Encopresis: symptoms, causes and treatments

Encopresis is a disorder that, together with enuresis, makes up elimination disorders. It affects children between four and nine years old, and is a cause of discomfort for those who suffer from it. This article explains what it is, the different types of encopresis, as well as its etiology and the most effective treatments.

Encopresis is a condition included in elimination disorders, along with enuresis. These alterations are characterized by the inability to control the emission of feces or urine at ages when the child should already be able to do so.

Encopresis, specifically, refers to the child’s inability to control fecal emission. This lack of control is problematic when it takes place in inappropriate places, whether it is a voluntary or intentional inability.

The time at which children must have learned to control their fecal emission is usually around 4 years of age. From that age on, the child would no longer have to defecate on himself. It is important, before diagnosing encopresis, to have examined other causes, such as organic or medical, or suffer the effects of a substance (for example, laxatives), which are precipitating it.

There are certain diseases that can be related to a lack of control in defecation, such as Hirschsprung’s disease – lack of peristaltic movements -, an aganglionic megacolon or something simpler such as lactose intolerance.

Encopresis with or without constipation

Depending on the classification criteria used, there are several types of encopresis. From the point of view of overflow, it can take place an encopresis with constipation or overflow incontinence; either an encopresis without incontinence.

In this elimination disorder, medical examinations and the child’s medical history are very relevant. These two types of encopresis would have different treatments.

Retentive encopresis (with constipation)

In the case of retentive encopresis, we are talking about unusual depositions, with many episodes of fouling. On some occasions, children with retentive encopresis do go to the bathroom every day, however, they do not have a complete evacuation.

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Medical exams are important because this can be seen through x-rays. Numerous studies ensure that retentive encopresis is usually due in part to physiological alterations. Of all cases of encopresis, approximately 80 percent are of the retentive type.

Non-retentive encopresis (without constipation)

The causes associated with this type of encopresis without overflow are found in inadequate training, environmental or family stress, or oppositional behaviors. In fact, if there is non-retentive encopresis, other types of disorders in the child would also have to be considered, such as antisocial or a major psychological disorder.

The DSM-5 recommends carrying out a psychiatric evaluation where disorders such as oppositional defiant, behavioral, affective and even psychotic disorders are explored. For example, the child may be suffering from childhood depression and encopresis may be a consequence of it.

Primary and secondary encopresis

Another characteristic to take into account in the diagnosis of encopresis is whether The lack of control of fecal emission is continuous or discontinuous. This means that there are certain children who never manage to control their bowel movements, as well as others who do manage to do so for a period of more than a year, but then the incontinence reappears.

This is also very relevant since The causes that can favor primary and secondary encopresis are different. If the child has never learned to control it, the symptom can be considered a reflection of an early evolutionary fixation and become more physiological.

In the case of secondary school, that is, when learning and unlearning, this may be related to environmental factors, stressors at school or at home, discomfort, etc. Finally, unlike enuresis, encopresis during the day it is usually more common than that which takes place at night.

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Epidemiology, who suffers the most?

Epidemiology refers to the groups that are usually most affected by the disorder in question. The condition of encopresis in children usually varies. After four years of age, Encopresis is usually more common in men than in women. Between seven and eight years, the frequency of encopresis is 1.5%, higher in boys compared to girls.

Impact on the child and the adult

Due to the nature of the disorder and the censorship that everything related to defecation has always had, encopresis usually causes a strong impact on the child. can come to greatly undermine their self-esteem and self-conceptsince it is something very difficult to hide on a day-to-day basis.

At the ages when encopresis occurs, children already go to school. Defecating in the middle of recess or not being able to contain oneself in class are situations that can be very stressful for the child.

It is also postulated as something difficult for parents and family tension is usually high. This is problematic because As it is a childhood condition, the course of treatment depends on the support the child receives and the family’s willingness to act as agents of change or co-therapists at home.

Etiology and causes

Encopresis, like most disorders, It is the result of the interaction of many factors. These factors are so much physiological and psychological. There does not appear to be evidence of genetic causes.

Among the physiological factors, we can find dietary abnormalities, problems in the child’s development or inadequate intestinal control. Among the psychological causes, encopresis may be related to the child’s distractibility, lack of attention, hyperactivity, fear of the toilet or fear of painful defecation.

There are theories that speak of a learning deficit, where the signals that indicate to the child that he has to go to the bathroom have not been conditioned as discriminative stimuli. This means that when he feels the urge to go to the bathroom, he doesn’t realize it and doesn’t go.

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Other theories speak of Avoidance learning in retentive encopresis. The child learns to retain stool to avoid pain or anxiety—that is, through negative reinforcement—and a cycle of constipation begins that can lead to secondary encopresis.

Regarding non-retentive encopresis, it is said that these children they have learned to defecate incorrectly. They are usually children who get distracted and, therefore, get dirty. Here the problem would also be in sphincter control.

Medical and behavioral treatment

Within the medical treatment we find the combined use of laxatives and enemas. A modification of the diet is also applied, with a lot of fiber consumption and fluid intake. Within the medical treatment we find Levine’s protocol (1982), where special emphasis is placed on psychoeducational aspects (explaining to the child with drawings what a colon is, etc.) and where a lot is played with incentives.

Regarding behavioral treatment, special emphasis is placed on teaching routine defecation habits, reorganize the environment, stimulate control and reinforce alternative behaviors. Finally, there is a program established by Howe and Walker (1992), also based on principles of operant conditioning.

The causes of encopresis are therefore varied, as are its different types. It is a disorder that, although some may call it natural, is very unpleasant for children.

Addressing them to discomfort while being able to treat it is unethical and many times We must be attentive to what encopresis may be telling us. It may not be a disorder but it is a symptom of another condition and therefore both medical and psychological evaluations should be essential.