Materiały źródłowe

• #1 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. […] In the absence of organic causes, encopresis is secondary to overflow, and therefore results from the presence of constipation. Withholding of stool creates a vicious circle of accumulation of feces and hardening of the fecal mass in the rectosigmoid colon. Finally, feces leak between the solid fecal mass and rectal wall and come out through the anal canal when the sphincter muscles are relaxed.

• #2 Encopresis: Practice Essentials, Background, Pathophysiology

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

  In the vast majority of cases, encopresis develops as a consequence of chronic constipation with resulting overflow incontinence, which is typically termed retentive encopresis; encopresis in the absence of a history of constipation or painful bowel movements is typically referred to as nonretentive. […] Chronic constipation due to irregular and incomplete evacuation results in progressive rectal distention and stretching of both the internal anal sphincter and the external anal sphincter (EAS). As the child habituates to chronic rectal distention, he or she no longer senses the normal urge to defecate. Soft or liquid stool eventually leaks around the retained fecal mass, resulting in fecal soiling.

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

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

  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. […] In the absence of organic causes, encopresis is secondary to overflow, and therefore results from the presence of constipation. Withholding of stool creates a vicious circle of accumulation of feces and hardening of the fecal mass in the rectosigmoid colon. Finally, feces leak between the solid fecal mass and rectal wall and come out through the anal canal when the sphincter muscles are relaxed. The volume of fecal matter that leaks out is usually small and, most of the time, just stain the underwear.

• #4

  https://journals.lww.com/abmj/fulltext/2023/04000/fecal_encopresis_in_a_syrian_pediatric_population_.4.aspx

  Encopresis, sometimes called fecal encopresis or soiling, is the repeated passing of stool (usually involuntarily) into clothing. Typically, it happens when impacted stool collects in the colon and rectum; the colon becomes too full and liquid stool leaks around the retained stool, staining underwear. Eventually, stool retention can cause swelling (distention) of the bowels and loss of control over bowel movements. […] Encopresis develops as a consequence of the chronic constipation with resulting overflow encopresis in 80% to 95%. In many cases, the constipation is well recognized before the child presents with fecal encopresis. […] In our study, 87.5 % of cases were correlated to chronic constipation. More detailed studies could decrease the difference with literature and joint to 95%.

• #5 Encopresis – StatPearls – NCBI Bookshelf

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

  Stool withholding may be an intentional behavior to avoid unpleasant sensations and associations with defecation. It may be due to a painful bowel movement that is caused by a stool that was larger or harder than normal, an anal fissure, or a perianal infection. […] On the other hand, children with non-retentive encopresis pass stools into inappropriate places without evidence of stool retention. The majority of them have a complete evacuation of bowel, not just staining of the underwear as in retentive incontinence. […] The overall pathophysiology of this pattern of encopresis is still unclear. […] 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.

• #6 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. […] When children withhold or delay going to the bathroom, stool builds up in their colon. This makes the childs colon grow larger, making it hard for them to feel when it is time to have a bowel movement. Liquid stool might leak out around harder stool, and parents might mistake this for diarrhea. […] 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.

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

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

  Stool withholding may be an intentional behavior to avoid unpleasant sensations and associations with defecation. It may be due to a painful bowel movement that is caused by a stool that was larger or harder than normal, an anal fissure, or a perianal infection. […] Incontinence of feces can occur during the day as well as at night time. Nocturnal incontinence is considered an indicator of severe fecal impaction in the rectum. On the other hand, children with non-retentive encopresis pass stools into inappropriate places without evidence of stool retention. The majority of them have a complete evacuation of bowel, not just staining of the underwear as in retentive incontinence. […] 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. […] The overall pathophysiology of this pattern of encopresis is still unclear.

• #8 Encopresis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Encopresis_pathophysiology

  Constipation is associated with hard, large stools (feces) in the large bowels (colon) and rectum, which become difficult and painful to evacuate (defecation). This leads to stool-withholding. A vicious circle ensues. […] The rectum becomes gradually distended with accumulated stool. The distension causes a loss of sensation in the rectum. This leads to further stool-withholding, as the urge to defecate becomes more and more irregular. […] Eventually, softer stools from higher up the bowels cannot be accommodated and leak around the bolus of hard stool (overflow). Due to the lack of rectal sensation, this is not noticed by the child until soiling has actually occurred.

