Encopresis Parent Guide Paper.

Encopresis Parent Guide Paper.

Respond to the following by providing at least two contributions for improving or including in their Parent Guide and at least two things that you like about their guide.

  • Encopresis Parent Guide
  • What is Encopresis?
  • Encopresis (en-ko-PREE-sis), is an elimination disorder that can be voluntary or involuntary in which an individual repeatedly passes feces into inappropriate places such as the floor or clothing (DSM-V, 2013).
  • How Common is Encopresis?
  • Encopresis can be an anxiety provoking and embarrassing disorder affecting 5% of children ages four and older (American Academy of Pediatrics, 2018).
  • What causes Encopresis?
  • There are several causes of encopresis, including constipation and emotional issues (Mayo Clinic, 2018).

 

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  • Risk Factors
  • Poverty
  • Dirty Toilets
  • Impoverished Neighborhoods
  • Stress & Anxiety
  • Depression
  • Behavioral Problems
  • Signs and Symptoms of Encopresis

Signs and symptoms of encopresis may include:

  • the leakage of stool into clothing or other inappropriate places which can be mistaken as diarrhea,
  • the passage of large stool that clogs the toilet,
  • the avoidance of bowel movements,
  • constipation,
  • abdominal pain,
  • lack of appetite (Mayo Clinic, 2018).

Stanford Children’s Health (2018) further describes the signs and symptoms of encopresis as involuntary stooling or urgency of stooling leading to soiling, anal irritation due to repeated liquid stools, hiding soiled clothing, and withdrawing from loved ones, school, and social settings. Encopresis Parent Guide Paper.

  • Pathophysiology of Encopresis
  • There are two types of encopresis, retentive and non-retentive. The former is characterized as constipation as a result of deliberate retention of the feces. Non-retentive encopresis refers to the depositing of feces in inappropriate places (Rajindrajith et al., 2013).
  • The pathophysiology of retentive encopresis is stool retention, which is present in 75-90% of children with constipation. In patients with the non-retentive subtype, total and segmental colonic transit times are within normal limits but abnormalities in the defecation process seems to underlie the problem, in which children have an inability to relax the external anal sphincter during defecation (Rajindrajith et al., 2013).
  • How to Diagnose Encopresis

The frequency of inappropriate defection should be for at least once a month for 3 months (American Psychiatric Association,2013). In addition, the DSM-5 provides two specifiers for encopresis. The specifiers are with constipation and overflow incontinence and without constipation and overflow incontinence (American Psychiatric Association,2013).

To receive a diagnosis of encopresis, the child must be at the developmental of chronological age of 4 years (Sadock, Sadock & Ruiz, 2014). Encopresis cannot be diagnosed in the presence of a medical condition that causes fecal incontinence (Sadock, Sadock & Ruiz, 2014).

  • How to Diagnose Encopresis (Continued)

Physical Assessment

On examination, the patient may present contracting gluteal muscles, holding legs together and tightening the external anal sphincter in an effort to withhold feces (Sadock, Sadock & Ruiz, 2014).

Fecal impaction and overflow soiling may be evident on examination of the patient (Sadock, Sadock & Ruiz, 2014). A physical assessment may reveal constipation with hard fecal masses found in the colon and rectum with an abdominal palpation and rectal exam (Sadock, Sadock & Ruiz, 2014).

  • How to Diagnose Encopresis (Continued)

Medical History

An obtained medical history may reveal history of intentional bowel control occurrences in clothes or in other places (Sadock, Sadock & Ruiz, 2014.

In addition, a patient’s history may reveal a history of involuntary bowel occurrences but in absence of physiological abnormalities (Sadock, Sadock & Ruiz, 2014). History of soiling beginning around age 4 may be revealed while collecting the medical history (Sadock, Sadock & Ruiz, 2014). The provider will need to rule out disorders such as a ganglionic megacolon or Hirschsprung’s disease to obtain a definitive diagnosis (Sadock, Sadock & Ruiz, 2014).Encopresis Parent Guide Paper.

