Physical Therapy for a Child With Encopresis: A Case Report.

PURPOSE: To describe the implementation and effectiveness of a multimodal therapeutic approach used to successfully treat a child with encopresis. SUMMARY OF KEY POINTS: The child demonstrated chronic constipation, poor pelvic floor muscle awareness, weakness, and incoordination during voiding. He participated in 8 sessions of physical therapy intervention including pelvic floor muscle awareness, strengthening and coordination exercises, behavioral adaptations, diet modification, and use of media, art, and interactive visualization activities. CONCLUSIONS: The child improved pelvic floor muscle strength and coordination and became fully continent of bowel in home and community settings. WHAT THIS CASE ADDS TO EVIDENCE-BASED PRACTICE: This case report demonstrates that pediatric age-appropriate educational and motivational tools (media, art, and interactive visualization activities) are readily available, economical, and effective when used in conjunction with current practice to decrease impairments and improve active participation and compliance during treatment of retentive encopresis in the pediatric population.

Entrenamiento anorrectal domiciliario como tratamiento de la encopresis y disinergia esfinteriana / Home anorectal training, as a treatment of faecal incontinence and sphincter dyssynergia

Objetivo. Los trastornos de la defecación representan el 3% de las consultas en pediatría. Nuestro objetivo fue demostrar la eficacia y eficiencia de la reeducación en la maniobra defecatoria mediante el entrenamiento domiciliario en los pacientes con encopresis y disinergia esfinteriana. Material y métodos. Estudio de los pacientes con encopresis tratados mediante entrenamiento domiciliario en nuestro centro entre 2014-2015. Se realizó manometría anorrectal y fue valorada la maniobra defecatoria mediante la expulsión o no de la sonda rectal con o sin balón. Se realizaron sesiones diarias de forma domiciliaria empleando una sonda de Foley (18-20 Fr.) con llenado progresivo del balón, máximo 20 cc. Se evaluó la respuesta al tratamiento en función de la presencia de manchado. Resultados. Se incluyeron 7 pacientes (6 varones y 1 mujer) con edad media de 9.7 años (rango, 5-15); dos con antecedente de malformación anorrectal, una enfermedad de Hirschsprung, 1 teratoma sacrococcígeo y 3 encopresis funcionales. Tres pacientes presentaban manchado diario y 4 de forma frecuente. La media de presión basal del canal fue de 32,34 mmHg (rango, 11,74-50,75) con maniobra defecatoria negativa en 2 casos, deficiente en 3 y disinérgica en 2. La media de tiempo realizando el entrenamiento intestinal hasta lograr estar asintomáticos fue 5.14 meses (rango, 2-11), con un seguimiento medio de 16,14 meses (rango, 3-24), manteniéndose limpios actualmente los 7 pacientes. Conclusiones. El presente estudio sugiere que la reeducación de la maniobra defecatoria mediante entrenamiento domiciliario parece ser una terapia eficaz y eficiente, logrando excelentes resultados a medio plazo (AU)

Objective. the defecation disorders represents the 3% of consultations in pediatrics patients. Our goal was to demonstrate the effectiveness and efficiency of the reeducation of the defecation maneuver through home training in patients with encopresis and sphincter dyssynergia. Material and methods. Study of patients with fecal incontinence treated with home training at our center between 2014-2015. Anorectal manometry was performed and was valued defecation maneuver by expulsion of rectal probe with or without the ball. Daily sessions were performed using a Foley catheter (18-20Fr.) with progressive filling of the balloon, maximum 20cc. The response to the treatment was assessed in terms of episodes of soiling. Results. Seven patients (6 males and 1 female) with a mean age of 9.7 years (range, 5-15) were included; two patients with anorectal malformation history, 1 Hirschsprung disease, 1 sacrococcygeal teratoma and 3 functional encopresis. Three patients had soiling episodes daily and 4 patients frequently. The mean basal pressure of anal channel was 32.34mmHg (range, 11.74-50.75) with negative defecation maneuver in 2 cases, deficient in 3 and dyssynergic in 2 patients. The mean time of biofeedback therapy to be asymptomatic was 5.14 months (range, 2-11), with a mean of 16.14 months (range, 3-24), with the 7 patients currently maintained clean. Conclusions. The present study suggests that re-education of defecation maneuver through home training, seems to be an effective and efficient therapy, achieving excellent results in medium term (AU)

[REASONS AND CONSEQUENCES OF SOMATOFORM DISORDERS IN CHILDREN AND ADOLESCENTS].

