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Functional EncopresisAka: Primary Nonretentive Encopresis, Stool Toileting Refusal
- Types
- Failed initial bowel training
- Toilet phobia
- Manipulative soiling
- Irritable Bowel Syndrome
- Evaluation
- See Encopresis
- Management: Address Toilet refusal behavior
- Positive toilet sits
- Start with short sits on toilet
- Sit 3-5 times per day for 30 seconds
- Increase to 5 minutes each (timer signals end)
- Leave on diapers and pants
- Provide relaxing, enjoyable activity
- Start with short sits on toilet
- Gradual shaping procedure (if above fails)
- Parent models toileting behavior for 2 weeks
- Male caretakers should sit while urinating
- Play games and read books in or near bathroom
- Gradually progress to positive toilet sits above
- Parent models toileting behavior for 2 weeks
- Positive toilet sits
- Management: Ensure soft, well-formed stools
- Adjust diet to ensure frequent well-formed stool
- Short-term supplements (flavored fiber drink, bran)
- Consider short-term daily Laxative
- Milk of Magnesia 1-3 ml/kg/day
- Mineral Oil 1-5 ml/kg/day (avoid if aspiration risk)
- Sorbitol 1-3 ml/kg/day
- Soiling may be more frequent with these regimens
- Prepare a matter-of-fact neutral clean-up procedure
- Management: Schedule prompt toilet sits
- Establish toilet sits when child most likely to stool
- Schedule up to 5 per day for 3-5 minutes each
- Consider sit 5-20 minutes after each meal
- Use daily toileting diary to set up other sit times
- Use a timer to signal end of toilet sit
- Once achieved, hold a graduation ceremony
- Declare the child a "big" girl or boy
- Completely switch from diapers to pants
- Establish toilet sits when child most likely to stool
- Management: Provide incentives for stools in toilet
- Reward child when stools in toilet
- Avoid rewarding clean pants (Stool withholding)
- Incentives might vary
- Candy
- Star chart
- Dot-to-dot
- Special activities
- Gradually reduce verbal prompts to toilet
- Allow child to recognize urge to urinate and defecate
- Reward child for requests to use bathroom
- Reward child when stools in toilet
- Management: Physician Contact for stool withholding
- See also Pediatric Constipation Management
- No stool for 4 days
- Try one of stool softening regimens above
- Impaction (may require inpatient management)
- Hypertonic phosphate enemas 1-2/day x1-3 days OR
- Mineral Oil
- Daily Dose: 15-30 ml per year of age
- Maximum: 8 ounces
- References
Encopresis (C0014089) | |
|---|---|
| Definition (MSH) | Incontinence of feces not due to organic defect or illness. |
| Concepts | Finding (T033) |
| ICD9 | 307.7, 307.7, 787.6 |
| MSH | D004688 |
| Danish | Enkoprese |
| Dutch | Encopresis |
| English | Encopresis, Encopresis of nonorganic origin, Faecal incontinence not due to organic disease, Fecal incontinence not due to organic disease, functional encopresis, Non-organic encopresis |
| Finnish | TUHRIMINEN |
| French | Encopresie |
| German | Enkopresis |
| Hebrew | enkoprezis |
| Hungarian | encopresis |
| Italian | Encopresi |
| Norwegian | UFRIVILLIG AVFORING/ENKOPRESE f98.1 |
| Portuguese | Encoprese |
| Spanish | encopresis, encopresis funcional, encopresis no organica, incontinencia fecal funcional, incontinencia fecal no causada por enfermedad organica, incontinencia fecal no debida a enfermedad organica |
| Swedish | ENKOPRES |
| Parent Concepts | Elimination Disorders (C0013895), Special symptoms or syndromes, NEC in ICD9CM_2008 (C0302370), Symptoms and Complaints Component (C0497525), Psychiatric problem (C1306597), Behavioral Symptoms (C0004941), Signs and Symptoms, Digestive (C0037089), Encopresis (C0014089), Fecal Incontinence (C0015732), Elimination pattern (C0231360), Ambiguous concept (C1274012), Duplicate concept (C1274013) |
| Sources | AOD, COSTAR, CSP, ICD9CM, ICPC, ICPCBAQ, ICPCDAN, ICPCDUT, ICPCFIN, ICPCFRE, ICPCGER, ICPCHEB, ICPCHUN, ICPCITA, ICPCNOR, ICPCPOR, ICPCSPA, ICPCSWE, LCH, MEDLINEPLUS, MSH, MTHICD9, NDFRT, SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System) |
