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Encopresis in children: a cyclical model of constipation and faecal retention
Insights
Encopresis, or fecal incontinence, affects 1% of children. A simple behavioral approach, including laxatives and family cooperation, can successfully manage this condition in general practice.
Area of Science:
- Pediatrics
- Gastroenterology
- Behavioral Medicine
Background:
- Encopresis affects 1% of children, causing significant distress and stigma.
- General practitioners can manage encopresis, but psychoanalytical theories may deter them.
- The condition involves stool retention leading to constipation and soiling, creating a perpetuating cycle.
Purpose of the Study:
- To outline a practical, non-psychoanalytical approach for managing encopresis in general practice.
- To emphasize the role of behavioral interventions and multidisciplinary support.
Main Methods:
- Exclusion of physical causes of encopresis.
- Implementation of a simple behavioral program focused on bowel retraining.
- Use of laxatives to prevent stool retention.
- Involvement of child, family, and school in the management plan.
Main Results:
- Successful management of encopresis is achievable in general practice settings.
- A collaborative approach involving laxatives, behavioral strategies, and support systems is effective.
Conclusions:
- Encopresis can be effectively managed in primary care by excluding organic causes and implementing a structured behavioral program.
- Addressing the cycle of constipation and retention through laxatives and retraining, with family and school involvement, leads to successful outcomes.
Abstract:
Encopresis afflicts one in 100 children causing considerable stigma and parental concern. General practitioners are in a position to help in most cases but are often deterred by the psychoanalytical theories which have been developed to explain this problem. It is currently accepted that children with encopresis tend to retain stools. This leads to constipation, overstretching of sphincters and resultant faecal soiling. Physical and psychological perpetuating factors result in retention once again, thus completing a cycle of constipation and retention. Various precipitant and predisposing factors can maintain this cycle. Once physical causes have been excluded a simple behavioural approach can be adopted aimed at retraining the bowel. By using laxatives to prevent retention, gaining the child's confidence, cooperation and understanding and involving both the family and school, encopresis can be successfully managed in general practice.