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PubMed1986

Locus of control as predictor of compliance and outcome in treatment of encopresis.

We examined the effectiveness of instruments that describe a child's locus of control and perceived self-competence as predictors of outcome in the treatment of encopresis. Fifty children 9 to 12 years of age completed such instruments prior to clinical interview. Clinicians were blind as to the results of these questionnaires and administered a standard encopresis protocol to all patients. Six to 17 months later, 45 (90%) of the patient's parents were interviewed to assess compliance and treatment outcome. Children who significantly improved had a more internal locus of control (P less than 0.05) and better compliance (P less than 0.05) as determined by two separate outcome variables. Locus of control and compliance were not, however, significantly correlated with each other; each appeared to have an independent association with outcome. There was no association between perceived self-competence and outcome. The positive association between locus of control and outcome was not mediated by socioeconomic status, age, duration of encopresis, severity of encopresis, gender, or time between initiation of treatment and follow-up. Measurement of locus of control in children with encopresis appears to be helpful in identifing a group at high risk for resistance of treatment.

Child↗
PubMedDate not supplied

Using the Internet to teach parents and children about constipation and encopresis.

Since 1995, we have maintained a tutorial about chronic childhood constipation and encopresis on our web site. The tutorial is directed at parents and older children and includes a feedback form comprised of six multiple-choice questions and a free-text comment field. Between 1 January 1998 and 30 April 2000, we received 1,142 completed feedback forms. The vast majority of respondents identified themselves as parents or guardians of a child with constipation or encopresis. All respondents felt the tutorial was clear and easy to understand. 98% of respondents felt the tutorial helped them understand why children develop constipation and/or encopresis and 91% of respondents felt the tutorial made them better able to take care of a child suffering from constipation and/or encopresis. More than 99% of respondents felt this type of tutorial was a good way to teach people about health problems. 74% of respondents sent us comments about the tutorial. Most often, the comments expressed thanks for having this information available in clear and understandable language, however a significant number of people inquired about a particular child's difficulties or asked a general question not clearly pertaining to a particular child. The results of this study indicate that many people are searching the Internet for information concerning childhood encopresis and that the World Wide Web can provide families with useful information about this common paediatric problem.

Adult↗
PubMed2004

Functional fecal retention with encopresis in childhood.

OBJECTIVES: The most common cause of encopresis in children is functional fecal retention (FFR). An international working team suggested that FFR be defined by the following criteria: a history of >12 weeks of passage of <2 large-diameter bowel movements (BMs) per week, retentive posturing, and accompanying symptoms, such as fecal soiling. These criteria are usually referred to as the ROME II criteria. The aims of this study were to evaluate how well the ROME II criteria identify children with encopresis; to compare these patients to those identified as having FFR by historical symptoms or physical examination; to determine whether 1-year treatment outcome varied depending on which definition for FFR was used; and to suggest improvements to the ROME II criteria, if necessary. METHODS: Data were reviewed from the history and physical examination of 213 children with encopresis. One-year outcomes identified were failure, successful treatment, or full recovery. RESULTS: Only 88 (41%) of the patients with encopresis fit the ROME II criteria for FFR, whereas 181 (85%) had symptoms of FFR by history or physical examination. Thirty-two (15%) patients did not fit criteria for FFR, but only 6 (3%) appeared to have nonretentive fecal soiling. Rates of successful treatment (50%) and recovery (39%) were not significantly different in the two groups. CONCLUSIONS: The ROME II criteria for FFR are too restrictive and do not identify many children with encopresis who have symptoms of FFR. The author suggests that the ROME II criteria for FFR could be improved by including the following additional items: a history of BMs that obstruct the toilet, a history of chronic abdominal pain relieved by enemas or laxatives, and the presence of an abdominal fecal mass or rectal fecal mass.

Cathartics↗
PubMed2005

Controlled study of encopresis and enuresis in children with a prepubertal and early adolescent bipolar-I disorder phenotype.