• #9 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 colon normally removes excess water from feces. If the feces or stool remains in the colon too long due to conditioned withholding or incidental constipation, so much water is removed that the stool becomes hard, and becomes painful for the child to expel in an ordinary bowel movement. A vicious cycle can develop, where the child may avoid moving his/her bowels in order to avoid the „expected” painful toilet episode. This cycle can result in so deeply conditioning the holding response that the rectal anal inhibitory response (RAIR) or anismus results. The RAIR has been shown to occur even under anesthesia and when voluntary control is lost. The hardened stool continues to build up and stretches the colon or rectum to the point where the normal sensations associated with impending bowel movements do not occur. Eventually, softer stool leaks around the blockage and cannot be withheld by the anus, resulting in soiling. The child typically has no control over these leakage accidents, and may not be able to feel that they have occurred or are about to occur due to the loss of sensation in the rectum and the RAIR. Strong emotional reactions typically result from failed and repeated attempts to control this highly aversive bodily product. These reactions then in turn may complicate conventional treatments using stool softeners, sitting demands, and behavioral strategies.

• #10 Stool Incontinence in Children – Pediatrics – MSD Manual Professional Edition

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

  Encopresis is most commonly caused by retentive constipation in children with behavioral and/or physical predisposing factors. […] Stool retention and constipation result in dilation of the rectum and sigmoid colon, which leads to changes in the reactivity of muscles and sensitivity of nerves of the bowel wall, particularly in the rectum. These changes decrease the efficacy of bowel excretory function and lead to further retention. […] As stool remains in the bowel, water is absorbed from the colon, which hardens the stool, making passage more difficult and painful. Softer, looser stool may then leak around the hardened stool bolus, resulting in overflow. […] Both leakage and ineffective bowel control result in stool accidents.

• #11 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. […] 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 stool out. The colon stretches, ultimately affecting the nerves that signal when it’s time to go to the toilet. 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. A child may experience stress from: […] Early treatment, including guidance from your child’s doctor or mental health professional, can help prevent the social and emotional impact of encopresis.

• #12 Encopresis | Phoenix Children’s Hospital

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

  In most cases, encopresis happens because a child has long-term (chronic) constipation. […] When a child is constipated, they have fewer bowel movements than normal. Bowel movements can then become hard, dry, and difficult to pass. Your child may stay away from going to the bathroom because it hurts. Then stool becomes backed up (impacted) in the rectum and the large intestine (colon). The stool cant move forward. The rectum and intestine become enlarged because of the hard, impacted stool. […] Over time, liquid stool can start to leak around the hard, dry, impacted stool. This soils your child’s clothing. […] 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.

• #13 Encopresis and Constipation: Information for Primary Care : Ottawa-Carleton, ON : eMentalHealth.ca

  https://primarycare.ementalhealth.ca/index.php?m=fpArticle&ID=22927

  Encopresis means (usually) involuntary leaking of stool into clothes or passing stools in the wrong place (eg. not in the toilet). Encopresis typically starts after a period of acute constipation, in which the child experiences a painful bowel movement. In an attempt to avoid future pain, the child withholds stool and refuses to defecate. As the child withholds, more stool accumulates in the colon. The stool becomes harder, drier and bulkier, resulting in an impaction. As this stool accumulates, there is leakage of stool around the impaction leading to soiling of underwear (sneaky poo). Note that due to loss of sensation, the child is likely unaware if small amounts of stool have leaked and does not have control over this leakage caused by pressure within the rectum. […] As it becomes too painful to force out the impacted stool, it becomes a vicious circle with the child ignoring the urge to defecate, in an attempt to avoid what will eventually be another painful bowel movement. Initially, there is overflow soiling with release of large stools within 5-7 days. Over time, the bowel movements become less frequent, but with large bowel movements and chronic overflow, abdominal pain and social withdrawal. Eventually, the child loses the ability to sense the need to defecate or feel the leakage around the impaction, nor notice the extremely unpleasant smell of feces that others notice. This is typical and not on purpose. […] The behavior is not attributable to the physiological effects of a substance (e.g., laxatives) or another medical condition except through a mechanism involving constipation.

