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At least 19 recordsLinked to original sources
PubMed1982

Interdisciplinary treatment of encopresis in individuals with developmental disorders: need and efficacy.

The specific target behavior of encopresis in individuals with mental retardation and developmental disorders (MR/DD) is not well-defined in the literature on encopresis or in the literature on specific interventions with MR/DD populations. The criteria for establishing a diagnosis of encopresis in individuals with MR/DD are not clear. The literature on encopresis was reviewed for two factors: (1) definitions according to three major definitional criteria of age, defecation patterns and etiology; and (2) the relationship between etiology and intervention in specific, MR/DD, and nonspecific populations. This review yielded no clinical description of encopresis in MR/DD children, no guidelines for differentiating encopresis from generalized developmental delay and no substantive treatment guidelines. Although no definitions or treatment formulations specific to MR/DD were identified, information and definitional guidelines derived from the general literature on encopresis are relevant to identification, definition and treatment issues for MR/DD populations. Interdisciplinary or team approaches are appropriate for individuals with multiple problems or developmental disorders and intractable encopresis. An interdisciplinary approach, neurodevelopmental-behavioral intervention, which was successfully employed with a 5-year-old encopretic child with multiple developmental problems, is described.

Age Factors↗
PubMedDate not supplied

Anorectal function and continence mechanisms in childhood encopresis.

We compared anorectal sensory and motor functions, expulsion dynamics, and continence mechanisms in 50 children with encopresis and 21 healthy control children. When expulsion dynamics were studied, 43% of boys with encopresis inappropriately contracted the muscles near the anal canal compared with 10% of girls with encopresis (p greater than 0.05) and 10% of control children of both sexes (p less than 0.05). In contrast to previous studies we demonstrated no abnormalities of thresholds of conscious rectal sensation or internal anal sphincter relaxation. In addition, children with encopresis had no demonstrable abnormalities of rectosphincteric continence mechanisms or strength of external anal sphincter contraction. We conclude that a significant number of boys with encopresis have abnormal anorectal expulsion dynamics, which may contribute to chronic fecal retention and incontinence. Abnormalities of anorectal sensory and motor function and of rectosphincteric continence mechanisms do not seem to be important in the pathogenesis of childhood encopresis.

Adolescent↗
PubMed1984

Abnormal rectoanal function in children recovered from chronic constipation and encopresis.

It is unknown if abnormal anal sphincter function as assessed by anorectal manometry is still present years after resolution of chronic constipation and encopresis. Twenty healthy controls, 12 children with constipation but no encopresis, and 20 children with chronic constipation and encopresis underwent anorectal manometric testing, using intraluminal pressure transducers and a balloon for rectal distention. Anorectal measurements were repeated in the 20 constipated and encopretic children 2.5-4 yr after treatment began; 11 children had recovered for at least 1 yr. The mean values of anal resting tone and of anal pull-through pressure were lower in the constipated and encopretic children than in the 20 control children (p less than 0.003). Percent relaxation of the rectosphincteric reflex after rectal distention of 30 and 60 ml was lower in constipated children with and without encopresis than in controls (p less than 0.003), whereas the means of rectosphincteric reflex threshold were comparable in the three groups of children. Three years after initiation of treatment with milk of magnesia, high-fiber diet, and bowel training techniques, the mean values of anal resting tone, anal pull-through pressure, and percent relaxation of rectosphincteric reflex remained significantly lower in both recovered and nonrecovered constipated and encopretic patients compared with controls. It was suggested that the underlying cause of chronic constipation is the decreased ability of the internal anal sphincter to relax with rectal distention, and the hypotonia of the anal canal is responsible for the encopresis. Abnormal anorectal functions were still present years after cessation of treatment and recovery and put the recovered patient at risk for recurrence of chronic constipation and encopresis.

Anal Canal↗
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↗
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↗
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↗
PubMed1991

A model for the treatment of encopresis.

Encopresis is a relatively common childhood disorder that continues to be poorly understood. An integrated assessment and treatment model for this disorder is presented. Data generated from a comprehensive assessment enables the diagnosis and identification of subtypes of encopresis based on objective, identifiable criteria. The rationale and methods for treating each subtype of encopresis then is presented. In addition, the importance of assessing and treating psychiatric comorbidity in children with encopresis is highlighted.

