Discussion ch

Group D

James, Robert

Kurth, Tiffany

Lawal, Musediq

Akron Children’s Hospital

“If your child has bowel movements (BMs) in places other than the toilet, you know how frustrating it can be. Parents might assume that kids who soil their pants are misbehaving or too lazy to use the bathroom when they have the urge to go.

Signs and Symptoms

According to Harvard Medical School (2018), the signs and symptoms of encopresis are:

· Underpants are soiled

· The smell of stool or foul-smelling of the child

· Large bowel movements that alternate with constipation

· Presence of blood on toilets or tissue used to clean the anal opening

· Clothes with stool stained hidden in closets around the house

· Pain in the rectum and lower abdomen

· Nocturnal enuresis due to pressure from the rectum

· Smearing of stool on walls, floors, and furniture in the house

Pathophysiology

According to Coehlo (2013), encopresis results from unpleasant events that must have occurred in the child’s life during toilet training, which could have affected the child to pass feces voluntarily. Other contributing factors are constipation in childhood, poor muscle tone coordination, short attention span in children, and male children.

Kidshealth.org

How the Disorder is Diagnosed

Coehlo (2013) used the following criteria in diagnosing children with encopresis, these are:

· Accidental or purposeful and repeated passing of feces by a child in inappropriate locations (clothing and on the floor).

· The act is done once a month in a three months period and the child is at least four years old in chronological age.

· The behavior is not influenced by physiological factors or substance used by the individual.

Treatment Options

According to Anderson (2019), current evidence-based treatments include:

· Fecal disimpaction and laxative therapy can be achieved by oral or rectal medication.

· Dietary interventions should address overall eating habits, water intake, and fiber intake. The focus should be to increase the consumption of specific fruits and vegetables, decrease the consumption of foods that are high in fat and sugar, and decrease the consumption of constipating foods, such as white bread, banana, and excessive dairy.

· Behavioral modification/intervention; implementation and maintenance of bowel and bladder-voiding schedule and log to monitor for constipation. Behavioral modification of the child’s posture (knees are above the hips) while on the toilet to allow for a more effortless stool flow.

· Child and family education should be child-friendly and age-appropriate explanations to the child and family about the disorder, the process of normal defecation, and the pathology of functional constipation to help alleviate anxiety, clarify misconceptions, and help support the child, family, and therapist relationship.

References

Akron Children’s Hospital (2021). For Family Members of Patients. Retrieved from

https://www.akronchildrens.org/kidshealth/en/parents/encopresis.html

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).