Encopresis is also known as paradoxical diarrhea, is voluntary or involuntary fecal soiling in children who have usually already been toilet trained. Persons with encopresis often leak stool into their undergarments. This term is usually applied to children, and where the symptom is present in adults, it is more commonly known as fecal leakage (FL), fecal soiling or fecal seepage.
The signs and symptoms of encopresis may include: • Leakage of liquid stool on your child's underwear. If it is large, you may think it as diarrhoea.
• Constipation with dry, hard stool.
• Passage of large stool that clogs or almost clogs the toilet.
• Avoidance of bowel movements.
• Long periods of time between bowel movements, possibly as long as a week.
• Lack of appetite. • Abdominal pain.
• Repeated urinary tract infections.
The prevalence of encopresis was 4.1% in the 5-to-6 age group and 1.6% in the 11-to-12 age group. Encopresis was more frequent among boys and children from the very depressed areas of the city. Encopresis was less frequent among Moroccan and Turkish children. A defecation frequency of less than three per week was found in 3.8% of the 5- to 6-year-olds and 10.1% of the 11- to 12-year-olds with encopresis. Only 37.7% of the 5- to 6-year-olds and 27.4% of the 11- to 12-year-olds who had encopresis had ever been taken to see a doctor for this problem. Psychosocial problems were far more common among children with encopresis than among normal children.
The first and the common therapy done will be medical therapy. Conventional medical therapy proves successful in approximately one half of children with chronic constipation and encopresis. 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. The child must be taught to use the toilet regularly to retrain his/her body. It is usually recommended that a child be required to sit on the toilet at a regular time each day and 'try' to go for 10–15 minutes, usually soon (or immediately) after eating.
Children are more likely to be able to expel a bowel movement right after eating. It is thought that creating a regular schedule of bathroom time will allow the child to achieve a proper elimination pattern. Repeated voiding success on the toilet itself helps it to become a releaser stimulus for successful bowel movements. Alternatively, when this method fails for six months or longer, a more aggressive approach may be undertaken using suppositories and enemas in a carefully programmed way to overcome the reflexive holding response and to allow the proper voiding reflex to take over. Failure to establish a normal bowel habit can result in permanent stretching of the colon. Certainly, allowing this problem to continue for years with constant assurances that the child "will grow out of it" should be avoided. Dietary changes are an important management element.
Recommended changes to the diet in the case of constipation-caused encopresis include: reduction in the intake of constipating foods such as dairy, peanuts, cooked carrots, and bananas, increase in high-fiber foods such as bran, whole wheat products, fruits, and vegetables, higher intake of water and liquids, such as juices, although an increased risk of diabetes and/or tooth decay has been attributed to excess intake of sweetened juices, limit drinks with caffeine, including cola drinks and tea provide well-balanced meals and snacks, and limit fast foods/junk foods that are high in fats and sugars, limit whole milk to 500 mL (16.9 ounces) a day for the child over 2 years of age, but do not completely eliminate milk because children need calcium for bone growth and strength. The standard behavioural treatment for functional encopresis, which has been shown to be highly effective, is a motivational system such as a contingency management system. In addition to this basic component, seven or eight other behavioural treatment components can be added to increase effectiveness.