What is the Inorganic Encopresis?
Inorganic encopresis – fecal incontinence at an age when physiological control over bowel activity must be developed and when toilet training is completed.
Intestinal control develops consistently with the ability to refrain from emptying the bowels at night, then during the day.
The achievement of these features in the development is determined by physiological maturation, intellectual abilities, degree of culture.
Causes of the Inorganic Encopresis
Lack of or insufficiently effective toilet training can lead to a delay in holding back bowel movements. Some children suffer from a failure of the contractile function of the intestine. The presence of a concomitant mental disorder is often indicated by emptying the intestines in the wrong places (with a normal consistency of discharge). Sometimes encopresis is associated with problems of the development of the nervous system, including the inability to sustain attention for a long time, easy distractibility, hyperactivity and poor coordination. Secondary encopresis is sometimes a regression associated with stress factors (birth of a sibling, divorce of parents, change of residence, the beginning of schooling).
Prevalence
This disorder is observed in 6% of three-year-olds and in 1.5% of 7-year-old children. 3-4 times more often in boys. Approximately 1/3 of children suffering from encopresis, there is also enuresis. Most often encopresis is observed in the daytime, if it occurs at night – the prognosis is poor.
Symptoms of Inorganic Encopresis
The decisive diagnostic sign is the act of defecation in inappropriate places. Excretion of feces (in bed, clothes, on the floor) is either arbitrary or involuntary. The frequency of at least one manifestation per month for at least 6 months. Chronological and mental age of at least 4 years. The disorder should not be associated with a medical condition.
Primary encopresis: if the disorder is not preceded by a period of control over bowel function for at least 1 year.
Secondary encopresis: the disorder was preceded by a period of control over bowel function lasting 1 year or more.
In some cases, the disorder is due to psychological factors – aversion, resistance, inability to comply with social norms, while there is normal physiological control over defecation. Sometimes the disorder is observed due to the physiological delay of feces with the secondary overflow of the intestine and discharge of feces in inappropriate places. Such a delay in defecation can occur as a result of conflicts between parents and children when learning to control the bowel or because of the painful act of defecation.
In some cases, encopresis is accompanied by smearing of feces over the body, the environment, or there may be a finger inserted into the anus and masturbation. At the same time accompanying emotional and behavioral disorders are often observed.
Diagnosis of Inorganic Encopresis
When making a diagnosis, it is important to consider: 1) encopresis due to an organic disease (colon agangliosis), spina bifida; 2) chronic constipation, including fecal overload and the subsequent soiling with semi-liquid feces as a result of “intestinal overflow”.
However, in some cases, encopresis and constipation can coexist, in such cases a diagnosis of encopresis is made with additional somatic coding of the condition that caused the constipation.
Treatment of Inorganic Encopresis
Effective psychotherapy is aimed at reducing stress in the family and alleviating the emotional reactions of a person suffering from encopresis (emphasis on increasing self-esteem). Recommended permanent positive reinforcement. When fecal incontinence is associated with impaired bowel function, secondary to the period of retention of feces (constipation), the patient is taught the rules of hygiene. Measures are being taken to relieve pain during defecation (anal fissures or hard stools), in these cases it is necessary to monitor the pediatrician.