Encopresis Parent Guide Sample Paper

Encopresis Parent Guide
What is Encopresis?
Encopresis (en-ko-PREE-sis), is an elimination disorder that can be voluntary or involuntary in which an individual repeatedly passes feces into inappropriate places such as the floor or clothing (DSM-V, 2013). Encopresis Parent Guide Sample Paper
How Common is Encopresis?
Encopresis can be an anxiety provoking and embarrassing disorder affecting 5% of children ages four and older (American Academy of Pediatrics, 2018).
What causes Encopresis?
There are several causes of encopresis, including constipation and emotional issues (Mayo Clinic, 2018).
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       Risk Factors

Poverty
Dirty Toilets
Impoverished Neighborhoods
Stress & Anxiety
Depression
Behavioral Problems
Signs and Symptoms of Encopresis
Signs and symptoms of encopresis may include:

the leakage of stool into clothing or other inappropriate places which can be mistaken as diarrhea,
the passage of large stool that clogs the toilet,
the avoidance of bowel movements,
constipation,
abdominal pain,
lack of appetite (Mayo Clinic, 2018).
Stanford Children’s Health (2018) further describes the signs and symptoms of encopresis as involuntary stooling or urgency of stooling leading to soiling, anal irritation due to repeated liquid stools, hiding soiled clothing, and withdrawing from loved ones, school, and social settings.

Pathophysiology of Encopresis
There are two types of encopresis, retentive and non-retentive. The former is characterized as constipation as a result of deliberate retention of the feces. Non-retentive encopresis refers to the depositing of feces in inappropriate places (Rajindrajith et al., 2013).
The pathophysiology of retentive encopresis is stool retention, which is present in 75-90% of children with constipation. In patients with the non-retentive subtype, total and segmental colonic transit times are within normal limits but abnormalities in the defecation process seems to underlie the problem, in which children have an inability to relax the external anal sphincter during defecation (Rajindrajith et al., 2013).
How to Diagnose Encopresis
The frequency of inappropriate defection should be for at least once a month for 3 months (American Psychiatric Association,2013). In addition, the DSM-5 provides two specifiers for encopresis. The specifiers are with constipation and overflow incontinence and without constipation and overflow incontinence (American Psychiatric Association,2013). Encopresis Parent Guide Sample Paper

To receive a diagnosis of encopresis, the child must be at the developmental of chronological age of 4 years (Sadock, Sadock & Ruiz, 2014). Encopresis cannot be diagnosed in the presence of a medical condition that causes fecal incontinence (Sadock, Sadock & Ruiz, 2014).

How to Diagnose Encopresis (Continued)
Physical Assessment

On examination, the patient may present contracting gluteal muscles, holding legs together and tightening the external anal sphincter in an effort to withhold feces (Sadock, Sadock & Ruiz, 2014).

Fecal impaction and overflow soiling may be evident on examination of the patient (Sadock, Sadock & Ruiz, 2014). A physical assessment may reveal constipation with hard fecal masses found in the colon and rectum with an abdominal palpation and rectal exam (Sadock, Sadock & Ruiz, 2014).

How to Diagnose Encopresis (Continued)
Medical History

An obtained medical history may reveal history of intentional bowel control occurrences in clothes or in other places (Sadock, Sadock & Ruiz, 2014.

In addition, a patient’s history may reveal a history of involuntary bowel occurrences but in absence of physiological abnormalities (Sadock, Sadock & Ruiz, 2014). History of soiling beginning around age 4 may be revealed while collecting the medical history (Sadock, Sadock & Ruiz, 2014). The provider will need to rule out disorders such as a ganglionic megacolon or Hirschsprung’s disease to obtain a definitive diagnosis (Sadock, Sadock & Ruiz, 2014).

How to Diagnose Encopresis (Continued)
Diagnostic Test

The primary diagnostic test in the encopresis work-up is an abdominal x-ray. The use of abdominal X-ray helps determine the extent of constipation (Sadock, Sadock & Ruiz, 2014).

What are my Treatment Options? (Pharmacologic and Non-pharmacologic)
Generally, the earlier that treatment begins for encopresis, the better.
The first step involves clearing the colon of retained, impacted stool. After that, treatment focuses on encouraging healthy bowel movements.
In some cases, psychotherapy may be a helpful addition to treatment.
– (University of Virginia School of Medicine, 2018)

Pharmacologic Treatment Options Encopresis Parent Guide Sample Paper
Your child’s doctor will likely recommend one or more of the following:

Laxatives
Rectal suppositories
Enemas
– (University of Virginia School of Medicine, 2018)

Laxatives
“The maintenance phase of management involves scheduling regular times to use the toilet in conjunction with daily laxatives like mineral oil or milk of magnesia,” (American Academy of Pediatrics, 2004).
“Laxatives such as magnesium hydroxide, lactulose, and mineral oil have been used in children for a long time. A new laxative, polyethylene glycol 3350, has been used successfully in children with constipation and encopresis,” (Dinesh S. Pashankar, M.D., 2005).
Powerful Laxatives“flush out” the lower intestine. This generally keeps lots of water in the intestine, softening any stool there, and causing diarrhea. Laxatives commonly used to flush out the intestine include:
Magnesium citrate
Golytely® or Colyte®
Fleet’s Phosphosoda®
Miralax® or Glycolax®
– (University of Virginia School of Medicine, 2018)