The aim of our study was to find the reason of various forms of somatoform disorders (phobias, behavioral disorders, insomnia, tics, stuttering, enuresis, encopresis) in children and adolescents of various social status for diagnosis and treatment. We have examined 202 patients who referred to our clinic from 2012-2016. The age range was 2-18 years. After examination we have concluded the following recommendations: - to implement neuropsychological rehabilitation in order to stimulate mental development; - to work with speech therapist to improvement the speech; - to work individually with psychotherapist to improve the behavior; - to train the parent to manage the behavior at home; - to give the personal card containing information about exercises, games and puzzles to stimulate the development and in some cases to give individual educational program; - to give separate information to parents and in some cases to teachers of kindergartens and schools.

Assessment of toileting difficulties in adults with intellectual disabilities: an examination using the profile of toileting issues (POTI).

A lack of toileting skills is one of many impairments that individuals with intellectual and developmental disabilities experience. Unfortunately, little research has focused on problems in this area including assessment, function, and treatment. A newly developed checklist, the Profile of Toileting Issues (POTI), is being considered for use to screen for toileting issues in this population, and to identify potential functions to target in treatment. The purpose of the current study was to examine the reliability of the POTI. Internal consistency was sound (α = .83) and interrater reliability was significant. The implications of these findings are included.

A group treatment approach to failure to toilet train: the case of Max.

Toilet training is a major developmental milestone for children and parents. Accurate statistics on the prevalence of toilet-training failure do not exist; however, it is estimated that approximately 4% of 4-year-olds are not bowel trained. A number of biopsychosocial and developmental factors can interfere with toilet training. Frequently, a cycle of withholding and constipation with painful bowel movements and/or overflow incontinence ensues. A case study of a 4-year-old boy with encopresis and pervasive developmental disorder will highlight an interdisciplinary team's approach to helping children (4-6 years old) toilet train. Along with individual patient care management, parents and children attended (separately) a six-session medical and psychoeducational group called "Toilet School." This group model employs the principles of behavior modification, the concepts of children's preoperational thinking, and a philosophy of care that values collaborative relationships between caregivers and families.

Evaluation of a standard protocol for retentive encopresis: a replication.

Replicated the efficacy of a short-term, combined medical and behavioral intervention protocol for retentive encopresis. Fifty-nine children who had failed standard medical management for retentive encopresis and their parents participated in six 1-hour group treatment sessions. Treatment protocol combined the medical management strategies of enema clean out, increasing dietary fiber, and daily toilet sitting with the child behavior management strategies of differential attention, contingency management, and contracting. For the overall sample, the number of soiling incidents decreased 85%, the weekly frequency of independent bowel movements increased 15%, the weekly frequency of parent-prompted bowel movements increased 9%, and daily dietary fiber intake increased 121% pre- to posttreatment. The majority of the sample (86%) stopped soiling by the end of treatment and did not require further treatment. Results are discussed in terms of the comparability with previous findings and the utility of combined medical and psychological treatments for children with encopresis who have failed standard medical approaches.

A behavioural approach to the treatment of non-retentive encopresis in adults with learning disabilities.

Problems such as encopresis are perceived as "normal' for some populations. For example, within the field of learning disability, little serious study has been devoted to either prevalence or aetiology of encopresis. Treatment issues have been obscured by problems of definition and aetiology. Treatment reports are rare despite the apparent magnitude of the problem, and involve a disproportionate number of cases with a mild intellectual disability or secondary encopresis. The following report describes a reinforcement-based treatment programme for primary, non-retentive encopresis in five young adult men with mainly more severe learning disabilities. Major soiling accidents were eliminated in four out of five cases and substantially reduced in the fifth. Treatment times were long. Issues relating to the use of aversive techniques are discussed, as are the limitations of the present study.

