Encopresis is a disease included in elimination disorders, along with enuresis. These changes are characterized by the inability to control the release of stool or urine at ages when the child should already be able to do so.
Encopresia, in particular, refers to a child’s inability to control faecal emissions. This lack of control is problematic when it occurs in inappropriate places, whether voluntary or intentional disability.
- The time in life when children must have learned to control their faecal emissions is usually around age 4.
- So the child should no longer evacuate in his pants.
Before diagnosing encopressia, it is important to have examined other organic and medical causes, or simply the effects of a substance (e. g. laxatives) given to the child.
Some diseases may be related to lack of defecation control, such as Hirschsprung’s disease, or something simpler, such as lactose intolerance.
Depending on the classification criteria used, there are several types of encopresia, from the point of view of extravasation may occur encopresia with constipation or incontinence by extravasation, or encopresia without incontinence.
In this elimination disorder, medical examinations and the child’s medical history are of absolute relevance, these two types of encopresia have different treatments.
Retentive encopresia (with constipation)
In the case of retentive encopressia, it is called unusual deposits, with many episodes of stool outside the vessel. Sometimes children with full encopressia go to the bathroom every day, but they don’t go to the saddle.
Medical exams are important because they allow you to see this through x-rays. Several studies claim that the restoration of encopressia is usually caused, in part, by physiological changes. Of all cases of encopresia, about 80% are residual.
The causes associated with this type of leak-free encopresia are the result of inadequate training, environmental or family stress or opposition behavior.
In fact, in the case of non-residual encopresia, other disorders should also be considered in children, such as a major antisocial or psychological disorder.
DSM-5 recommends developing a psychiatric evaluation that explores disorders such as opposition challenging, behavioral, emotional, and even psychotic. For example, the child may suffer from childhood depression and encopresia can be a consequence.
Another characteristic to consider in the diagnosis of encopresia is whether the uncontrolled fecal emission is continuous or discontinuous.
This means that there are some children who never manage to control their evacuation, and others who can do so for a period of more than a year, but then return to incontinence.
This is also very relevant, since the causes that can promote primary and secondary encopresia are different, if the child has never learned to control, the symptom can be seen as a reflection of an early developmental fixation and eventually become more physiological.
In the case of high school, i. e. during learning and detachment, this may be related to environmental factors, stressors at school or at home, discomfort, etc.
Finally, unlike enuresis, encopressia during the day is generally more common than overnight.
Epidemiology refers to the groups most commonly affected by the disorder in question. The presence of this condition in children generally varies.
After age four, encopresia is generally more common in boys than in girls; between the age of seven and eight, the frequency is 1. 5% higher in boys than in girls.
Due to the nature of the disorder and censorship that has always surrounded everything related to evacuation, encopy usually has a strong impact on the child, this can greatly undermine his self-esteem and self-image, as it is a very difficult thing. to hide in everyday life.
In the age of the encopresia, children already go to school, evacuate in the middle of recess or not be able to hold on to the classroom are situations that can be very stressful for the child.
It also runs as difficult for parents and family tensions are often high.
This ends up being problematic because, as it is a childhood condition, the course of treatment depends on the child’s support and the family’s willingness to act as exchange agents or co-therapists at home.
Encopresia, like most disorders, is the result of the interaction of many factors, both physiological and psychological. There doesn’t seem to be any evidence of genetic causes.
Physiological factors include food abnormalities, childhood developmental problems, or inadequate bowel control.
Psychological causes may be related to a child’s distraction, inaterment, hyperactivity, fear of bathing, or fear of evacuation with pain.
There are theories about a learning deficit, in which the signs that indicated to the child that he needs to go to the bathroom were not conditioned as important stimuli, that is, when the child wants to go to the bathroom, he does not notice. and so it doesn’t go.
Other theories talk about learning avoidance in residual encopresia Does the child learn to retain stool to avoid pain or anxiety?by negative reinforcement? and thus begins a cycle of constipation that can cause secondary encopresia.
As for non-permanent encopresia, it is said that these children have learned to evacuate incorrectly, usually it is the children who are distracted and therefore defecate out of the pot, eventually getting dirty, in this case the problem would also be related to control. sphincter.
As part of medical treatment, combined use of laxatives and enemas is found. A change in diet can also be made, with high fiber intake and high water intake.
In medical treatment, there is the Levine Protocol (1982), which places special emphasis on psychoeducation (explaining to the child with drawings what a settler is, etc. ) and uses many incentives.
Regarding behavioral treatment, the strength is teaching routine habits to evacuate, reorganize the environment, stimulate control and reinforce alternative behaviors.
Finally, there is a program established by Howe and Walker (1992), also based on the principles of operational conditioning.
Therefore, the causes of encopresia are varied, as are its different types, it is a disorder that, although some may consider it natural, is very unpleasant for children.
Letting them go through this discomfort means that it is possible to treat it is unethical and often it is necessary to focus on what encopresia can mean. It may not be a disorder, but a symptom of another condition.
Therefore, evaluations, both medical and psychological, should be essential.