Encopresis

Encopresis is a medical condition where a child, more often a male, repeatedly has bowel movements somewhere other than the toilet. The condition is fairly common in early childhood and even occurs in some adolescents.

While the disorder usually resolves spontaneously, it can be problematic for months or years, causing conste
ation and frustration for all conce
ed. Some medical experts believe that encopresis represents a developmental delay and should be managed behaviorally. Some believe the condition should be managed by purging, a fairly well established and contemporary treatment. Usually, once a physician has determined the absence of an identifiable physical illness, encopresis falls into the realm of a mental disorder, particularly when it is protracted or becomes a factor that precipitates an adjustment disorder.

The Diagnostic and Statistical Manual of Mental Disorders (DSM IV) published by the American Psychiatric Association includes in its guidelines for the diagnosis of encopresis, that one event occurs once a month for at least three months, that the child with the disorder should be chronologically and developmentally four years of age and the activity may be either voluntary or involuntary. DSM IV divides encopresis into two categories:
Encopresis with Constipation and Overflow Incontinence
Encopresis without Constipation and Overflow Incontinence

The first category is often rather constant soiling with poorly formed or liquid stools. This type often responds when the constipation is treated but returns in time when purging is stopped. The affected child often complains of pain when toileting and often fails to have a completely satisfactory evacuation.

In the second category, the affected child is not constipated. The stool is usually well formed but the bowel movement occurs in a particular place other than the toilet.

DSM IV suggests that deliberate encopresis is often associated with anxiety or may be the result of an Oppositional Defiant Disorder or Conduct Disorder. The ABLE Development Group, using a comprehensive mental health inventory, has preliminary evidence that children with both forms of encopresis often have symptoms of obsessions or compulsions and /or repetitious behaviors that are ritualistic in nature. These behaviors are also often associated with anxiety.

If indeed some cases of encopresis are anxiety related, then a logical therapeutic approach would be to treat the child for anxiety. Searching for the cause of anxiety and eliminating the cause may prove to be rewarding. In some children one might augment treatment with a medication for anxiety. There are many safe medications approved for the treatment of anxiety in childhood.