• #14 What Is Encopresis? – Child Mind Institute

  https://childmind.org/article/what-is-encopresis/

  One of the major roles of the colon is to remove water from your poop before it passes through the anus. And the longer a bowel movement stays in the colon, the dryer it becomes. This makes it harder to push out. The build-up of poop also causes the colon to stretch, weakening the sphincter — the muscle valve that passes feces out of the anus — and damaging the nerves that alert a child when it’s time to pass a bowel movement. […] As new stool inevitably enters the colon but has nowhere to go, it can become watery and begin to leak out of the anus. And because of the nerve damage, the child can’t feel this happening. So, they’re often unaware that they’ve soiled their pants. […] There are a variety of reasons why a child might develop chronic constipation and in turn, encopresis. Some are strictly health related, in which case the doctor will refer you to a neurologist or gastroenterologist, as the culprit may be a neurological or developmental issue involving digestion. But there can also be emotional challenges causing behaviors that lead to chronic constipation. If your doctor suspects this might be the case, they’ll suggest that your child see a mental health professional. This can also help the child cope with the emotional and social distress that often comes along with having encopresis.

• #15 Encopresis | 5-Minute Pediatric Consult

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

  Chronic constipation with fecal impaction results in overflow incontinence and reduced sensation secondary to rectal distention. The pattern of holding fecal matter, leading to chronic constipation and overflow incontinence, may result from a variety of causes, such as a painful experience from a fissure, difficult toilet training, or reluctance to use school bathrooms. However, eliciting a medical history often does not reveal a triggering event. […] 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).

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

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

  Over time, the child with encopresis may also develop incoordination of the muscles used to pass bowel movements. […] This disturbed coordination of muscle function, which causes fecal retention, is a key to the diagnosis and is also called anismus or paradoxic contraction of the pelvic floor to defecation. […] 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 final step is working with your child to develop regular bowel habits. […] The duration of encopresis treatment varies from child to child. […] Most cases of encopresis respond to the treatment regimen outlined above.

• #17 Childhood Encopresis — Pathophysiology, Evaluation and Treatment | IntechOpen

  https://www.intechopen.com/chapters/45826

  Encopresis is defined as persistent faecal incontinence without associated anatomic abnormality. It is considered to be primarily a disorder associated with chronic constipation, with stool retention in 96% of children over the age of four years presenting with faecal incontinence. […] The underlying pathologies resulting in childhood faecal retention remain relatively poorly understood. Colonic motility, large gut innervation, cyclic anal activity, bowel sensation and evacuation release, as well as behavioural factors may all contribute in varying degrees to the condition known generically as constipation with secondary encopresis. […] Some authors attribute soiling and the generally associated faecal retention solely or predominantly to psychogenic causes. […] The pathophysiology of disturbed anorectal function is relatively poorly studied in children and results often interpreted with data obtained from adult studies. Most children do have some type of manometric abnormality and many have a degree of rectal enlargement. Dynamic abnormalities also exist and the best studied is paradoxical sphincteric contraction or anismus.

• #18

  https://www.tropicalgastro.com/articles/28/3/Review-of-pathogenesis-and-management-of-constipation.html

  Several histologic abnormalities have been demonstrated in resected colon specimens from such patients. […] These abnormalities include decreased numbers of enteric neuronal elements including interstitial cells of Cajal as well as nuclear abnormalities in the ganglia and reduction of acetylcholinesterase activity. […] Others have shown abnormalities in the contractile properties of colonic smooth muscle. […] Normal defecation involves the coordinated relaxation of the internal anal sphincter, puborectalis and external anal sphincter muscles, together with increased intra-abdominal pressure and colonic motor activity that propels stools towards the rectum. […] In some patients, ineffective defecation seems to be associated with a failure to relax (or with inappropriate contraction of) the puborectalis and the external anal sphincter muscles.

