II. Epidemiology

  1. Children of at least 4 years old
  2. Affects 1-4% of school aged children
  3. Boys more affected than girls

III. History

  1. Stool pattern
    1. Stool size
    2. Stool consistency
    3. Interval between stools
  2. History of Constipation (Age of onset)
  3. History of Stool Soiling
    1. Age of onset
    2. Type and amount of material
  4. Diet history
    1. Type and amount of food
    2. Changes in diet
  5. Associated symptoms
    1. Abdominal Pain
    2. Decrease in appetite
    3. Urinary symptoms
      1. Enuresis
      2. Dysuria or Urinary Tract Infection
  6. Medications
  7. Family History of Constipation

IV. Assessment: Readiness for Toilet Training

  1. Usually occurs between 24-30 months
  2. Physical Readiness
    1. Sphincter control (usually by time of walking)
    2. Bladder and bowel readiness
      1. Remains dry for several hours at a time
      2. Fully empties Bladder on Vomiting
  3. Developmental readiness
    1. Awareness of stooling time
      1. Facial expressions or squatting with stooling
      2. Go to specific or private location to stool
    2. Motor skills
      1. Walk to bathroom
      2. Undress
      3. Sit on toilet
      4. Flush
    3. Cognitive skills
      1. Understanding toileting words (wet, bathroom)

V. Assessment: Behavioral

  1. Disruptive behavior problems
    1. Aggression
    2. Oppositional behavior
    3. Temper tantrums
  2. Child compliance with adult instructions
    1. Bedtime, Bath-time, and Dressing
    2. Child should follow 7 of 10 instructions
  3. Daily diary of toileting habits

VI. Examination

  1. Growth Curve plotted
    1. Pediatric Height
    2. Pediatric Weight
  2. Abdomen
    1. Abdominal Distention
    2. Abdominal mass (suprapubic)
  3. Rectum
    1. Sacral dimple
    2. Position of anus
    3. Anal Fissure
    4. Anal Wink
    5. Sphincter tone
    6. Rectal vault size
    7. Presence or absence of stool in Rectum
    8. Pelvic mass
  4. Neurological exam

VII. Differential Diagnosis: Retentive Encopresis

  1. Functional Constipation (95%)
    1. Typically related to stool witholding
  2. Anal causes
    1. Anal Fissure
    2. Anal stenosis or anal atresia with fistula
    3. Anterior displacement of anus
    4. Anal Trauma
    5. Postsurgical repair
  3. Neurogenic causes
    1. Hirschsprung's Disease
    2. Chronic intestinal pseudo-obstruction
    3. Spinal cord disorders (e.g. Spinal Dysraphism)
    4. Cerebral Palsy or hypotonia
    5. Pelvic mass
  4. Neuromuscular disease
  5. Endocrine causes
    1. Hypothyroidism
    2. Hypercalcemia
    3. Lead Intoxication
  6. Medications
    1. Codeine or other Narcotics
    2. Antacids

VIII. Differential Diagnosis: Functional Encopresis

  1. Functional Encopresis (99%)
  2. Severe Ulcerative Colitis
  3. Acquired spinal cord disease
    1. Sacral Lipoma
    2. Spinal cord tumor
  4. Rectoperineal fistula with imperforate anus
  5. Postsurgical damage to anal sphincter

IX. Management

  1. Evaluate and treat causes of Retentive Encopresis
  2. See Functional Encopresis

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Ontology: Functional encopresis (C0014089)

Definition (MSHCZE) Neschopnost udržet stolici. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI) An elimination disorder characterized by fecal incontinence, whether involuntary or intentional, which is not due to a medical condition and which occurs at an age of at least 4 years.
Definition (MSH) Incontinence of feces not due to organic defect or illness.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D004688
ICD9 307.7
ICD10 F98.1
SnomedCT 302752001, 192026001, 192023009, 192629009, 25378008
English Encopresis, Non-organic encopresis NOS, Nonorganic encopresis, Non-organic encopresis NOS (disorder), Functional encopresis (finding), encopresis, functional encopresis, encopresis (diagnosis), Psychogenic encopresis, Incontinence of feces of nonorganic origin, Functional encopresis, Non-organic encopresis (finding), Non-organic encopresis (disorder), Functional encopresis (disorder), Non-organic encopresis NOS (finding), Faecal incontinence not due to organic disease, Fecal incontinence not due to organic disease, Non-organic encopresis, encopresis; functional, encopresis; nonorganic origin, feces; incontinence, functional, feces; incontinence, nonorganic origin, functional; encopresis, incontinence; fecal, nonorganic origin, nonorganic origin; encopresis, Encopresis, NOS, Functional encopresis, NOS, Functional encopresis (disorder) [Ambiguous], Encopresis of nonorganic origin
Spanish encopresis funcional (hallazgo), encopresis no orgánica, SAI (trastorno), incontinencia fecal no causada por enfermedad orgánica, encopresis no orgánica, SAI (hallazgo), encopresis no orgánica, encopresis no orgánica (hallazgo), encopresis no orgánica, SAI, encopresis funcional (trastorno), encopresis funcional (concepto no activo), encopresis funcional, incontinencia fecal funcional, incontinencia fecal no debida a enfermedad orgánica, Encopresis
Swedish Tarmtömning, ofrivillig
Czech enkopréza
Finnish Tuhriminen
Russian ENKOPREZ, ЭНКОПРЕЗ
German Nichtorganische Enkopresis, Einkoten, Enkopresis, Einstuhlen
Korean 비기질성 유분증
Croatian ENKOPREZA
Polish Zanieczyszczanie się kałem, Popuszczanie kału, Zanieczyszczanie się kałem nieorganiczne
Norwegian Enkoprese, Funksjonell enkoprese, Ikke-organisk enkoprese, Psykogen enkoprese
Dutch encopresis; functioneel, encopresis; niet-organische oorsprong, faeces; incontinentie, functioneel, faeces; incontinentie, niet-organische oorsprong, functioneel; encopresis, incontinentie; faeces, niet-organische oorsprong, niet-organische oorsprong; encopresis, Niet-organische encopresis, Encopresis
French Encoprésie
Italian Encopresi
Portuguese Encoprese