Child↗
PubMed1988

Polyethylene glycol-electrolyte solution for intestinal clearance in children with refractory encopresis. A safe and effective therapeutic program.

Severely constipated children with encopresis in whom outpatient management has failed frequently require several days of hospitalization, as well as conventional treatments involving cathartics and enemas. A balanced electrolyte solution of the nonabsorbable polymer polyethylene glycol (GoLytely, Braintree [Mass] Laboratories Inc) offers a safe and efficient method for clearing the intestine. Twenty-four patients with a mean age of 8.1 years (range, 0.8 to 17.6 years) and an average weight of 31.5 kg received polyethylene glycol-electrolyte solution: eight patients with encopresis were given it as treatment for severe fecal retention unresponsive to outpatient management; the other 16 were being prepared for colonoscopy. Weight, complete blood cell count, and serum electrolyte, serum urea nitrogen, and serum creatinine levels were measured before solution administration and two hours afterward. Abdominal roentgenograms were obtained from the encopretic patients. The two groups were comparable in age and weight. Polyethylene glycol-electrolyte solution was given at a rate of 14 to 40 mL/kg/h until clear fluid was excreted through the rectum. Intestines were cleaned out successfully in all patients, and side effects were minimal. Children with encopresis required an average of 11.8 L (574 mL/kg) given over 22.5 hours, while the other children needed only 4.0 L (128 mL/kg) given over 7.5 hours. Weight and serum electrolyte and creatinine levels did not change significantly in any patient. The hematocrit decreased only in encopretic patients (0.38 to 0.36 [37.6% to 35.8%]) and the serum urea nitrogen level decreased in the patients undergoing colonoscopy (3.6 to 2.0 mmol/L [10 to 8 mg/dL]).

Adolescent↗
PubMedDate not supplied

Evaluation of biofeedback in childhood encopresis.

In order to evaluate the efficacy of biofeedback for childhood encopresis, 50 children with encopresis were prospectively studied and randomized to receive biofeedback (B) or mineral oil therapy (M). Specificity of biofeedback was also evaluated by comparing outcomes of both regimens in children with normal (n = 32) and abnormal (n = 18) defecation patterns. Using a single blinded design, there were no significant differences in clinical outcomes between the 24 children receiving B and the 26 children receiving M at 3, 6, and 12 months. However, at 12 months six of nine children with abnormal defecation patterns were in remission or markedly improved after receiving B, compared to only three of nine children receiving M. In contrast, children with normal patterns appeared to respond better to M than did those receiving B (71 vs. 40% at 12 months). Biofeedback appears to warrant further evaluation in children with encopresis and abnormal defecation patterns.

Adolescent↗
PubMed1988

Encopresis responsive to non-psychiatric interventions. With remittance of familial psychopathology.

A case report of an adolescent with primary encopresis is presented in which the patient responded to standard medical interventions despite apparent significant psychopathology in the child and family. Psychological symptoms proved to be secondary and resolved with successful medical treatment and with attending to other concerns, such as this patient's school problems. Behavioral and medical literature related to encopresis is reviewed. It indicates that encopresis is associated more consistently with physiological abnormalities of the bowel rather than definable psychological disorders.

Adolescent↗
PubMed1975

Children with encopresis: A descriptive analysis.

During an 18-month period, 102 children with encopresis were seen in a general pediatric outpatient clinic. Through interviews and questionnaires, extensive historical information was obtained. Children were compared with respect to demographic characteristics, bowel-function histories, early training and management, and present manifestations of bowel dysfunction. A wide variety of historical backgrounds and manifestations was observed. It was found that many of the traditional generalizations about encopresis could not be substantiated. It is suggested that a very individualized approach to this problem be adopted and that children with encopresis be investigated carefully to uncover early developmental problems, critical life events, and the precise physiology and dynamics of present bowel dysfunction.

Adolescent↗
PubMed1991

Encopresis in children: a cyclical model of constipation and faecal retention.