  • How to Diagnose Encopresis (Continued)

Diagnostic Test 

The primary diagnostic test in the encopresis work-up is an abdominal x-ray. The use of abdominal X-ray helps determine the extent of constipation (Sadock, Sadock & Ruiz, 2014).

  • What are my Treatment Options? (Pharmacologic and Non-pharmacologic)
  • Generally, the earlier that treatment begins for encopresis, the better.
  • The first step involves clearing the colon of retained, impacted stool. After that, treatment focuses on encouraging healthy bowel movements.
  • In some cases, psychotherapy may be a helpful addition to treatment.

- (University of Virginia School of Medicine, 2018)

  • Pharmacologic Treatment Options

Your child's doctor will likely recommend one or more of the following:

  • Laxatives
  • Rectal suppositories
  • Enemas

- (University of Virginia School of Medicine, 2018)

  • Laxatives
  • “The maintenance phase of management involves scheduling regular times to use the toilet in conjunction with daily laxatives like mineral oil or milk of magnesia,” (American Academy of Pediatrics, 2004).
  • Laxatives such as magnesium hydroxide, lactulose, and mineral oil have been used in children for a long time. A new laxative, polyethylene glycol 3350, has been used successfully in children with constipation and encopresis,” (Dinesh S. Pashankar, M.D., 2005).
  • Powerful Laxatives“flush out” the lower intestine. This generally keeps lots of water in the intestine, softening any stool there, and causing diarrhea. Laxatives commonly used to flush out the intestine include:
  • Magnesium citrate
  • Golytely® or Colyte®
  • Fleet’s Phosphosoda®
  • Miralax® or Glycolax®

            - (University of Virginia School of Medicine, 2018)

  • Rectal Suppositories
  • Suppositoriesirritate the bottom of the intestine, causing it to contract (squeeze) and push out a bowel movement. Some suppositories also stimulate the intestine to secrete salt and water, softening the stool in the rectum, and making it easier to push out. Commonly used suppositories include:
  • Glycerin
  • Dulcolax®
  • BabyLax®

- (University of Virginia School of Medicine,2018)

  • Enemas
  • Enemaspush fluid into the rectum. This softens the stool in the rectum but also stretches the rectum, giving the child a tremendous urge to pass a bowel movement. Almost all enemas consist mostly of water with another substance mixed in to keep the water inside the intestine. The most commonly used enemas are:
    • Fleet’s® Phosphosoda: contain water and the salt sodium-phosphate. The phosphate is not absorbed in the lower intestine and thus keeps the water from the enema in the intestine.Encopresis Parent Guide Paper.
    • Soap suds: contain water with a small amount of soap. The soap is mildly irritating and stimulates the lower intestine to secrete water and salt.
    • Milk and Molasses: contain milk sugars and proteins as well as molasses. None of these are absorbed in the lower intestine and thus keep the water from the enema in the intestine.

- (University of Virginia School of Medicine, 2018)

  • Non-Pharmacologic Treatment Options

Behavior modification

  • Your child's doctor or mental health professional can discuss techniques for teaching your child to have regular bowel movements. This is sometimes called behavior modification or bowel retraining.
  • Emotional distress not only affects the child but also can lead to anger between immediate family members and caretakers. Families may feel the need to adjust their routines and become preoccupied with the child’s encopresis. It is essential to keep in mind that most cases of encopresis are involuntary.
  • Your child's doctor may recommend psychotherapy with a mental health professional if the encopresis may be related to emotional issues.
  • Psychotherapy may also be helpful if your child feels shame, guilt, depression or low self-esteem related to encopresis.