OBJECTIVE: To examine the prevalence of encopresis/enuresis, relationship between maternal hostility and encopresis, parent-child concordance of reporting encopresis/enuresis, and familial aggregation of enuresis in subjects with a prepubertal and early adolescent bipolar-I disorder phenotype (PEA-BP), attention-deficit/hyperactivity disorder (ADHD), and healthy controls (HC). METHOD: There were 268 consecutively ascertained subjects (93 PEA-BP, 81 ADHD, and 94 HC). PEA-BP was defined as DSM-IV BP-I (manic or mixed phase) with elation and/or grandiosity. The WASH-U-KSADS and Psychosocial Schedule for School-Age Children-Revised were administered to parents about their children and separately to children about themselves. RESULTS: Encopresis was more prevalent in PEA-BP versus HC subjects (15.1% versus 3.2%, chi2 = 6.4, p = .012). Enuresis was more common in PEA-BP versus HC (21.5% versus 6.4%, chi2 = 7.8, p = .005) and ADHD versus HC (22.2% versus 6.4%, chi2 = 6.1, p = .014) subjects. All enuresis onset in subjects not receiving lithium. Most encopresis (81.8%) and enuresis (75.0%) onset before mania. Familial aggregation of enuresis was more frequent in enuretics than nonenuretics (47.7% versus 5.4%, chi2 = 41.2, p < .0001). Maternal hostility was more prevalent in encopretic versus nonencopretic subjects (91.7% versus 55.6%, chi2 = 8.3, p = .004). Parent-child concordance on reporting encopresis and enuresis was poor to fair. CONCLUSIONS: Children with PEA-BP need to be evaluated for encopresis, enuresis, and mother-child relationships.

Adolescent↗
PubMed1995

A collaborative protocol for encopresis management in school-aged children.

Encopresis affects 1% to 3% of the general pediatric population, yet most parents are unaware of the condition. Parents frequently view encopretic symptoms as deliberate actions and react punitively. Children with encopresis live in constant fear of ridicule about a problem over which they have no control. The lengthy, complex management program for encopresis usually includes physiological and behavioral approaches. Noncompliance and withdrawing from the program too quickly are major obstacles to success. The collaborative protocol model, focused on medical clinicians, children and families, and school nurses in collaboration with the children's teachers provides comprehensive strategical management of encopresis. As health professionals with frequent opportunity for communication with children and their parents, schools nurses are essential members of the collaborative management team. Also, the unique position of school nurses offers the opportunity to identify children with encopresis and help them work toward a positive outcome.

Behavior Therapy↗
PubMed1996

Randomised trial of biofeedback training for encopresis.

AIMS: To evaluate biofeedback training in children with encopresis and the effect on psychosocial function. DESIGN: Prospective controlled randomised study. PATIENT INTERVENTIONS: A multimodal treatment of six weeks. Children were randomised into two groups. Each group received dietary and toilet advice, enemas, oral laxatives, and anorectal manometry. One group also received five biofeedback training sessions. MAIN OUTCOME MEASURES: Successful treatment was defined as less than two episodes of encopresis, regular bowel movements, and no laxatives. Psychosocial function after treatment was assessed using the Child Behaviour Checklist. RESULTS: Children given laxatives and biofeedback training had higher success rates than those who received laxatives alone (39% v 19%) at the end of the intervention period. At 12 and 18 months, however, approximately 50% of children in each group were successfully treated. Abnormal behaviour scores were initially observed in 35% of children. Most children had improved behaviour scores six months after treatment. Children with an initial abnormal behaviour score who were successfully treated had a significant improvement in their behavioural profiles. CONCLUSIONS: Biofeedback training had no additional effect on the success rate or behaviour scores. Psychosocial problems are present in a subgroup of children with encopresis. The relation between successful treatment and improvement in behavioural function supports the idea that encopresis has an aetiological role in the occurrence and maintenance of behavioural problems in children with encopresis.

Adolescent↗
PubMed1988

[Psychosomatic aspects of encopresis].

37 children (aged 4 1/2-15 1/2 years) with encopresis were seen at the psychosomatic outpatient unit of the university children's hospital of Graz in the course of two years, comprising 1.8% of all our outpatients of that time (n = 2037). They had been referred to us by pediatricians general practitioners, welfare institutions and the local children's surgical hospital. Based an our observations and data-analysis of this heterogenic group we would like to suggest a subdivision of the new classification group of "elimination disorders" (307.70/307.60 DSM III-R) into three main subgroups; according to the use of the fifth digit in the DSM III-R (e.g. mood disorders 296.xx) we define: 307.71: primary infantile encopresis (group I); 307.72: primary reactive encopresis (group II a); 307.73: secondary reactive encopresis (group II b); 307.74: late "neurotic" encopresis (group III); 307.70: not otherwise specified NOS. Moreover, we hope to draw attention to the specific psychodynamics of this functional disorder, since we believe this to be a fundamental prerequisite for any successful therapeutic intervention.

Adolescent↗
PubMed1995

Biofeedback treatment for chronic constipation and encopresis in childhood: long-term outcome.