Encopresis afflicts one in 100 children causing considerable stigma and parental concern. General practitioners are in a position to help in most cases but are often deterred by the psychoanalytical theories which have been developed to explain this problem. It is currently accepted that children with encopresis tend to retain stools. This leads to constipation, overstretching of sphincters and resultant faecal soiling. Physical and psychological perpetuating factors result in retention once again, thus completing a cycle of constipation and retention. Various precipitant and predisposing factors can maintain this cycle. Once physical causes have been excluded a simple behavioural approach can be adopted aimed at retraining the bowel. By using laxatives to prevent retention, gaining the child's confidence, cooperation and understanding and involving both the family and school, encopresis can be successfully managed in general practice.

Child, Preschool↗
PubMed1991

[Significance of electroencephalography in the physical examination of children with encopresis].

At an one time transversal examination 28 of 36 children with encopresis exhibited abnormal findings, increased incidence of sharp waves, a back ground that was too slow for their age and subcortical dysfunctions was striking. The abnormalities are approached as constitutional risks and maturational retardation with increased environmental propensity. Increased frequency of enuresis and encopresis in premature craniosynostosis was found. Electroencephalography should be used in paediatric and child psychiatric examination as a not burdening screening method for clarifying the aetiologic conditions of encopresis and getting hints of brain maturation, constitutional disorders and may be signs of brain damage.

Adolescent↗
PubMed1991

[Encopresis in children. Preliminary report of new therapeutic and diagnostic aspects].

There appears to be no strict boundary between encopresis, which is defined as a psychogenic disorder, and incontinence, in which there is an inability to retain faeces voluntarily. Our findings over an 8-year period suggest that unrecognized functional or organic retention disorders are present in encopresis more often than previously thought. Of 16 children with encopresis who were examined by perfusion manometry 14 were found to have disorders of anorectal functions. Of these, 7 showed pathologically low sphincteral pressure rates and 3 abnormally high rates with coordination disorders. Four had normal sphincteral pressure rates but considerably disturbed sensitivity. In the 3 children examined by MRI so far clear morphological changes were found. The question of whether the deviations found were the result of primary or secondary changes could not be clarified. However, of key importance is that these additional findings enable the use of a combined course of treatment (passive sphincter training by electrostimulation and active sphincter training with biofeedback) that seemed to bring improvement quickly and reliably.

Adolescent↗
PubMed1988

Behavioral ratings and outcome of medical treatment for encopresis.

The relationship between behavior problems and encopresis remains controversial. Recent research suggests that children with encopresis do have numerous behavior problems, but that these problems are generally not as severe as the behavior problems found in children referred for mental health services. This study explores the relationship between baseline behavior ratings of encopretic boys, ages 6-11, on a standardized rating form, the Child Behavior Checklist (CBCL), and outcome of medical treatment for their encopresis. A strong correlation between the product of the sum of the factors on the internalizing scales and the sum of the factors on the externalizing scales and their interaction on the CBCL was associated with outcome. Specifically, moderate elevations of this function predicted good outcome at 3, 6, and 12 months. Very high elevations and minimal or no elevation predicted poor outcome at 3, 6, and 12 months. Possible reasons for these somewhat surprising results are discussed.

Child↗
PubMed1979

Encopresis in adolescence: two case studies.

Encopresis is an underreported psychopathological symptom of adolescence, not necessarily defining a specific diagnostic entity. The two cases presented offer an opportunity to evaluate encopresis occurring in markedly different adolescent pathological entities and developmental backgrounds. The first patient presented a longitudinal life course wherein toilet training and fecal considerations were prominent throughout his development. Indeed, this young man had such areas of cohesive functioning, as to be appropriately considered within the range of characterological pathology, severe, though it may be. In marked contrast, the second patient's encopresis represented but a small part of a totally encompassing psychotic disintegration.

Adolescent↗
PubMed1990

Encopresis: behavioral parameters associated with children who fail medical management.

The present study examined behavioral parameters such as parent management of encopresis and parental coping styles (active, cognitive, and avoidance) as predictors of success with medical management of encopresis. The results suggest that parents use a variety of management strategies and treatment success cannot be predicted using these variables. However, in line with previous research the presence of child behavior problems appeared to be a potential predictor variable.

Adolescent↗
PubMed1990

Combined medical and psychological treatment of hospitalized children with encopresis.

Sixteen children, all inpatients at a state psychiatric hospital, received combined medical and psychological treatment for encopresis. One-year follow-up showed significant improvement. The results suggest that encopresis can be treated in severely emotionally disturbed children with a multifaceted and multidisciplinary approach.

Behavior Therapy↗