- (Mayo Clinic, 2018)

  • Is Encopresis Preventable?
  • Encopresis has been contributed to physiological and psychological factors which result in the avoidance of defecation (Sadock, Sadock & Ruiz, 2014).
  • Parents should avoid being punitive of shaming the child (Sadock, Sadock & Ruiz, 2014).
  • What Can I Do?

Strategies that can be implemented to help prevent Encopresis and its many complications include:

  • Avoiding constipation
  • Learning effective toilet training                             techniques
  • Avoiding Constipation
  • Make sure children get enough exercise.Physical activity nudges the bowels into action, so encourage your children to get plenty of  It can be as simple as playing catch, riding bikes, or shooting a few basketball hoops.Encopresis Parent Guide Paper.
  • Give your child more liquids.Drinking enough water and other liquids helps stools move more easily through the intestines. Most school-age children need at least 3 to 4 glasses of water each day. If your infant is constipated during the move from breast milk or to solid foods, try serving just a few ounces (2–4) of apple, pear, or prune juice each day.
  • Serve more fiber.High-fiber foods (such as fruits, vegetables, and whole-grain bread) can help prevent constipation. Fiber helps clean out the intestines by moving the bowels along. When adding more fiber to your child's diet, do so slowly over a few weeks.Encopresis Parent Guide Paper.

- (KidsHealth, 2018)

  • Learn about effective toilet training techniques
  • Get your child into the habit of going. Encourage your child to sit on the toilet at least twice a day for 3-5 minutes, preferably 15-30 minutes after a meal. Make this time pleasant; do not scold or criticize the child if they are unable to poop.Encopresis Parent Guide Paper.
  • Giving stickers or other small rewards and making posters that chart your child's progress can help motivate and encourage him / her. Incentives will be most effective if they are age-appropriate, given immediately after the desired behavior is displayed and provided after every occurrence of the behavior during the early phases of teaching.
  • Taking a change of underwear and / or pants to school can help decrease your child's embarrassment and improve his / her self-esteem as bowel control improves.
  • Talk to school teachers about your child's need to be able to go to the bathroom at any time. Many children prefer privacy in bathrooms and will avoid going to the bathroom at school.

- (American Academy of Family Physicians, 2018), - (KidsHealth, 2018)

These small changes help most children feel better and get the bowels moving the way they should. Talk with your doctor before giving your child any kind of over-the-counter medicine for constipation.Encopresis Parent Guide Paper.

  • To Learn More about Encopresis, Please Visit:

Mayo Clinic - Encopresis

  • https://www.mayoclinic.org/diseases-conditions/encopresis/symptoms-causes/syc-20354494

Stanford Children’s Health – Encopresis

  • http://www.stanfordchildrens.org/en/topic/default?id=encopresis-90-P01992

U.S. National Library of Medicine - Childhood Constipation: Evaluation and Management

  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780136/
  • References
  • American Academy of Pediatrics. (2018). Soiling (Encopresis). Retrieved July 27, 2018,
    from https://www.healthychildren.org/English/health-
    issues/conditions/emotional-problems/Pages/Soiling-Encopresis.aspx
  • American Psychiatric Association (2013). Diagnostic and statistical manual of mental
    disorders
    (5th ed.). Washington, DC: Author.Encopresis Parent Guide Paper.
  • Mayo Clinic. (2018, May 16). Encopresis. Retrieved July 27, 2018, from
    https://www.mayoclinic.org/diseases-conditions/encopresis/symptoms-      causes/syc-20354494
  • Rajindrajith, S., Devanarayana, N. M., & Benninga, M. A. (2013). Review article: Fecal
    incontinence in children: Epidemiology, pathophysiology, clinical evaluation and
    Alimentary Pharmacology & Therapeutics, 37(1), 37-48.
    doi:10.1111/apt.12103
  • Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11 ed.). Philadelphia, PA:           Wolters Kluwer.
  • Stanford Children's Health. (2018). Encopresis. Retrieved July 27, 2018, from
    http://www.stanfordchildrens.org/en/topic/default?id=encopresis-90-P01992

uEncopresis Parent Guide

uWhat is Encopresis?