OBJECTIVE: Abnormal defecation dynamics often are present in children with chronic constipation and encopresis. Patients who learned normal defecation dynamics with biofeedback treatment had improved short-term outcome. The aim of our research was to evaluate if biofeedback treatment improved long-term outcome. DESIGN: One hundred twenty-nine children with constipation, encopresis, and abnormal defecation dynamics were treated conventionally; 63 of them received additional biofeedback training directed towards teaching normal defecation dynamics. RESULTS: At follow-up (4.1 +/- 1.5 years), 86% of conventionally treated patients and 87% of biofeedback-treated patients had improvement in encopresis; 62% of conventionally treated patients, 50% of successful biofeedback-treated patients, and 23% of unsuccessful biofeedback-treated patients had recovered from chronic constipation and encopresis. Recovery rates were similar for conventionally treated patients and biofeedback-treated patients who learned normal defecation dynamics (P > .2) but significantly lower for unsuccessful biofeedback-treated patients (P < .02). Length of follow-up was significantly related to recovery (P < .01). CONCLUSION: Learning normal defecation dynamics with biofeedback training did not increase long-term recovery rates in children with chronic constipation, encopresis, and abnormal defecation dynamics above those achieved with conventional treatment alone.

Adolescent↗
PubMed1993

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.

Adolescent↗
PubMed1993

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.

Attitude to Health↗
PubMed1996

Lack of correlation of anorectal manometry with symptoms of chronic childhood constipation and encopresis.

UNLABELLED: Chronic constipation is an extremely common problem in children. Many authors have advocated using anorectal manometric examination during evaluation of chronic childhood constipation and encopresis as a means of developing individualized modes of treatment. PURPOSE: This study was designed to prospectively examine frequency and severity of symptoms of childhood constipation and encopresis and associate these symptoms with anorectal manometric findings. METHODS: Forty-four children with chronic constipation participated in the study. Before performing anorectal manometry, bowel-related symptoms were collected for two consecutive weeks with a computerized voice mail system. Anorectal manometry was performed using a triple lumen catheter attached to a hydraulic manometry infusion system. RESULTS: Frequency of voluntary bowel movements did not correlate with any manometric parameters. Frequency of fecal soiling, age at onset of symptoms, and duration of symptoms were all highly correlated with degree of sphincter spasm during attempted defecation; however, none of these variables correlated with any other manometric parameter. Amount of pain associated with bowel movements correlated with frequency of soiling and was inversely correlated with maximum squeeze pressure but was not correlated with any other manometric parameter. CONCLUSIONS: In children with chronic constipation and encopresis, sphincter spasm demonstrated with anorectal manometry is highly correlated with frequency of fecal soiling, age at onset, and duration of symptoms; however, none of the other commonly measured manometric parameters appear to correlate with symptoms of chronic childhood constipation and encopresis.

Age of Onset↗
PubMedDate not supplied

Encopresis.

Encopresis is fecal soiling associated with functional constipation in a child. Constipation and encopresis are common problems in children. Encopresis is most common between ages 3 and 7 years. Infants and pre-school children present with a history of constipation and withholding maneuvers. The school-age child may have constipation and fecal soiling for some time prior to detection. In some children encopresis is associated with enuresis and urinary tract infection. Family education is the essential first step in management, followed by disimpaction of stool and complete evacuation of the rectum. Reaccumulation of stool should be prevented by appropriate use of laxatives and stool softeners. This is followed by a gradual weaning of the laxative regimen and instituting toilet training. Relapses may occur. Up to 50-60% of children achieve acceptable bowel control, free of soiling, within a year.

Age Factors↗
PubMed1996

Balloon defecation as a predictor of outcome in children with functional constipation and encopresis.

OBJECTIVE: To evaluate whether the ability to defecate a rectal balloon might predict 12-month recovery in children with functional constipation and encopresis. METHODS: We evaluated the ability to defecate within 5 minutes a 100 ml waterfilled rectal balloon by 20 healthy children and 139 children with functional constipation and encopresis. RESULTS: All healthy children and only 47% of the patients were able to defecate the balloon. Twelve months after the start of treatment, 51% of patients able to and 34% of patients unable to defecate the balloon had recovered (p < 0.03). Logistic regression revealed that the ability to defecate the balloon and a history of secondary encopresis were related to recovery (p < 0.04). Patients who were unable to defecate the balloon or who did not recover had significantly more impairment in anorectal functions than those who were able to defecate the balloon or who did recover. The ability of the balloon defecation test to predict recovery had a sensitivity of 57%, a specificity of 60%, a positive predictive value of 0.51, and a negative predictive value of 0.66. CONCLUSION: Children with functional constipation and encopresis who were able to defecate the rectal balloon were twice as likely to recover. Even though there was a clinically significant difference in the recovery rates between patients who could and those who could not defecate the balloon, calculation of predictive values showed that the balloon defecation test could not reliably predict recovery.

