Causes of Encopresis continued...
Over time, the child with encopresis may also develop incoordination of the muscles used to pass bowel movements. In many children, the anal sphincter contracts rather than relaxes when they are trying to push out bowel movements. This disturbed coordination of muscle function, which causes fecal retention, is a key to the diagnosis and is also called anismus or paradoxic contraction of the pelvic floor to defecation.
What causes the constipation in the first place?
- Some experts believe children become constipated when they do not eat enough fiber, available in fruits, vegetables, and whole grain foods.
- Many doctors think that some children become constipated because they do not drink enough water.
- Constipation does seem to run in certain families.
- For many children, no clear cause of the constipation can be identified.
Encopresis is a very frustrating condition for parents. Many parents become angry at the repeated need to bathe the dirty child and to clean or discard soiled underwear. Many parents assume the soiling is the result of the child being lazy or that the child is soiling intentionally. In most cases, this is not the case. Children with encopresis are no more likely than other children to have major behavioral or emotional problems.
Symptoms of Encopresis
More than 80% of children with encopresis have experienced constipation or painful defecation in the past. In many cases, constipation or pain occurred years before the encopresis is brought to a doctor's attention.
Most children with encopresis say they have no urge to pass a bowel movement before they soil their underwear. Soiling episodes usually occur during the day, while the child is awake and active. Many school age children soil late in the afternoon after returning home from school. Soiling at night is uncommon.
In many children with encopresis, the colon has become stretched out of shape, so they may intermittently pass extremely large bowel movements.
When to Seek Medical Care for Encopresis
Any of the following warrants a visit to your child's primary care provider:
- Severe, persistent, or recurrent constipation
- Pain during bowel movements
- Reluctance to have bowel movements, including straining to hold stool in
- Soiling in a child who is at least 4 years old
Exams and Tests for Encopresis
To diagnose enopresis, your child’s health care provider will ask many questions about his medical history, toilet training history, diet, lifestyle, habits, medications, and behavior. A thorough physical exam will be done to assess the child’s general health as well as the status of the colon, rectum, and anus. The examiner may insert a gloved finger into the child’s rectum to feel for stool and make sure the anal opening and rectum are of normal size and that the anal muscles are of normal strength.