Encopresis (soiling)

•       Definition
Encopresis refers to passage of faeces into inappropriate places at age when bowel control should have been established. Chronological age must be > 4 years ,

•       Usually occurs in day time

•       High incidences in mentally retard children

•       Male : female ratio :: 2.5:1- 6:1

Etiology-

Inefficient intestinal motility

Improper toilet training

Aggressive and prolonged  medical management (laxatives, enemas, suppositories)

Dietary manipulation for perceived constipation

Anal fissures and rashes

Surgical procedures for imperforate anus

Psychosocial stresses or illness

Clinical features-

Blood streaked stool, abdominal pain, distension, poor appetite, hiding behind door, standing with characteristic posture, feel rejected

Management

Initial Counselling

Education

Psychological therapy

Behavioural therapy

Initial catharsis   (laxatives – lactulose)

Maintenance regimen

At home:                    

Dietary management

Nursing consideration:

Education , treat constipation, family counselling