uEncopresis (en-ko-PREE-sis), is an elimination disorder that can be voluntary or involuntary in which an individual repeatedly passes feces into inappropriate places such as the floor or clothing (DSM-V, 2013).

uHow Common is Encopresis?

uEncopresis can be an anxiety provoking and embarrassing disorder affecting 1.5% of children ages four and older (American Academy of Pediatrics, 2018).

uWhat causes Encopresis?

uThere are several causes of encopresis, including constipation and emotional issues (Mayo Clinic, 2018).

u

 

uRisk Factors

uPoverty

uDirty Toilets

uImpoverished Neighborhoods

uStress & Anxiety

uDepression

uBehavioral Problems

uSigns and Symptoms of Encopresis

Signs and symptoms of encopresis may include:

uthe leakage of stool into clothing or other inappropriate places which can be mistaken as diarrhea,

uthe passage of large stool that clogs the toilet,Encopresis Parent Guide Paper.

uthe avoidance of bowel movements,

uconstipation,

uabdominal pain,

ulack of appetite (Mayo Clinic, 2018).

u

Stanford Children’s Health (2018) further describes the signs and symptoms of encopresis as involuntary stooling or urgency of stooling leading to soiling, anal irritation due to repeated liquid stools, hiding soiled clothing, and withdrawing from loved ones, school, and social settings.

u

uPathophysiology of Encopresis

uThere are two types of encopresis, retentive and non-retentive. The former is characterized as constipation as a result of deliberate retention of the feces. Non-retentive encopresis refers to the depositing of feces in inappropriate places (Rajindrajith et al., 2013).

uThe pathophysiology of retentive encopresis is stool retention, which is present in 75-90% of children with constipation. In patients with the non-retentive subtype, total and segmental colonic transit times are within normal limits but abnormalities in the defecation process seems to underlie the problem, in which children have an inability to relax the external anal sphincter during defecation (Rajindrajith et al., 2013).

uHow to Diagnose Encopresis

The frequency of inappropriate defection should be for at least once a month for 3 months (American Psychiatric Association,2013). In addition, the DSM-5 provides two specifiers for encopresis. The specifiers are with constipation and overflow incontinence and without constipation and overflow incontinence (American Psychiatric Association,2013).Encopresis Parent Guide Paper.

To receive a diagnosis of encopresis, the child must be at the developmental of chronological age of 4 years (Sadock, Sadock & Ruiz, 2014). Encopresis cannot be diagnosed in the presence of a medical condition that causes fecal incontinence (Sadock, Sadock & Ruiz, 2014).

uHow to Diagnose Encopresis (Continued)

Physical Assessment

On examination, the patient may present contracting gluteal muscles, holding legs together and tightening the external anal sphincter in an effort to withhold feces (Sadock, Sadock & Ruiz, 2014).

Fecal impaction and overflow soiling may be evident on examination of the patient (Sadock, Sadock & Ruiz, 2014). A physical assessment may reveal constipation with hard fecal masses found in the colon and rectum with an abdominal palpation and rectal exam (Sadock, Sadock & Ruiz, 2014).

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u

uHow to Diagnose Encopresis (Continued)

Medical History

An obtained medical history may reveal history of intentional bowel control occurrences in clothes or in other places (Sadock, Sadock & Ruiz, 2014.