A behavioral approach to the treatment of nonretentive nocturnal encopresis in an adult with severe learning disabilities.

Encopresis is widely assumed to be "normal" among individuals who are learning disabled. Yet, reports on its prevalence, etiology and treatment are rare and mainly confined to secondary encopresis or to populations with milder learning disabilities. The behavioral treatment of a life-long nonretentive, nocturnal encopresis is described for a young adult with severe learning and physical disabilities living at home. Treatment involved waking prior to soiling, time-limited use of suppositories and rewards for appropriate evacuation. Soiling decreased to zero over 20 weeks. Time of waking was then gradually "shaped" back to normal.

Attentional dysfunction in children with encopresis.

Encopresis and attentional dysfunction are common neurobehavioral disorders of childhood. The extent to which these disorders occur in association is unknown. The purpose of this study is to document the comorbidity of attentional dysfunction in a clinically identified population of encopresis patients. We used the Child Behavior Checklist (CBCL) to estimate the prevalence of disordered attention or hyperactivity in a group of children with encopresis seen at a tertiary care facility. Responses to CBCL questionnaires were analyzed to compare scores on the "hyperactive" behavior subscale with published normative data. The number of encopretic respondents with T scores above 70 (> 2 SD above the mean) on a hyperactivity subscale was ascertained for each age and gender cohort. From 347 eligible new clinic patients, responses from 167 were suitable for analysis. Overall, 23.4% of children with encopresis (95% confidence interval: 17.2%-30.5%) had T scores on the hyperactive subscale higher than 70. This prevalence (ten fold greater than expected in the normal population) was similar in both genders and across age groups. This association between attentional dysfunction and encopresis has significance for theories regarding etiology and for practical treatment strategies.

Parental and patient perceptions about encopresis and its treatment.

Treatment of encopresis in childhood is often a long and trying process. Children followed for secondary encopresis in a multidisciplinary clinic between 1984 and 1989 were sent a parent/child mail questionnaire seeking information on their understanding of encopresis as well as their opinions on current treatment modalities. Twenty-eight families responded (20 boys and 8 girls), the child's mean age was 9.8 years, and the mean time elapsed after diagnosis was 3.5 years. Parents and children reported that intestinal dysfunction (53%) and painful defecation (46%) were the most important causes of their encopresis. Treatment modalities including enemas were well accepted by both parents and children, with parents considering dietary changes the most useful treatment modality (p < .01). Children reported that regular "toilet routine" was the most helpful in reestablishing continence. Despite good comprehension of the problem and acceptance of the treatment modalities, the complete recovery rate after 3.5 years was only 35.7%, with no differences noted between responders and nonresponders. Encopresis is a chronic condition that persists in a significant proportion of patients, despite adequate patient and parental knowledge and patient acceptance of treatment.

Use of play with clay to treat children with intractable encopresis.

We used play with modeling clay to treat six children, aged 4 to 12 years, with a history of intractable constipation with encopresis for a mean of 5.4 (2 to 8) years, refractory to treatment; biofeedback therapy had not been tried. Clay was chosen because, as a brown, messy material, it was a metaphor for feces and could let the child express either his disgust or aggressivity, or let him build symbolic structures. No interpretation was made during treatment. Four children had no symptoms during 2 months of therapy and no relapse during 1 year of follow-up, one child improved significantly, and one child failed to respond but withdrew from treatment after only three sessions. Modeling clay may be a cheap and effective treatment modality for refractory constipation with encopresis.

Encopresis in Hirschsprung's disease: a report on two cases.

Two patients with persistent severe encopresis after surgery for Hirschsprung's disease were treated with a token economy type of behavior modification therapy. After eight weeks there was very marked improvement, which persisted after discharge home without relapse after four and eight months respectively.