include: Not toilet training the child, Starting toilet training when the child was too young, Emotional problems, such as oppositional defiant disorder or conduct disorder. […] Factors that may increase the risk of encopresis include: Chronic constipation, Low socioeconomic status. […] Encopresis is much more common in boys than in girls. It tends to go away as the child gets older.

• #33 Encopresis Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/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 child may or may not be doing this on purpose. […] The child may have constipation. The stool is hard, dry, and stuck in the colon (called fecal impaction). The child then passes only wet or almost liquid stool that flows around the hard stool. It may leak out during the day or night. […] Other causes may include: Not toilet training the child, Starting toilet training when the child was too young, Emotional problems, such as oppositional defiant disorder or conduct disorder. […] Factors that may increase the risk of encopresis include: Chronic constipation, Low socioeconomic status. […] For encopresis without constipation, the child may need a psychiatric evaluation to find the cause.

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