In addition, a patient’s history may reveal a history of involuntary bowel occurrences but in absence of physiological abnormalities (Sadock, Sadock & Ruiz, 2014). History of soiling beginning around age 4 may be revealed while collecting the medical history (Sadock, Sadock & Ruiz, 2014). The provider will need to rule out disorders such as a ganglionic megacolon or Hirschsprung’s disease to obtain a definitive diagnosis (Sadock, Sadock & Ruiz, 2014).

u

uHow to Diagnose Encopresis (Continued)

Diagnostic Test 

The primary diagnostic test in the encopresis work-up is an abdominal x-ray. The use of abdominal X-ray helps determine the extent of constipation (Sadock, Sadock & Ruiz, 2014).

u

uWhat are my Treatment Options? (Pharmacologic and Non-pharmacologic)

uGenerally, the earlier that treatment begins for encopresis, the better.

u

uThe first step involves clearing the colon of retained, impacted stool. After that, treatment focuses on encouraging healthy bowel movements.Encopresis Parent Guide Paper.

u

uIn some cases, psychotherapy may be a helpful addition to treatment.

- (University of Virginia School of Medicine, 2018)

u

uPharmacologic Treatment Options

Your child's doctor will likely recommend one or more of the following:

uLaxatives

uRectal suppositories

uEnemas

- (University of Virginia School of Medicine, 2018)

u

uLaxatives

u“The maintenance phase of management involves scheduling regular times to use the toilet in conjunction with daily laxatives like mineral oil or milk of magnesia,” (American Academy of Pediatrics, 2004).

u“Laxatives such as magnesium hydroxide, lactulose, and mineral oil have been used in children for a long time. A new laxative, polyethylene glycol 3350, has been used successfully in children with constipation and encopresis,” (Dinesh S. Pashankar, M.D., 2005).Encopresis Parent Guide Paper.

uPowerful Laxatives “flush out” the lower intestine. This generally keeps lots of water in the intestine, softening any stool there, and causing diarrhea. Laxatives commonly used to flush out the intestine include:

uMagnesium citrate

uGolytely® or Colyte®

uFleet’s Phosphosoda®

uMiralax® or Glycolax®

  - (University of Virginia School of Medicine, 2018)

u

u

uRectal Suppositories

uSuppositories irritate the bottom of the intestine, causing it to contract (squeeze) and push out a bowel movement. Some suppositories also stimulate the intestine to secrete salt and water, softening the stool in the rectum, and making it easier to push out. Commonly used suppositories include:

uGlycerin

uDulcolax®

uBabyLax®

- (University of Virginia School of Medicine,2018)

u

uEnemas

uEnemas push fluid into the rectum. This softens the stool in the rectum but also stretches the rectum, giving the child a tremendous urge to pass a bowel movement. Almost all enemas consist mostly of water with another substance mixed in to keep the water inside the intestine. The most commonly used enemas are:

uFleet’s® Phosphosoda: contain water and the salt sodium-phosphate. The phosphate is not absorbed in the lower intestine and thus keeps the water from the enema in the intestine.

uSoap suds: contain water with a small amount of soap. The soap is mildly irritating and stimulates the lower intestine to secrete water and salt.

uMilk and Molasses: contain milk sugars and proteins as well as molasses. None of these are absorbed in the lower intestine and thus keep the water from the enema in the intestine.

- (University of Virginia School of Medicine, 2018)Encopresis Parent Guide Paper.

u

uNon-Pharmacologic Treatment Options

Behavior modification

uYour child's doctor or mental health professional can discuss techniques for teaching your child to have regular bowel movements. This is sometimes called behavior modification or bowel retraining.

uEmotional distress not only affects the child but also can lead to anger between immediate family members and caretakers. Families may feel the need to adjust their routines and become preoccupied with the child’s encopresis. It is essential to keep in mind that most cases of encopresis are involuntary.

uYour child's doctor may recommend psychotherapy with a mental health professional if the encopresis may be related to emotional issues.

uPsychotherapy may also be helpful if your child feels shame, guilt, depression or low self-esteem related to encopresis.

- (Mayo Clinic, 2018)

u

uIs Encopresis Preventable?

uEncopresis has been contributed to physiological and psychological factors which result in the avoidance of defecation (Sadock, Sadock & Ruiz, 2014).Encopresis Parent Guide Paper.

u

uParents should avoid being punitive of shaming the child (Sadock, Sadock & Ruiz, 2014).

u

uWhat Can I Do?

