Encopresis in children. Outcome and predictive factors of successful management.

OBJECTIVE: To elucidate our experience and outcome in the management of childhood encopresis, and to emphasize the factors that may predict successful management. METHODS: This prospective study was carried out between September 2003 and September 2011 in the Department of Pediatric Surgery, Al-Thoura Teaching Hospital, Al-Beida and Al-Butnan Medical Teaching Center, Tobruk, Libya. RESULTS: One hundred and thirty-two patients (117 male, 15 female) took part of the study. The male and female ratio was 7.8:1. The participants were patients aged 4-9 years. There were 30 (22.7%) patients between 4-5 years, 61 (46.2%) between 6-7 years, and 41 (31%) between 8-9 years. Nonretentive encopresis patients were 36 (27.2%) (Group I) and 96 (72.8%) patients had retentive encopresis (Group II). Patients with low fluid intake were 87 (65.9%) and low fiber diet were 91 (68.9%). Patients with delayed toilet training were 99 (75%). The total rate of successful conservative treatment was 70.5%. The rate of successful treatment in Group I was 94.4% and in Group II was 61.5%. We observed 18.2% of the patients had recurrence of encopresis. The factors found to predict good resolution rate after medical treatment included: cooperation of the parent and patient, female gender, ages above 5 years, and non-retentive encopresis. CONCLUSION: Encopresis remains a problem for the parents and the patients. Clinical evaluation is indispensable. Good outcome can be achieved effectively. Cooperative parents and patient, female gender, age above 5 years, and nonretentive encopresis are predictors for good response to medical treatment.

Early childhood risk factors associated with daytime wetting and soiling in school-age children.

OBJECTIVE: To examine the impact of a range of early childhood factors on the risk for daytime wetting and soiling. METHODS: This is a longitudinal study based on a UK population of over 10,000 children from age 4 to 9 years. Parents completed questionnaires on child development (at 18 months); child temperament (24 months); maternal depression/anxiety (21 months), and parenting behaviors (24 months). The analysis examined whether these risk factors distinguish between children with normal development of daytime bladder and bowel control and those with delayed acquisition of daytime continence; persistent daytime wetting/soiling, and relapse in wetting/soiling. RESULTS: Delayed development, difficult temperament, and maternal depression/anxiety were associated with an increase in the odds of experiencing problems with bladder and bowel control. CONCLUSIONS: The current findings provide evidence that risk factors in early childhood are associated with a subsequent increase in the odds of children experiencing daytime wetting and soiling at school age.

Children who soil: guidelines for good practice.

The need for a more coherent and integrated national service for children with constipation and soiling has been recognised for some years. It became clear to the team at the voluntary organisation Enuresis Resource & Information Centre (ERIC) as a result of the experiences of the many parents and professionals who contacted them. They responded by setting up a multidisciplinary working group to begin the process of reviewing the research. The group then went on to oversee the publication of the first national minimum standard guidelines for service delivery in this area of child health.

Self-care interventions for the school-aged child with encopresis.

Encopresis, an elimination disorder in children, presents as a challenging problem for gastroenterology nurses working with patients and families confronted with this disorder. This article offers a summary of the literature on encopresis, including pathogenesis, causative factors, early treatment, and clinical interventions focused on self-care. The antecedent factors that facilitate the child's participation in self-care are summarized, along with the intended outcomes of the self-care intervention plan.

Cisapride for the treatment of constipation in children: A double-blind study.

OBJECTIVE: To determine whether cisapride is effective in the treatment of children with constipation. STUDY DESIGN: Double-blind, placebo-controlled study in which children with chronic constipation were randomly assigned to treatment with cisapride or placebo for 12 weeks. RESULTS: Forty children were enrolled, and 36 completed the therapy. Treatment successes occurred in 13 of 17 (76%) subjects in the cisapride group and 8 of 19 (37%) subjects in the placebo group (P <.03). The odds ratio for response after cisapride administration was 8.2 times higher (95% CI 1.3 to 49.4). During cisapride therapy, there was a significant improvement in number of spontaneous bowel movements per week (from 0.9 +/- 0.1 to 4.1 +/- 1.1), and there was a significant decrease in number of fecal soiling episodes per day (1.8 +/- 0.5 to 0.08 +/- 0.4), percent with encopresis (82% vs 23%), number of laxative doses per week (from 10.3 +/- 2.6 to 0.8 +/- 0.6), percent using laxatives (77% to 24%), and total gastrointestinal transit time (from 115.0 +/- 3.7 hours to 77.0 +/- 11.1 hours). With placebo, there were no significant changes in the number of spontaneous bowel movements (from 1.0 +/- 0.8 to 2.2 +/- 0.6), percent with encopresis (74% vs 47%), or total gastrointestinal transit time (from 112.5 +/- 4.9 hours to 95.4 +/- 9.8 hours); but there was a significant decrease in number of fecal soiling episodes per day (from 1.3 +/- 0.4 to 0.4 +/- 0.2) and number of laxative doses used per week (from 11.5 +/- 2.9 to 2.05 +/- 0.7). The final number of spontaneous bowel movements, fecal soiling episodes, laxatives used, or percent patients with encopresis was not different when patients receiving cisapride were compared with those receiving placebo. CONCLUSION: Cisapride was effective in the treatment of children with constipation.

