Encopresis (stool holding)

Abdomen | Gastroenterology | Encopresis (stool holding) (Disease)


Description

Encopresis represents the inability to control the elimination of stool. Encopresis can have a variety of causes, including inability to control the anal sphincter muscle or gastrointestinal problems, particularly chronic diarrhea and Crohns disease. Several neurological disorders, including Tourette syndrome and obsessive-compulsive disorder, are also occasionally associated with the symptom of encopresis, particularly in children.

The colon normally removes excess water from feces. If the feces or stool remains in the colon too long due to conditioned withholding or incidental constipation, so much water is removed that the stool becomes hard, and becomes painful for the child to expel in an ordinary bowel movement.

Causes and Risk factors

Encopresis is also called stool holding. It usually occurs in children older than 4 and results from a resistance to have a bowel movement. With time stool backs up in the large intestine and rectum and can become lodged (impacted) at the rectum. The child then experiences involuntary passage of liquid stool around the blockage which stains the underwear.

Diagnosis and Treatment

A vicious cycle can develop, where the child may avoid moving his/her bowels in order to avoid the expected painful toilet episode. The hardened stool continues to build up and stretches the colon or rectum to the point where the normal sensations associated with impending bowel movements do not occur. Eventually, softer stool leaks around the blockage and cannot be withheld by the anus, resulting in soiling. The child typically has no control over these leakage accidents, and may not be able to feel that they have occurred or are about to occur due to the loss of sensation in the rectum and the RAIR. Strong emotional reactions typically result from failed and repeated attempts to control this highly aversive bodily product. These reactions then in turn may complicate conventional treatments using stool softeners, sitting demands, and behavioral strategies. ...