Strategies that can be implemented to help prevent Encopresis and its many complications include:

uAvoiding constipation

uLearning effective toilet training            techniques

uAvoiding Constipation

uMake sure children get enough exercise. Physical activity nudges the bowels into action, so encourage your children to get plenty of exercise. It can be as simple as playing catch, riding bikes, or shooting a few basketball hoops.

uGive your child more liquids. Drinking enough water and other liquids helps stools move more easily through the intestines. Most school-age children need at least 3 to 4 glasses of water each day. If your infant is constipated during the move from breast milk or to solid foods, try serving just a few ounces (2–4) of apple, pear, or prune juice each day.Encopresis Parent Guide Paper.

uServe more fiber. High-fiber foods (such as fruits, vegetables, and whole-grain bread) can help prevent constipation. Fiber helps clean out the intestines by moving the bowels along. When adding more fiber to your child's diet, do so slowly over a few weeks.

- (KidsHealth, 2018)

u

uLearn about effective toilet training techniques

uGet your child into the habit of going. Encourage your child to sit on the toilet at least twice a day for 3-5 minutes, preferably 15-30 minutes after a meal. Make this time pleasant; do not scold or criticize the child if they are unable to poop.

uGiving stickers or other small rewards and making posters that chart your child's progress can help motivate and encourage him / her. Incentives will be most effective if they are age-appropriate, given immediately after the desired behavior is displayed and provided after every occurrence of the behavior during the early phases of teaching.Encopresis Parent Guide Paper.

uTaking a change of underwear and / or pants to school can help decrease your child's embarrassment and improve his / her self-esteem as bowel control improves.

uTalk to school teachers about your child's need to be able to go to the bathroom at any time. Many children prefer privacy in bathrooms and will avoid going to the bathroom at school.

- (American Academy of Family Physicians, 2018), - (KidsHealth, 2018)

u

These small changes help most children feel better and get the bowels moving the way they should. Talk with your doctor before giving your child any kind of over-the-counter medicine for constipation.

uTo Learn More about Encopresis, Please Visit:Encopresis Parent Guide Paper.

Mayo Clinic - Encopresis

uhttps://www.mayoclinic.org/diseases-conditions/encopresis/symptoms-causes/syc-20354494

Stanford Children’s Health – Encopresis

uhttp://www.stanfordchildrens.org/en/topic/default?id=encopresis-90-P01992

U.S. National Library of Medicine - Childhood Constipation: Evaluation and Management

uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780136/

uReferences

uAmerican Academy of Pediatrics. (2018). Soiling (Encopresis). Retrieved July 27, 2018,
from https://www.healthychildren.org/English/health-
issues/conditions/emotional-problems/Pages/Soiling-Encopresis.aspx

uAmerican Psychiatric Association (2013). Diagnostic and statistical manual of mental
disorders
(5th ed.). Washington, DC: Author.

uMayo Clinic. (2018, May 16). Encopresis. Retrieved July 27, 2018, from
https://www.mayoclinic.org/diseases-conditions/encopresis/symptoms-  causes/syc-20354494

uRajindrajith, S., Devanarayana, N. M., & Benninga, M. A. (2013). Review article: Fecal
incontinence in children: Epidemiology, pathophysiology, clinical evaluation and
management. Alimentary Pharmacology & Therapeutics, 37(1), 37-48.
doi:10.1111/apt.12103Encopresis Parent Guide Paper.

uSadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of   psychiatry: Behavioral sciences/clinical psychiatry (11 ed.). Philadelphia, PA:   Wolters Kluwer.

uStanford Children's Health. (2018). Encopresis. Retrieved July 27, 2018, from
http://www.stanfordchildrens.org/en/topic/default?id=encopresis-90-P01992

u

u

Encopresis Parent Guide Paper.