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Early constipation and toilet training in children with encopresis
Laurie Fishman1, Leonard Rappaport, Dominique Cousineau
1Combined Program in Gastroenterology and Nutrition, and Division of General Pediatrics, Children's Hospital, Boston, Massachusetts 02115, USA. Laurie.Fishman@tch.harvard.edu
Insights
This study found that children with primary encopresis experienced more difficult toilet training, including interruptions and punishment, compared to those with secondary encopresis. Early constipation and early toilet training initiation were less common than anticipated.
Area of Science:
- Pediatric gastroenterology
- Child psychology
- Bowel dysfunction research
Background:
- Encopresis, or fecal incontinence, affects children during toilet training.
- Understanding predisposing factors and toilet training practices is crucial for effective intervention.
- Differentiating between primary and secondary encopresis may reveal distinct etiological pathways.
Purpose of the Study:
- To determine the prevalence of factors that predispose children to encopresis.
- To compare these factors and toilet training experiences between children with primary and secondary encopresis.
- To analyze the impact of toilet training practices on encopresis development.
Main Methods:
- Retrospective review of questionnaires from 411 children evaluated at an encopresis clinic.
- Analysis of factors in the first two years of life, toilet training practices, and disruptive events.
- Exclusion of children under 48 months and those with organic defecation disorders.
Main Results:
- Constipation was reported in 35% of children with encopresis; 24% had prior constipation treatment.
- Primary encopresis cases showed higher rates of toilet training interruption (50% vs. 23%) and punishment (52% vs. 26%).
- Constipation (30% vs. 18%), abdominal pain (23% vs. 9%), and fear of the toilet (47% vs. 10%) were more frequent in primary encopresis.
Conclusions:
- Early difficult defecation, prior constipation treatment, and early toilet training initiation were less frequent than expected.
- Children with primary encopresis did not show increased early constipation or invasive treatments compared to secondary encopresis.
- Primary encopresis is associated with more challenging and disruptive toilet training experiences.
Objective:
To evaluate the frequency of predisposing factors for encopresis before and during toilet training, comparing children with primary and secondary encopresis.
Methods:
In this retrospective study, questionnaires from the initial evaluation at an encopresis clinic at a tertiary care pediatric hospital were reviewed for the presence or absence of factors in the first 2 years of life, for toilet training practices, and for disruptive events during the training process. Children younger than 48 months or those with organic defecation disorders were excluded.
Results:
In 411 children with encopresis, the reported frequency of predisposing factors included constipation in 35%, and previous treatment for constipation in 24%. Toilet training was initiated before age 2 years in 26% and after age 3 years in 14%. Interruption of toilet training and punishment were seen more in primary encopresis than in secondary encopresis (50% versus 23%; P < 0.05) and (52% versus 26%; P < 0.05) respectively. Constipation (30% versus 18%; P < 0.05) and abdominal pain (23% versus 9%; P <0.0:5) during toilet training were more common in primary encopresis as was fear of the toilet (47% versus 10%; P < 0.05).
Conclusions:
In children with encopresis, early difficult defecation, previous treatment for constipation, and early initiation of toilet training were less common than expected. Children with primary encopresis did not have an increased incidence of early constipation or invasive treatments compared with those with secondary encopresis. However, children with primary encopresis did have more difficult and disruptive toilet training experiences.