• #19

  https://www.tropicalgastro.com/printerfriendly.aspx?id=37

  Several histologic abnormalities have been demonstrated in resected colon specimens from such patients. […] These abnormalities include decreased numbers of enteric neuronal elements including interstitial cells of Cajal as well as nuclear abnormalities in the ganglia and reduction of acetylcholinesterase activity. […] Others have shown abnormalities in the contractile properties of colonic smooth muscle. […] Patients with severe degree of abnormalities including severe visceral myopathy and neuropathy can have a severe degree of slowing of colonic transit called colonic inertia or acquired megacolon and megarectum. […] Normal defecation involves the coordinated relaxation of the internal anal sphincter, puborectalis and external anal sphincter muscles, together with increased intra-abdominal pressure and colonic motor activity that propels stools towards the rectum.

• #20 Constipation in Children: Novel Insight Into Epidemiology, Pathophysiology and Management

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2011.17.1.35

  Other intestinal pathologies leading to chronic constipation surprisingly have not received much attention. Several studies have demonstrated slow colonic transit in 25%-69% children with constipation. Furthermore, those with slow transit constipation had more severe symptoms including night time soiling. Laparoscopic biopsies of the colon have shown deficiency of neurotransmitters such as substance P in some children. Furthermore it was shown that number of antegrade pressure waves in the colon was significantly decreased in children with slow transit constipation.

• #21 Encopresis | 5-Minute Pediatric Consult

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

  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.

• #22 Radiometric Analysis of Contrast Enema for Encopresis in Children: A Review Article

  https://www.mathewsopenaccess.com/journals/case-reports/abstract/radiometric-analysis-of-contrast-enema-for-encopresis-in-children-a-review-article

  In children with encopresis without constipation, a decrease in the width of the rectum and the left side of the colon was found. […] We hypothesize that the inflammatory process leads to increased intestinal tone and rapid movement of the bolus into the rectum, with high rectal tone stimulating the defecation reflex with small volumes of feces. […] The data obtained on the pathogenesis of different forms of encopresis will allow for the implementation of pathogenetic treatment.

• #23 Encopresis | Phoenix Children’s Hospital

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

  Other health problems may cause chronic constipation. These include diabetes, hypothyroidism, Hirschsprung disease, and inflammatory bowel disease. […] Encopresis can cause both physical and emotional problems. Stool that is backed up (impacted) in the intestine can cause belly (abdominal) pain. It can also cause a loss of appetite. Some children may get bladder infections. […] Children with encopresis often feel upset by the accidents they have when they soil their clothes. In most cases, they cant control this stool leakage. This can affect how they feel about themselves, or their self-esteem. […] You may help prevent stool soiling if you prevent 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. […] 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.

• #24 Encopresis – Stanford Medicine Children’s Health

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

  In most cases encopresis happens because a child has long-term (chronic) constipation. […] When a child is constipated, he or she has fewer bowel movements than normal. Bowel movements can then become hard, dry, and difficult to pass. Your child may avoid going to the bathroom because it hurts. Then stool becomes backed up (impacted) in the rectum and the large intestine (colon). The stool cant move forward. The rectum and intestine become enlarged because of the hard, impacted stool. […] Over time, liquid stool can start to leak around the hard, dry, impacted stool. This soils your child’s clothing. […] 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. […] Other health problems may cause chronic constipation. These include diabetes, hypothyroidism, Hirschsprung disease, and inflammatory bowel disease.

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

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

  Some other factors increase a child’s risk of developing encopresis and constipation. These include: Being male. Encopresis is approximately twice as common among boys as girls. […] Having a neurodevelopmental disorder. Having attention-deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) increases the risk of encopresis. […] The treatment for encopresis depends on the severity of the condition and the child’s age, among other factors. Typically, the earlier a child begins treatment, the better the outlook. […] If emotional issues underlie encopresis, a child may benefit from psychotherapy. During therapy, they can explore the issues that are contributing to encopresis. […] Most children with encopresis will overcome the condition with treatment and caregiver support. It may take several months for children to regain normal bowel function. During this time, relapses can be frequent.

