Encopresis

A Comprehensive Overview

Encopresis, also known as paradoxical diarrhea, stool withholding, and chronic constipation, is a condition characterized by involuntary fecal soiling in children who have been or are in the process of toilet training or well past the toilet training natural stage. 

Children and adults with encopresis often experience unintentional leakage of stool into their undergarments.

While the term is primarily applied to children, adults can also experience encopresis, which is more commonly referred to in adults, teens or young adults as fecal leakage or fecal soiling.

Causes of Encopresis

Encopresis can be caused by a variety of factors, including:

• Diet: Poor dietary habits, such as a lack of fiber, sugar intake, high fructose, and soda or juices can contribute to constipation.
• Constipation: Chronic constipation is a common underlying cause of encopresis. When stool becomes hard and difficult to pass, it can build up in the colon, leading to leakage.
• Reflexive Stool Withholding: Some children and adult individuals may instinctively withhold stool due to fear, anxiety, or past negative toileting habits and experiences.
• Physiological, Psychological, or Neurological Disorders: Underlying medical conditions can contribute to encopresis as well, especially emotional inconsistencies.
• Surgery: While less common, surgery can sometimes lead to encopresis.

The Encopresis Cycle

The colon's primary function is to remove excess water from feces. When stool remains in the colon for extended periods, often due to conditioned withholding or constipation, it becomes dehydrated and hardened, making it painful to expel, therefore children especially have an even harder time because they associated with pain.

This discomfort can create a vicious cycle, where the individual avoids bowel movements to avoid the associated pain. Over time, this conditioned withholding can lead to the rectal anal inhibitory response (RAIR) or anismus, which can occur even under anesthesia or when voluntary control is lost.

As hardened stool accumulates in the colon or rectum, it can stretch the intestinal walls, desensitizing the individual to the normal sensations associated with impending bowel movements. This can result in softer stool leaking around the blockage, leading to involuntary soiling.

Individuals with encopresis often have no control over these leakage accidents and may not be aware of them due to a loss of sensation in the rectum and the RAIR.

Emotional Impact

Repeated failed attempts to control bowel movements can lead to strong emotional reactions, such as shame, embarrassment, and anxiety. These emotional factors can further complicate the condition and make treatment more challenging.

Triggers and Onset

The onset of encopresis is often associated with significant life events, such as:

• Toilet Training: Demands to sit on the toilet for extended periods or negative parental reactions to accidents can contribute to encopresis.
• Starting School or Preschool: The transition to a new environment with shared bathrooms can be stressful for some children, especially if they have not reached a level of complete and their confidence is still lacking. 
• Family Dynamics: Feuding parents, siblings, moving, or divorce can disrupt toileting routines and contribute to constipation.

While these factors may trigger the initial onset of encopresis, chronic stimuli often play a more significant role in maintaining the condition.

The Role of the Pelvic Floor Muscles

The pelvic floor muscles play a crucial role in bowel control. These muscles help to support the pelvic organs, including the rectum, and control the passage of stool. In individuals with encopresis, the pelvic floor muscles may become weak or dysfunctional, leading to difficulty in coordinating the expulsion of stool.

Psychological Factors

In addition to the physical factors discussed earlier, psychological factors can also contribute to encopresis. Children and adults with encopresis may experience anxiety, depression, or trauma, which can affect their bowel habits. These emotional factors can lead to avoidance behaviors, such as withholding stool, which can exacerbate constipation and encopresis.

Treatment and Management

The treatment of encopresis typically involves a combination of approaches, including:

• Dietary Changes: Increasing fiber intake and ensuring adequate hydration can help to soften stool and promote regular bowel movements.
• Medication: In some cases, medications may be prescribed to treat constipation or address underlying medical conditions.
• Behavioral Therapy: Behavioral therapy can help individuals to develop healthy bowel habits, manage anxiety, and address any underlying psychological factors.
• Pelvic Floor Physical Therapy: Physical therapy can help to strengthen and coordinate the pelvic floor muscles, improving bowel control.

The Importance of Early Intervention

Early intervention is crucial in the treatment of encopresis. The longer the condition persists, the more difficult it can be to manage. By seeking help early on, children with encopresis can improve their quality of life and reduce the long-term consequences of the condition.

Additional Considerations

• Family Support: Encopresis can be a challenging condition for both the child and the family. It is important to provide support, understanding, and encouragement throughout the treatment process.
• School Accommodations: If necessary, accommodations may be needed at school to help the child manage their bowel movements.
• Prevention: Promoting healthy bowel habits, such as regular physical activity and a balanced diet, can help to prevent encopresis.

By understanding the causes, symptoms, and treatment options for encopresis, individuals and families can work together to manage the condition and improve quality of life, and we are here to help.