The Schoolchild with Encopresis

Abstract

Often, a schoolchild with encopresis feels desperate, lacking a most primitive form of control, harboring a painful secret, susceptible to exposure and peer ridicule, wounded by the disdainful remarks of parents and siblings, and perplexed over why he messes. Often children with encopresis receive inconsistent care; management may vacillate from intentional disregard of the problem to active coercion or vindiction. Parents may be baffled by conflicting advice from neighbors, teachers, grandparents, pharmacists, and even pediatricians. Most "accidents" occur in the late afternoon (commonly 3:00 to 7:00 PM). Unlike enuresis, nocturnal encopresis is rare and more difficult to treat successfully. Many children insist (correctly) that they do not receive a "signal" or feel the call to use a bathroom. They may plan furtively to conceal their shameful out-flow, burying underwear in the garden or sequestering soiled clothing in trash cans and behind dressers! Encopresis is defined as the deposition of formed or semiformed stools in a child's underwear (or other unorthodox sites), occurring after the age of 4 years on a regular basis. Some authors differentiate between encopresis and fecal soiling, basing the distinction on the extent to which full-bowel movements are passed.1 This classification, however, often does not conform to clinical experience, since longstanding cases commonly fluctuate over time in patterns of incontinence and stool consistency.