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encopresis in children treatment

Encopresis or faecal soiling is the voiding of faeces in inappropriate places and usually involves the soiling of the child’s clothes. At the age of 7, the prevalence in boys is 2.3 per cent and 0.7 per cent in girls with a male:female ratio of almost 3.5:1. By the age of 11, less than 1 per cent of children soil themselves once a month. Faecal soiling can occur for a variety of reasons. Some children fail to achieve continence as they have never learned bowel control and this is termed primary faecal soiling. This is usually found in the context of inconsistent or coercive toilet training practice.

Treatment involves educating parents in proper toilet training methods on realistic targets and reinforcement of achievement by the child. Star charts can be used to record success. Fear of using the toilet can lead to some children soiling their clothes. General reassurance and rewards for appropriate use of the toilet can help resolve the problem. In some children encopresis may occur as a result of long-standing faecal retention. The original cause may be emotional or physical but, in time, leads to constipation. Chronic constipation can lead to hard faeces acting as a plug. Liquid and semi-solid stools eventually leak past the plug causing soiling. This form of soiling arises as a result of constipation with overflow leading to soiling.

Appropriate measures need to be adopted to unblock the bowel by using a laxative such as senna in combination with a stool softener such as Lactulose, although enemas may be needed in resistant cases. Family counselling and training in appropriate toilet training methods is essential. Close monitoring and support to families helps motivate parents in keeping to an agreed programme. Soiling can occur in children who have achieved continence when they experience stressful situations such as physical or sexual abuse. The main aim of treatment is to reduce stress.

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