Causes of Retentive Encopresis

"The problem originates following one or more episodes of constipation. Constipation may cause distention of the colon, decreasing the child's ability to detect the urge to have a bowel movement, fecal hardening and build up in the colon, and subsequent leakage of fecal material.

Constipation may result from a number of causes including environmental factors such as:

• withholding bowel movements during toilet training
• ignoring physiological cues to use the toilet while distracted by activities
• failing to use the toilet during school
• genetic predisposition toward decreased bowel motility
• food intolerance
• certain medications

Once the problem begins, it can be maintained by the child's avoidance of large or painful bowel movements, attempts to assert independence or control, or insensitivity to stool in the colon.

Standard medical management typically includes some combination of rectal clean out, stool softening, daily toilet sitting, and recommendations for increased dietary fiber." (Journal of Pediatric Psychology, Vol 22, No. 5, 1997, pp. 619-633)

For more information on Constipation in Toddlers and Children, please click here.

Encopresis is defined as the voluntary or involuntary passage of fecal material into underwear or other inappropriate place. The most common type of this disorder is retentive encopreis, which accounts for 80% of all encopresis cases and is characterized by chronic constipation, stool impaction, and leakage of fecal material (Levine, 1975).

(Journal of Pediatric Psychology, Vol 22, No. 5, 1997, pp. 619-633)

The leakage may occur during the day or night and it is NOT under the conscious control of the child. The frequency of leakage varies from infrequent occurrences to a continuous flow.

In fecal impactions, feces become impacted in the child's colon, causing it to distend. This causes the child not to feel the urge to defecate. As a result, the anal sphincter muscle becomes weak and unable to contain the soft stools that pass around the impaction.

Despite the constipation, these children actually do have regular bowel movements. However, these bowel movements are often soft and frequently involuntary. The child may not even be aware that he or she has defecated until the fecal matter has already passed.

So now you know what it is, do you want help on treatment for retentive encopresis?