Stephen Borowitz, MD
Bhupinder Anand, MD
IN THIS ARTICLE
Rarely, encopresis is caused by an anatomic abnormality or disease that the child is born with. In the vast majority of cases, encopresis develops as a result of chronic (long-standing) constipation.
What is constipation?
Many people think of constipation as not passing a bowel movement every day. However constipation implies not only infrequent bowel movements, but also having difficulty in passing bowel movements and/or experiencing pain with the passage of stools. In most cases of childhood constipation, the constipation develops after the child experiences pain when passing stools.
In most children with encopresis, the problem begins with the passage of large stools and/or having pain while passing stools. This often happens long before the encopresis starts, and the child may not remember this when asked.
Over time, the child with encopresis may also develop incoordination of the muscles used to pass bowel movements. In many children, the anal sphincter contracts rather than relaxes when they are trying to push the stools out. This disturbed coordination of muscle function called anismus or paradoxical contraction of the pelvic floor during defecation, makes it very difficult for the child to empty his or her colon when they go to the toilet.
What causes the constipation in initially?
Encopresis is a very frustrating condition for parents. Many parents become angry at the repeated need to bathe the dirty child and to clean or discard soiled underwear. Many parents assume the soiling is the result of the child being lazy or that the child is soiling intentionally to annoy them. In most instances, this is not the case. Children with encopresis are however significantly more likely to suffer from attention deficit hyperactivity disorder (ADHD) than the general population. It is important to remember that in almost all cases, encopresis is involuntary - the child does not soil on purpose.
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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."