Rectal Suppositories
Suppositoriesirritate the bottom of the intestine, causing it to contract (squeeze) and push out a bowel movement. Some suppositories also stimulate the intestine to secrete salt and water, softening the stool in the rectum, and making it easier to push out. Commonly used suppositories include:
Glycerin
Dulcolax®
BabyLax®
– (University of Virginia School of Medicine,2018)

Enemas
Enemaspush fluid into the rectum. This softens the stool in the rectum but also stretches the rectum, giving the child a tremendous urge to pass a bowel movement. Almost all enemas consist mostly of water with another substance mixed in to keep the water inside the intestine. The most commonly used enemas are:
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Fleet’s® Phosphosoda: contain water and the salt sodium-phosphate. The phosphate is not absorbed in the lower intestine and thus keeps the water from the enema in the intestine.
Soap suds: contain water with a small amount of soap. The soap is mildly irritating and stimulates the lower intestine to secrete water and salt.
Milk and Molasses: contain milk sugars and proteins as well as molasses. None of these are absorbed in the lower intestine and thus keep the water from the enema in the intestine. Encopresis Parent Guide Sample Paper
– (University of Virginia School of Medicine, 2018)

Non-Pharmacologic Treatment Options
Behavior modification

Your child’s doctor or mental health professional can discuss techniques for teaching your child to have regular bowel movements. This is sometimes called behavior modification or bowel retraining.
Emotional distress not only affects the child but also can lead to anger between immediate family members and caretakers. Families may feel the need to adjust their routines and become preoccupied with the child’s encopresis. It is essential to keep in mind that most cases of encopresis are involuntary.
Your child’s doctor may recommend psychotherapy with a mental health professional if the encopresis may be related to emotional issues.
Psychotherapy may also be helpful if your child feels shame, guilt, depression or low self-esteem related to encopresis.
– (Mayo Clinic, 2018)

Is Encopresis Preventable?
Encopresis has been contributed to physiological and psychological factors which result in the avoidance of defecation (Sadock, Sadock & Ruiz, 2014).
Parents should avoid being punitive of shaming the child (Sadock, Sadock & Ruiz, 2014).
What Can I Do?
Strategies that can be implemented to help prevent Encopresis and its many complications include:

Avoiding constipation
Learning effective toilet training techniques
Avoiding Constipation
Make sure children get enough exercise.Physical activity nudges the bowels into action, so encourage your children to get plenty of It can be as simple as playing catch, riding bikes, or shooting a few basketball hoops.
Give your child more liquids.Drinking enough water and other liquids helps stools move more easily through the intestines. Most school-age children need at least 3 to 4 glasses of water each day. If your infant is constipated during the move from breast milk or to solid foods, try serving just a few ounces (2–4) of apple, pear, or prune juice each day.
Serve more fiber.High-fiber foods (such as fruits, vegetables, and whole-grain bread) can help prevent constipation. Fiber helps clean out the intestines by moving the bowels along. When adding more fiber to your child’s diet, do so slowly over a few weeks. Encopresis Parent Guide Sample Paper
– (KidsHealth, 2018)

Learn about effective toilet training techniques
Get your child into the habit of going. Encourage your child to sit on the toilet at least twice a day for 3-5 minutes, preferably 15-30 minutes after a meal. Make this time pleasant; do not scold or criticize the child if they are unable to poop.
Giving stickers or other small rewards and making posters that chart your child’s progress can help motivate and encourage him / her. Incentives will be most effective if they are age-appropriate, given immediately after the desired behavior is displayed and provided after every occurrence of the behavior during the early phases of teaching.
Taking a change of underwear and / or pants to school can help decrease your child’s embarrassment and improve his / her self-esteem as bowel control improves.
Talk to school teachers about your child’s need to be able to go to the bathroom at any time. Many children prefer privacy in bathrooms and will avoid going to the bathroom at school.
– (American Academy of Family Physicians, 2018), – (KidsHealth, 2018)

These small changes help most children feel better and get the bowels moving the way they should. Talk with your doctor before giving your child any kind of over-the-counter medicine for constipation.

To Learn More about Encopresis, Please Visit:
Mayo Clinic – Encopresis

https://www.mayoclinic.org/diseases-conditions/encopresis/symptoms-causes/syc-20354494
Stanford Children’s Health – Encopresis

http://www.stanfordchildrens.org/en/topic/default?id=encopresis-90-P01992
U.S. National Library of Medicine – Childhood Constipation: Evaluation and Management

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780136/
References
American Academy of Pediatrics. (2018). Soiling (Encopresis). Retrieved July 27, 2018,
from https://www.healthychildren.org/English/health-
issues/conditions/emotional-problems/Pages/Soiling-Encopresis.aspx
American Psychiatric Association (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washington, DC: Author.
Mayo Clinic. (2018, May 16). Encopresis. Retrieved July 27, 2018, from Encopresis Parent Guide Sample Paper
https://www.mayoclinic.org/diseases-conditions/encopresis/symptoms- causes/syc-20354494
Rajindrajith, S., Devanarayana, N. M., & Benninga, M. A. (2013). Review article: Fecal
incontinence in children: Epidemiology, pathophysiology, clinical evaluation and
Alimentary Pharmacology & Therapeutics, 37(1), 37-48.
doi:10.1111/apt.12103
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11 ed.). Philadelphia, PA: Wolters Kluwer.
Stanford Children’s Health. (2018). Encopresis. Retrieved July 27, 2018, from
http://www.stanfordchildrens.org/en/topic/default?id=encopresis-90-P01992
Encopresis Parent Guide Sample Paper

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