Childhood encopresis (incontinence): causes, types and treatment

Many boys and girls, and even some adults, have experienced some type of incontinence, whether urinary or fecal. As for fecal incontinenceIn a large number of cases, we can see that this loss of control can be due to a disease such as gastroenteritis or epilepsy, loss of muscle tone of the sphincters due to age, the presence of alterations such as those caused by surgery or the use of certain substances.

But the cause is not always organic: sometimes sensations and emotions such as fear or anxiety, even laughter, can result in at least part of our organic waste not being able to be retained (having same and all popular expressions in this regard). When this happens in the absence of pathology and frequently, we are talking about a problem or disorder called encopresis, and if given to children it is called infantile encopresis.

    An excretion disorder

    Encopresis is a disorder characterized by repeated and frequent deposition of feces for at least three months in inappropriate places such as clothing or the floor, it may be an involuntary or willful deposit.

    For the diagnosis of this disorder, classified as an excretion disorder alongside enuresis or urinary incontinence, the subject must be at least four years old (the age at which a large proportion of children already have control of their sphincters) and the incontinence is not due to the presence of disease or physiological alteration beyond possible constipation, or the consumption of substances such as laxatives or spoiled food.

    This disorder can cause the presence of deep feelings of shame or guilt in the minor, This sometimes leads to problems with emotional attachment to others, as well as concealing bowel movements when they occur unintentionally.

    Types of encopresis according to sphincter control

    Childhood encopresis can be classified into primary and secondary depending on whether the problem is that the minor has not controlled the excretion process at all times or is due to a lack of control produced by a particular element.

    Primary encopresis

    Primary or continuous encopresis is that in which the minor has at no time been able to control the emission of excrement, despite already a sufficiently advanced level of development to be able to do it.

    secondary encopresis

    Also called discontinuous encopresis, in it the subject in he has already acquired good control of his sphincters and the emission of feces, but for some reason in the present has ceased to do so. In other words, in secondary encopresis, the incontinence is not due to the fact that the minor has not yet been able to control the defecation before.

    Type of encopresis according to the level of stool retention

    Infant encopresis can be divided into two depending on whether the excretion is carried out in case of excessive retention of stool by the child. or if it occurs in the absence of any type of constipation.

    Persistent encopresis

    Retentive encopresis or overflow constipation and incontinence occurs when the child retains the release of feces for a long time and may be bowel-free for two weeks. The boy or girl ends up having a bowel movement because of the overflow, expelling weak feces first and later hard, tall stools. which involves a certain level of pain expelling.

    Non-persistent encopresis

    In this type of encopresis without constipation or overflow incontinence there is no overly prolonged retention, There is no severe constipation. The child’s stools are normal.

    Possible causes (etiology)

    Over time, the possible causes of this disorder have been explored, finding that the main causes of childhood encopresis are psychological. however, there are organic factors that can influence in their presence as the tendency to constipation.

    When encopresis is primary, it is considered that this may be due to the fact that the child has failed to achieve incorrect learning of sphincter control and the child cannot recognize the signs that warn of the need. to defecate.

    In the case of secondary encopresis, the main etiology is the existence of a kind of sensation that causes the child to hold the stool or to lose control. Fear and anxiety are some of the emotions that can cause this loss of control. Living in situations of conflict, domestic violence or in precarious conditions can cause some children to react to this disorder.

    Another closely related aspect concerns the type of education given to the child: Overworking parents who provide an education that is too rigid can lead to fear of failure and punishment that can lead to loss of control, or in the case of an overly permissive or ambivalent upbringing that causes them insecurity or fear of facing the outside world. In cases where defecation in inappropriate places is voluntary, we may be faced with a sign of rebellion on the part of the child.

      treatment

      Treatment of encopresis generally incorporates a multidisciplinary methodology incorporating psychological as well as medical and nutritional aspects.

      As for psychological treatment, he focused on achieving training in bowel movements which will be reinforced by the use of positive reinforcements. First, one needs to assess whether there is an emotional reason behind the defecation and / or retention of feces, and if so, they need to be addressed through the appropriate means. For example, systematic desensitization or relaxation in case of anxiety.

      As for the defecation process itself, the child will first learn to identify the signs that warn of the need to evacuate, and then to mold and mold the practice of appropriate habits so that the minor is more in addition autonomous.

      At all times, the acquisition of ducts will be strengthened, and techniques such as token economy can be used for this, both before and during and after defecation (when the child goes to the toilet, evacuates to the toilet and keep clean). Sometimes punishment was also used as part of the process, like having him clean dirty clothes, but it’s crucial not to induce guilt or lower the child’s self-esteem.

      Nutritional and medical intervention

      Nutritionally and medically, in addition to assessing whether the incontinence is not due to organic causes they can prescribe medication to facilitate evacuation in specific situations or enemas that allow the stool to soften in case of constipation. In fact, the doctor and psychologist should guide the use of laxatives while practicing bowel movements.

      It is also advisable to provide the child a balanced diet rich in fiber this helps the minor to carry out his evacuations in a normative way, next to an abundant hydration.

      Bibliographical references:

      • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
      • Thief, A. (2012). Clinical child psychology. CEDE PIR preparation manual, 03. CEDE: Madrid.

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