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

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

  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. […] When stool is hard and difficult to pass, it can become impacted in the rectum and colon. This is known as fecal impaction. Eventually, liquid stool begins to leak around the hard stool, leading to stool soiling. […] Emotional issues can trigger 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, social problems.

• #26 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). […] According to the Diagnostic Statistical Manual (DSM-V) (American Psychiatric Association, 2013) encopresis (or otherwise known as Elimination Disorder) is essentially the repeated passing of stools into inappropriate places, after the age at which toilet training is expected to be accomplished. […] 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).

• #27 Encopresis |Understanding & Managing Encopresis In Children

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

  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. […] Behavioural modification with the assistance of a Psychologist is an integral treatment component for encopresis. […] Comorbid emotional and behavioural disorders should be treated separately according to evidence-based recommendations (von Gontard, 2013).

• #28 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. […] Assessment and treatment of encopresis is based on a biobehavioral model. […] The treatment approach with the best outcome data is usually referred to as Medical-Behavioral. Typically, this consists of the use of medication to address the child’s constipation (either oral medications and/or rectal) and implementation of behavioral modification strategies to promote and maintain appropriate defecation. […] There is emerging evidence for the efficacy of pelvic floor biofeedback in the management of constipation and encopresis. […] Regardless of the treatment approach, there seems to be general agreement that treatment that prevents or quickly addresses the reappearance of constipation is necessary.

• #29 Encopresis

  https://healthlibrary.uwmedicine.org/library/diseasesconditions/pediatric/Pregnancy/90,P01992

  Encopresis can cause both physical and emotional problems. […] Stool that is backed up (impacted) in the intestine can cause belly (abdominal) pain. It can also cause a loss of appetite. Some children may get bladder infections. […] Children with encopresis often feel upset by the accidents they have when they soil their clothes. In most cases, they cant control this stool leakage. This can affect how they feel about themselves, or their self-esteem. […] You may help prevent stool soiling if you prevent 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. […] 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.

• #30 Elimination Disorders | Abnormal Psychology

  https://courses.lumenlearning.com/wm-abnormalpsych/chapter/elimination-disorder/

  Many pediatricians will recommend the following three-pronged approach to the treatment of encopresis associated with constipation: cleaning out, using stool softening agents, scheduled sitting times, typically after meals. The initial clean-out is achieved with enemas, laxatives, or both. The predominant approach today is the use of oral stool softeners like Movicol, Miralax, Lactulose, mineral oil, etc. Following that, enemas and laxatives are used daily to keep the stools soft and allow the stretched bowel to return to its normal size.

• #31 Functional Megacolon in Children (Etiology, Pathogenesis, Diagnosis): A Review

  https://fortuneonline.org/articles/functional-megacolon-in-children-etiology-pathogenesis-diagnosis-a-review.html

  The obstructive nature of FM has been proven, and two variants of its pathogenesis. […] There is no consensus on the pathogenesis of megacolon and its association with chronic constipation. […] The primary stage of the pathogenesis of FM is the discrepancy between the wide fecal masses in the rectum and the throughput of the anal canal, i.e., we are talking about anorectal outlet obstruction. […] Elongation and expansion of the sigmoid colon, thickening of the colonic wall with histological changes in it, colonic slow transit, and pressure changes in different parts of the colon are secondary to anorectal obstruction. They are proportional to the degree of megacolon. […] Megarectum is always accompanied by expansion and lengthening of the sigmoid colon. This term can only be used when measuring the rectum, but it cannot be used to describe an illness.

• #32 Functional Megacolon in Children (Etiology, Pathogenesis, Diagnosis): A Review

  https://fortuneonline.org/articles/functional-megacolon-in-children-etiology-pathogenesis-diagnosis-a-review.html

  Fecal incontinence (encopresis) occurs with grade 2-3 megacolon because of stretching and weakness PRM (DPS). […] A method for determining megacolon, and anal canal function in children of different ages is described. This made it possible to establish that acquired megacolon is always of an obstructive nature, either over constriction or because of a dysfunction of the anal canal.

