Encopresis also known as paradoxical diarrhea, stool withholding and chronic constipation is
involuntary fecal soiling in children who have been or have yet to be toilet
trained. Children or adults with encopresis often leak stool into their undergarments.
This term is usually applied to children, and where the symptom
is present in adults, it is more commonly known as fecal leakage, or fecal
soiling.
Causes
Encopresis is commonly caused by diet, constipation, by
reflexive withholding of stool, by various physiological, psychological, or
neurological disorders, or from surgery (a somewhat rare occurrence).
The colon normally removes excess water from feces. If the
feces or stool remain in the colon too long due to conditioned withholding or
incidental constipation, so much water is removed that the stool becomes hard,
and becomes painful for the child or adult to expel in an ordinary bowel movement.
A
vicious cycle can develop, where the child or adult may avoid moving his/her bowels in
order to avoid the "expected" painful elimination.
This cycle can
result deeply conditioning the holding response that the rectal anal
inhibitory response (RAIR) or anismus results.
The RAIR has been shown to occur
even under anesthesia and when voluntary control is lost.
The hardened stool
continues to build up and stretches the colon or rectum to the point where the
normal sensations associated with impending bowel movements do not occur.
Eventually, softer stool leaks around the blockage and cannot be withheld by
the anus, resulting in soiling.
The person typically has no control over these
leakage accidents, and may not be able to feel that they have occurred or are
about to occur due to the loss of sensation in the rectum and the RAIR.
Strong
emotional reactions typically result from failed and repeated attempts to
control this highly aversive bodily product. These reactions then in turn may
complicate conventional treatments using stool softeners, sitting demands, and
behavioral strategies.
The onset of encopresis is most often benign. The usual
onset is associated with toilet training, demands that the child sit for long
periods of time, and intense negative parental reactions to feces. Beginning
school or preschool is another major environmental trigger with shared
bathrooms. Feuding parents, siblings, moving, and divorce can also inhibit
toileting behaviors and promote constipation. An initiating cause may become
less relevant as chronic stimuli predominate.
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