Anal Canal↗
PubMed1996

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.

Adolescent↗
PubMed2001

Enuresis and encopresis: ten years of progress.

OBJECTIVE: To review the progress made over the past decade with regard to the treatment of enuresis and encopresis, as well as advances in the understanding of etiological mechanisms. METHOD: Separate computerized literature (English language only) searches of Medline and PsycINFO databases were conducted under the parameter of enuresis and children-adolescents, as well as encopresis and children-adolescents. RESULTS: There has been a substantial decrease in published research concerning the use of imipramine to treat enuresis compared with the prior two decades, accompanied by a corresponding increase in the number of papers concerning desmopressin acetate (DDAVP), which has become the primary pharmacological treatment. Genetic studies of large pedigrees have further confirmed the importance of heritable factors. With regard to encopresis, the research has focused primarily on pathophysiological factors related to the colon and anal sphincter. CONCLUSIONS: The widespread use of DDAVP has been the primary addition to treatment strategies over the past decade. The bell-and-pad method of conditioning, the only major treatment that has enduring benefit after being withdrawn, is the most cost-effective and appears to be underutilized. Research into etiological mechanisms has focused primarily on the mechanism of action of DDAVP and advances in the understanding of genetic factors. Advances in the treatment and etiological understanding of encopresis have been less impressive.

Adolescent↗
PubMed1986

Locus of control and self-esteem in children with encopresis.

Children with encopresis were compared to children with other "high prevalence low-severity" disorders on measures of locus of control and self-esteem. Children with encopresis tended to feel less in control of positive life events, had lower self-worth, and were more apt to want to change and be different than children with other chronic symptoms. Data tend to contradict traditional interpretations of encopresis as a system of unconscious motives involving independence and control. Also, this information adds to the clinical impression culled from experience that active intensive remediation is the appropriate clinical response when treating children with encopresis.

Child↗
PubMed2002

Polyethylene glycol without electrolytes for children with constipation and encopresis.

BACKGROUND: Children with functional constipation and encopresis benefit from behavior modification and from long-term laxative medication. Polyethylene glycol without electrolytes has become the first option for many pediatric gastroenterologists. METHODS: Twenty-eight children treated with polyethylene glycol without electrolytes were compared with 21 children treated with milk of magnesia to evaluate the efficiency, acceptability, side effects, and treatment dosage of polyethylene glycol in long-term treatment of functional constipation and encopresis. Children were rated as "doing well," "improved," or "not doing well," depending on resolution of constipation and encopresis. RESULTS: At the 1-, 3-, 6-, and 12-month follow-ups, bowel movement frequency increased and soiling frequency decreased significantly in both groups. At the 1-month follow-up, children on polyethylene glycol were soiling more frequently (P < 0.01) and fewer were improved (P < 0.01). At the 3- and 6-month follow-ups, both groups had similarly improved. At the 12-month visit, 61% of children on polyethylene glycol and 67% of children on milk of magnesia were doing well. Children on polyethylene glycol soiled more frequently (P < 0.01). None refused polyethylene glycol, but 33% refused to take milk of magnesia. The mean initial treatment dosage of polyethylene glycol was 0.6 +/- 0.2 g/kg daily. Polyethylene glycol had no taste, and no loss of efficacy occurred. Polyethylene glycol did not cause clinically significant side effects. CONCLUSIONS: Polyethylene glycol without electrolytes is an alternative for long-term management of children with constipation and encopresis.

Adolescent↗
PubMed2000

Encopresis and anal masturbation.

Current pediatric and psychiatric studies on encopresis and its treatment are heavily influenced by mechanical, physiological, and behavioral considerations. Although psychodynamic treatment has generally been considered to be of little benefit, and its findings suspect, the authors suggest that a psychodynamic approach adds substantially to the understanding of some cases of encopresis; that the anal sensations and anal erotic feelings reported by a number of encopretic children are intense, and that the encopretic symptom, soiling, in these children is the result of a conscious form of anal masturbation in which the fecal mass is used for stimulation; and that any study of encopresis is incomplete that does not include what encopretic children, engaged in a sound therapeutic relationship, know and say about their soiling. The authors further suggest that physical treatments of those children whose encopresis is psychologically driven may be contraindicated. The presence of a large stool does not in itself substantiate a physical illness. Further research is needed to elucidate the prevalence of anal masturbation in encopretic children.

Anal Canal↗