Encopresis (Faecal Incontinence in Children)

Encopresis is the involuntary passage of formed or semi-formed stools into clothing occurring repeatedly for at least 1 month, in children 4 yrs and over. Inadequate toileting and poor diet are features. The key feature is significant faecal retention → rectal dilatation. PR reveals poor anal tone, capacious rectum overload with firm faeces.

Assessment

• History incl. development

• Examination incl. check underwear

• Consider abdominal X-ray (serves as baseline)

Management The majority are cured with the following strategies. The initial task is to empty the bowel of faeces (can take months).

Laxative medication:

• Stool softener (e.g. paraffin oil) 20–40 mL daily

• Macrogol 3350 (Movicol) sachets 1 bd day 1, 2 bd day 2, 3 bd day 3 and so on until desired result

• Consider Microlax enema, then Senokot granules, one teaspoon daily

If severe faecal impaction:

• Admit to hospital (day care)

• Consider abdominal X-ray

• Macrogol 3350: double usual dosage

• Microlax enema

If unsuccessful, sodium phosphate (Fleet) enema (not <2 y)

If oral medication refused, sodium sulphate (ColonLYTLEY) via naso-gastric tube.

General care:

• Ongoing interest and support (critical)

• Education and counselling

• A good normal diet, adequate fluids and exercise

• Structured toileting program (e.g. regular sitting on toilet for at least 10 mins, 3 times/d after each meal)

• Regular follow-up with encouragement, e.g. star-chart diary

• Avoid punitive methods, criticism and undue focus on the problem

• Consider encopresis clinic if problematic