How to resolve stool retention in a child. Underwear soiling is not a behavior problem.

Many parents do not realize their child has stool retention when they bring him or her for an office visit. Some complaints that may be a tip-off and should prompt questioning about stool frequency and underwear soiling are vague abdominal pain, urinary incontinence, and stools so large they plug the toilet. A rectal examination is usually adequate to confirm the diagnosis. Management begins with educating parents that leaking of liquid stool around impaction and onto underwear is completely involuntary, so the child should never be scolded or embarrassed. Stool retention may begin because of unpleasant or unavailable toilet facilities, constipation, or painful elimination and often becomes self-perpetuating. Impaction must be removed immediately; magnesium citrate solution is usually effective. To allow the rectum to return to its normal size, which can take an extended time, stool must be kept soft and movable with administration of mineral oil and appropriate dietary choices (eg, fruit, juice, fiber). Recurrence is common, so ongoing measures and follow-up are important.

Análise de estratégias de intervençäo psicológica comportamental em encoprese infantil / Analysis of the psychological behavioral intervention strategies employed in the treatment of child encopresis

Este trabalho teve por objetivo efetuar uma análise das estratégias utilizadas para o tratamento de encoprese na tentativa de melhor compreender o processo que levava à sua eficácia. O conjunto de estratégias abrangia: coleta de dados, orientaçöes para reeducaçäo do processo digestivo, registro de "acidentes" (defecaçöes fora do vaso) pela família, conhecimento do processo digestivo, relaxamento, atividades de desenhos e atividades de jogos. Para possibilitar a análise, as sessöes terapêuticas foram gravadas em fita cassete e procedeu-se à categorizaçäo das interaçöes entre terapêutas e clientes (mäe e criança) durante o processo terapêutico. As categorias criadas foram: 1)informaçöes do processo terapêutico, 2)informaçöes do caso, 3)registro de evacuaçöes, 4)informaçöes relativas ao contexto no qual ocorreram as evacuaçöes, 5)informaçöes do comportamento alimentar, 6)informaçöes do comportamento da criança em casa, na escola ou outros ambientes, 7)manejo da criança pela família, 8)manejo da criança pela escola, 9)orientaçäo do manejo alimentar, 10)orientaçäo do manejo da criança, 11)atividades de desenho e 12)atividades de jogos. A metodologia abrangeu portanto duas fases. Na primeira, foram relatados três casos: um caso de encoprese retentiva, um caso de encoprese por stress e manejo do ambiente por parte do cliente e um caso de encoprese näo retentiva. Nos dois primeiros houve sucesso e no terceiro fracasso no tratamento. Foram discutidos também procedimentos e resultados terapêuticos, para cada caso e comparativamente. Na segunda fase, foram categorizadas interaçöes terapeuta-cliente, acima citadas, relevantes por seu índice de freqüência no tratamento. Quanto aos resultados da primeira fase, foi possível observar alteraçöes no comportamento de evacuar em todos os casos. As estratégias utilizadas foram similares, mas sua utilizaçäo se deu de acordo com a análise funcional de cada caso. Na segunda fase pode-se verificar categorias relativas ao processo da terapia comportamental, que aparecem em todos os casos. A freqüência do aparecimento das categorias foi diferente de acordo com o tipo de encoprese diagnosticado (primária ou secundária, retentiva ou näo retentiva, por stress ou por manipulaçäo do ambiente) bem como as estratégias utilizadas em sua abordagem

[Re-education in biofeedback: role in terminal constipation in children]. / La rééducation en biofeedback: rôle dans la constipation terminale de l'enfant.

BACKGROUND: Chronic constipation with or without encopresis is often associated with abnormal defecation dynamics evidenced by manometric study and possibly manageable with biofeedback treatment. PATIENTS AND METHODS: Twenty-six children more than 5 years of age suffering from constipation with or without encopresis for at least 6 months were treated with biofeedback plus lactulose; 15 of them were also given psychiatric attention. Pressure recordings from the internal and external sphincters in response to transient balloon distension of the rectum were obtained in all patients as did the recto-anal inhibitory reflex and the rectal sensitivity. RESULTS: Sixteen patients were considered as definitely cured or improved with this management; two others had relapses 6-12 months later and five were not improved; the three remaining patients were lost for follow-up. CONCLUSION: As already reported, biofeedback treatment represents an interesting role in management of such children.

Preventing encopresis.

Pediatric nurses can play a major role in preventing encopresis through anticipatory guidance and education. An understanding of contributing factors that may lead to constipation and encopresis will assist pediatric nurses in their efforts to help prevent this condition.

The prevention of constipation and encopresis: a developmental model and approach.

This article proposes a developmental model for understanding the evolution and treatment of bowel problems in infancy and childhood. It focuses on anticipatory guidance to maximize parental understanding of the normal variations of bowel function and specific interventions to limit the long-term effects of mild bowel problems.