• #33 Radiometric Analysis of Contrast Enema for Encopresis in Children: A Review Article

  https://www.mathewsopenaccess.com/full-text/radiometric-analysis-of-contrast-enema-for-encopresis-in-children-a-review-article

  The data obtained on the pathogenesis of different forms of encopresis will allow for the implementation of pathogenetic treatment. […] An analysis of the literature and our research shows that patients with functional megacolon (FM) develop encopresis due to rectal overflow with feces, which is invariably accompanied by megacolon. […] Without pathogenetic treatment, this process progresses from minimal damage to descending perineal syndrome (DPS), which ultimately causes encopresis. […] The combination of clinical and radiological symptoms provides insight into the pathophysiological process. […] Inflammation leads to an increase in the tone of the left side of the colon and rectum, causing the fecal bolus to move rapidly into the rectum. […] This understanding of the pathophysiology of encopresis without constipation explains why laxatives, which further increase the already high intestinal tone, exacerbate the symptoms of encopresis. […] Based on the data presented, there is reason to believe that anti-inflammatory treatment, either orally or through transanal irrigation, may be effective in children with encopresis without constipation.

• #34

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

  A number of other factors can also contribute to the eventual development of encopresis. Sometimes children may have pain when they have a bowel movement due to an infection or a tear near their rectum. […] Encopresis is a chronic, complex but solvable problem. However, the longer it exists, the more difficult it is to treat. […] 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. […] To accomplish these goals, attention will be focused not only on the physical basis of encopresis but also on its behavioral and psychological components and consequences.

• #35 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

  Other health problems may cause chronic constipation. These include diabetes, hypothyroidism, Hirschsprung disease, and inflammatory bowel disease. […] 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. […] 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. […] 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.

• #36 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. […] In most cases, encopresis is not a disease but rather a symptom of chronic constipation. […] There are three main causes of encopresis: Constipation. Most cases of encopresis are the result of chronic constipation. […] Motility is the ability of the colon to pass stool. […] Emotional stress such as premature toilet training or an important change in the child’s life—for instance, the divorce of a parent or the birth of a sibling—also may trigger encopresis. […] Treatment of encopresis focuses on clearing the colon of retained, impacted stool and encouraging healthy bowel movements. […] The best treatment for encopresis is to encourage regular bowel movements.

• #37 Elimination Disorders | Abnormal Psychology

  https://courses.lumenlearning.com/wm-abnormalpsych/chapter/elimination-disorder/

  The onset of encopresis is most often benign. The usual onset is associated with toilet training, demands that the child sit for long periods of time, and intense negative parental reactions to feces. […] Encopresis is commonly caused by constipation, reflexive withholding of stool, due to various physiological, psychological, or neurological disorders, or from surgery (a somewhat rare occurrence). The colon normally removes excess water from feces, but if the feces or stool remains in the colon too long due to conditioned withholding or incidental constipation, so much water is removed that the stool becomes hard, and becomes painful for the child to expel in an ordinary bowel movement. A vicious cycle can develop, where the child may avoid moving his/her bowels in order to avoid the expected, painful toilet episode. This cycle can result in deeply conditioning the holding response; thus the rectal anal inhibitory response or anismus results. The rectal anal inhibitory response has been shown to occur even under anesthesia and when voluntary control is lost. The hardened stool continues to build up and stretches the colon or rectum to the point where the normal sensations associated with impending bowel movements do not occur. Eventually, softer stool leaks around the blockage and cannot be withheld by the anus, resulting in soiling. The child typically has no control over these leakage accidents, and may not be able to feel that they have occurred or are about to occur due to the loss of sensation in the rectum and the rectal anal inhibitory response. Strong emotional reactions typically result from failed and repeated attempts to control this highly aversive bodily product. These reactions, in turn, may complicate conventional treatments using stool softeners, sitting demands, and behavioral strategies.

• #38 Encopresis

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

  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.

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