Encopresis
Encopresis
General and supportive measures
ICD-10 code: F98.1
DESCRIPTION
When the passage of faeces is involuntary, there is usually constipation, impaction and retention with subsequent overflow. The constipation may develop due to psychological reasons, e.g. anxiety around defaecation that leads to avoidant behaviour or physiological reasons, e.g. paradoxical contraction of the external sphincter. Deliberate encopresis may be part of a disruptive behaviour disorder, e.g. oppositional defiant disorder. Constipation can lead to enuresis, urinary reflux and chronic UTIs.
DIAGNOSTIC CRITERIA (DSM 5)
Involves the involuntary or intentional, repeated passage of faeces into inappropriate places. This occurs at least once each month for 3 months and the chronological or mental age of the child is at least 4 years. Substances, medications and medical illnesses need to be excluded. Encopresis is specified as either with or without constipation and overflow incontinence.
GENERAL AND SUPPORTIVE MEASURES
- History to include medical and psychological factors.
- Assess the type of encopresis.
- Medical examination and investigations, e.g. urine test strip.
- Refer to paediatrician for further work-up as needed.
- Treat constipation with diet and exercise.
- For the retentive subtype – educate the child and parent about bowel function and use laxatives if necessary.
- Management requires educational, psychological and behavioural approaches, e.g. timed daily intervals on the toilet with rewards.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 14: Child & Adolescent Psychiatry, 14.2 Elimination Disorders, 14.2.2 Encopresis