Encopresis (307.7 or 787.9) |
Page Contributors: Thuy Nguyen, Tina Chang, RN, and Bo-Yun Huh
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Criteria:
- Repeated passage of feces into inappropriate places (e.g., clothing or floor) whether involuntary or intentional.
- At least one such event a month for at least 3 months.
- Chronological age is at least 4 years (or equivalent developmental level).
- The behavior is not due exclusively to the direct physiological effects of a substance (e.g., laxatives) or a general medical condition except through a mechanism involving constipation.
- With Constipation and Overflow Incontinence (787.6) -- i.e. There is evidence of constipation on physical exam or by history.
- Without Constipation and Overflow Incontinence (307.7) -- i.e. there is no evidence of constipation on physical exam or by history.
Functional fecal incontinence: involuntary passage of stool in the underwear after the acquisition of toileting skills, in the absence of overt neuromuscular anorectal dysfunction. Classified into two types:
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Fecal incontinence: The repetitive, voluntary or involuntary, passage of stool in inappropriate places by children four years of age and older, at which time a child may be reasonably expected to have completed toilet training and to exercise bowel control, after organic causes are ruled out. *the term fecal incontinence is preferred rather than encopresis or soiling
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Diagnostic Criteria for functional constipation (Rome III Criteria): Must include 2 or more of the following in a child with a developmental age of at least 4 years with insufficient criteria for diagnosis of IBS:
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Diagnostic Criteria for nonretentive fecal incontinence (Rome III Criteria): Must include all of the following in a child with a developmental age at least 4 years:
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Reference: Rasquin, A., Di Lorenzo, C., Forbes, D., Guiraldes, E., Hyams, J. S., Staiano, A., & Walker, L. S. (2006). Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology, 130(5), 1527-1537.
Screening
History
General health of child, including developmental history Presenting signs and symptoms Detailed stooling history:
Review dietary habits. Review emotional and social adjustment of child. |
Physical Exam
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Bristol stool scale
- Useful chart for parents and children to identify type of stool
- Can also help with treatment monitoring
Quick tip: GREAT screening overview at in the Encopresis chapter in IACAPAP Textbook of Child and Adolescent Mental Health by Alexander von Gontard. Make sure to look at the appendices as well. It includes sections on:
- Taking a Clinical History of Encopresis and Constipation: Examples of Questions
- Encopresis Questionnaire - Screening Version
- Encopresis Chart
Reference: Loening-Baucke, V. (2002). Encopresis. Current Opinion in Pediatrics, 14, 570-575.
Position Papers
- AAFP's "Treatment Guidelines for Primary Nonretentive Encopresis and Stool Toileting Refusal" (Kuhn, Marcus & Pittner, 1999)
- Evaluation and Treatment of Functional Constipation in Infants and Children -- Evidence-Based Recommendations from ESPGHAN and NASPGHAN (2014)
Articles
- Encopresis (Har & Croffie, 2010), in Pediatrics in Review
- Schonwald, A. & Rappaport, L. (2004). Consultation with the specialist: encopresis: assessment and management. Pediatrics in Review, 25(8), 278-282.
- Loening-Baucke, V. (2002). Functional Fecal Retention in Childhood. Practical Gastroenterology, 13-25.
- Loening-Baucke, V. (2002). Encopresis. Current Opinion in Pediatrics, 14, 570-575.
- Bongers, M. E., Tabbers, M. M., & Benningaa, M. A. (2007). Functional nonretentive fecal incontinence in children. Journal of Pediatric Gastroenterology and Nutrition, 44, 5-13.
- Montgomery, D. A. & Navarro, F. (2008). Management of constipation and encopresis in children. J Pediatr Health Care, 22, 199-204.
- Loening-Baucke, V. (2002). Encopresis. Current Opinion in Pediatrics, 14, 570-575.
- Kratimenos & Sell (2012) Elimination Disorders in Children and Adolescents. Journal of Developmental & Behavioral Pediatrics.
- Rasquin, A., Di Lorenzo, C., Forbes, D., Guiraldes, E., Hyams, J. S., Staiano, A., & Walker, L. S. (2006). Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology, 130(5), 1527-1537.
- Rockney, R. (1999) Encopresis. In Developmental Behavioral Pediatrics, 3rd ed, Levine, MD, Carey, WB, Crocker, AC (Eds), WB Saunders, Philadelphia. p. 413.
Resources
FOR PROVIDERS
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FOR FAMILIES
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