Stephen Borowitz, MD
Bhupinder Anand, MD
IN THIS ARTICLE
Encopresis Other Therapy
Fiber supplements and certain foods, such as fruit juices and prunes, can have a laxative effect. These foods and juices function as osmotic laxatives. They all contain various sugars that are not efficiently absorbed by the intestinal lining, thus increasing the amount of water in the colon. Given in large enough doses, all of these foods and juices are very effective laxatives. However, most children are not willing to take in enough of these fruits and juices day in and day out for many months to serve as primary treatment for encopresis. Eaten in large enough quantities to ensure two soft bowel movements a day, these foods and juices often cause bloating and gas.
There is little evidence that eating a high-fiber diet significantly improves encopresis once it is established, although it may help prevent constipation in the first place.
Drinking plenty of fluids helps keep stools soft and may help prevent constipation initially.
Children with encopresis rarely need surgery. However, surgery may be used in extremely chronic and refractory cases.
Enemas: Most enema preparations contain large amounts of water in addition to something that is not efficiently absorbed by the intestinal lining. This prevents the water in the enema from being absorbed, so the water remains in the colon. The enema is inserted into the rectum. This softens the stool in the rectum and creates pressure within the rectum. This pressure gives the child a powerful urge to have a bowel movement, and the stool is usually expelled rapidly. Common examples include phosphate or saline (salt) solutions or milk and molasses. The effectiveness of any particular enema preparation is probably more dependent on the volume (size) of the enema than on its chemical make-up. The phosphate-sodium enema (Fleet Enema) is probably the most widely used type.
Note: Some gastrointestinal specialists discourage the use of enemas and suppositories or any anal intervention because the child associates fear and pain with the anal area. The child may struggle or feel additional trauma when these types of manipulations are performed. Eventually, all impacted stool can be dissolved or disimpacted by using medications taken by mouth.
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According to the Diagnostic and Statistical Manual of Mental Disorders, Third edition (DSM-III), encopresis is defined as the "repeated involuntary passage of feces into places not appropriate for that purpose...the event must take place for at least 6 months, the chronologic and mental age of the child must be at least 4 years."