Encopresis in children. Outcome and predictive factors of successful management

OBJECTIVE

To elucidate our experience and outcome in the management of childhood encopresis, and to emphasize the factors that may predict successful management.

METHODS

This prospective study was carried out between September 2003 and September 2011 in the Department of Pediatric Surgery, Al-Thoura Teaching Hospital, Al-Beida and Al-Butnan Medical Teaching Center, Tobruk, Libya.

RESULTS

One hundred and thirty-two patients (117 male, 15 female) took part of the study. The male and female ratio was 7.8:1. The participants were patients aged 4-9 years. There were 30 (22.7%) patients between 4-5 years, 61 (46.2%) between 6-7 years, and 41 (31%) between 8-9 years. Nonretentive encopresis patients were 36 (27.2%) (Group I) and 96 (72.8%) patients had retentive encopresis (Group II). Patients with low fluid intake were 87 (65.9%) and low fiber diet were 91 (68.9%). Patients with delayed toilet training were 99 (75%). The total rate of successful conservative treatment was 70.5%. The rate of successful treatment in Group I was 94.4% and in Group II was 61.5%. We observed 18.2% of the patients had recurrence of encopresis. The factors found to predict good resolution rate after medical treatment included: cooperation of the parent and patient, female gender, ages above 5 years, and non-retentive encopresis.

CONCLUSION

Encopresis remains a problem for the parents and the patients. Clinical evaluation is indispensable. Good outcome can be achieved effectively. Cooperative parents and patient, female gender, age above 5 years, and nonretentive encopresis are predictors for good response to medical treatment.

Children who soil: guidelines for good practice

The need for a more coherent and integrated national service for children with constipation and soiling has been recognised for some years. It became clear to the team at the voluntary organisation Enuresis Resource & Information Centre (ERIC) as a result of the experiences of the many parents and professionals who contacted them. They responded by setting up a multidisciplinary working group to begin the process of reviewing the research. The group then went on to oversee the publication of the first national minimum standard guidelines for service delivery in this area of child health.

Self-care interventions for the school-aged child with encopresis

Encopresis, an elimination disorder in children, presents as a challenging problem for gastroenterology nurses working with patients and families confronted with this disorder. This article offers a summary of the literature on encopresis, including pathogenesis, causative factors, early treatment, and clinical interventions focused on self-care. The antecedent factors that facilitate the child's participation in self-care are summarized, along with the intended outcomes of the self-care intervention plan.

Cisapride for the treatment of constipation in children: A double-blind study

OBJECTIVE

To determine whether cisapride is effective in the treatment of children with constipation.

STUDY DESIGN

Double-blind, placebo-controlled study in which children with chronic constipation were randomly assigned to treatment with cisapride or placebo for 12 weeks.

RESULTS

Forty children were enrolled, and 36 completed the therapy. Treatment successes occurred in 13 of 17 (76%) subjects in the cisapride group and 8 of 19 (37%) subjects in the placebo group (P <.03). The odds ratio for response after cisapride administration was 8.2 times higher (95% CI 1.3 to 49.4). During cisapride therapy, there was a significant improvement in number of spontaneous bowel movements per week (from 0.9 +/- 0.1 to 4.1 +/- 1.1), and there was a significant decrease in number of fecal soiling episodes per day (1.8 +/- 0.5 to 0.08 +/- 0.4), percent with encopresis (82% vs 23%), number of laxative doses per week (from 10.3 +/- 2.6 to 0.8 +/- 0.6), percent using laxatives (77% to 24%), and total gastrointestinal transit time (from 115.0 +/- 3.7 hours to 77.0 +/- 11.1 hours). With placebo, there were no significant changes in the number of spontaneous bowel movements (from 1.0 +/- 0.8 to 2.2 +/- 0.6), percent with encopresis (74% vs 47%), or total gastrointestinal transit time (from 112.5 +/- 4.9 hours to 95.4 +/- 9.8 hours); but there was a significant decrease in number of fecal soiling episodes per day (from 1.3 +/- 0.4 to 0.4 +/- 0.2) and number of laxative doses used per week (from 11.5 +/- 2.9 to 2.05 +/- 0.7). The final number of spontaneous bowel movements, fecal soiling episodes, laxatives used, or percent patients with encopresis was not different when patients receiving cisapride were compared with those receiving placebo.

CONCLUSION

Cisapride was effective in the treatment of children with constipation.

How to resolve stool retention in a child. Underwear soiling is not a behavior problem

Many parents do not realize their child has stool retention when they bring him or her for an office visit. Some complaints that may be a tip-off and should prompt questioning about stool frequency and underwear soiling are vague abdominal pain, urinary incontinence, and stools so large they plug the toilet. A rectal examination is usually adequate to confirm the diagnosis. Management begins with educating parents that leaking of liquid stool around impaction and onto underwear is completely involuntary, so the child should never be scolded or embarrassed. Stool retention may begin because of unpleasant or unavailable toilet facilities, constipation, or painful elimination and often becomes self-perpetuating. Impaction must be removed immediately; magnesium citrate solution is usually effective. To allow the rectum to return to its normal size, which can take an extended time, stool must be kept soft and movable with administration of mineral oil and appropriate dietary choices (eg, fruit, juice, fiber). Recurrence is common, so ongoing measures and follow-up are important.

[Re-education in biofeedback: role in terminal constipation in children]

BACKGROUND

Chronic constipation with or without encopresis is often associated with abnormal defecation dynamics evidenced by manometric study and possibly manageable with biofeedback treatment.

PATIENTS AND METHODS

Twenty-six children more than 5 years of age suffering from constipation with or without encopresis for at least 6 months were treated with biofeedback plus lactulose; 15 of them were also given psychiatric attention. Pressure recordings from the internal and external sphincters in response to transient balloon distension of the rectum were obtained in all patients as did the recto-anal inhibitory reflex and the rectal sensitivity.

RESULTS

Sixteen patients were considered as definitely cured or improved with this management; two others had relapses 6-12 months later and five were not improved; the three remaining patients were lost for follow-up.

CONCLUSION

As already reported, biofeedback treatment represents an interesting role in management of such children.

Preventing encopresis

Pediatric nurses can play a major role in preventing encopresis through anticipatory guidance and education. An understanding of contributing factors that may lead to constipation and encopresis will assist pediatric nurses in their efforts to help prevent this condition.

The prevention of constipation and encopresis: a developmental model and approach

This article proposes a developmental model for understanding the evolution and treatment of bowel problems in infancy and childhood. It focuses on anticipatory guidance to maximize parental understanding of the normal variations of bowel function and specific interventions to limit the long-term effects of mild bowel problems.

Reinforcement procedures in the control of encopresis: a case study

A student and his problems were pin-pointed, recorded, and changed. The first 3 wk. were used to establish a base rate. S defecated in class, once every few days. After he was programmed with reinforcers (charting and coupons toward book purchases), he may have had one accident, only, for the remainder of the school year (8 wk.). Follow-up through the seventh month of the next school year (the time of this writing) indicates one accident only. During this 7-mo. period, he was not programmed with book coupons or any other specific reinforcer. He had internalized a previous external model of control.