Encopresis

Treatments

Biobehavioral Treatment   

Treatment Summary: Before applying the Biobehavioral treatment to an encopretic child the therapist should get a medical evaluation. After the medical evaluation confirms the disorder, this method of treatment can be considered. Treatment of Encopresis targets the processes that creates or makes worse the condition, including reducing colonic motility, constipation, and fecal impaction. Parents of children suffering from Encopresis are taught to demystify the elimination process. In other words parents should show no disapproval or blame the child when he or she defecates outside the toilet. Bowel evacuation (full cleansing of bowels, usually done using a combination of enemas, suppositories, or laxatives), toileting schedule, monitoring, and providing positive feedback if the child has a bowel movement in the toilet are the stages of modality for this treatment. 

• Reference: Friman, P.C., Hofstadter, K.L. & Jones, K.M. (2006).A biobehavioral approach to the treatment of functional Encopresis in children. Journal of Early & Intensive Intervention, 3(3) 

• Submitter: N/A 

Multi-modal treatment with bio-behavioral approach 

Treatment Summary: Child is given a thorough medical exam and then treated with a stool softeners, followed by a three-phase behavioral approach. This approach has a 75-80% success rate and has a significantly higher rate of success compared to either a medical or a behavioral approach alone. 

• Reference: Carney, T. & Murphy, S. (2004). The classification of soiling and Encopresis and a possible treatment protocol. Child and Adolescent Mental Health, 9 (3), 125-129. 

• Submitter: Rachel Dawson 

Treatment pathway for elimination disorder 

Treatment Summary: Determine whether the encopresis is caused by constipation. If it is determined that constipation is the primary cause of encopresis then laxatives and colon irrigation may be recommended as well as adding fiber and water to child’s diet. If constipation is not the primary cause then behavioral treatment may be deemed necessary such as retraining toilet skills, strengthening of anal muscles and positive reinforcement. Treatment of enuresis can be treated by a method that was made in the 1930’s which includes a bell and pad; the pad is connected to a bell or buzzer that initiates an alarm to wake the child when the child begins to wet the bed. After time the child begins to recognize when their bladder is full and wakes up and uses the restroom. 

• Reference: Oswalt, A., Reiss, N., Dombeck, M. (2008). Child Development and Parenting: Early Childhood. Mental Help.net Retrieved from http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=14320&cn=462. 

• Submitter: Sherone Smith 

Classification of Soiling and Encopresis and a Possible Treatment Protocol 

Summary of Treatment: The research article below suggests that Elimination disorders can be exclusively psychological, medical, or a combination of both factors. In order to properly formulate a treatment for developmental pediatric elimination disorders, it is important to first understand the types and variety of etiologies. Some research based on a multi-modal approach (behavioral therapy and medical intervention such as a laxative for stool withholding) have shown to be 80-90% effective, while medical management using enemas, laxatives, mineral oils and regular toilet schedules have also shown a good (70-80% effective) outcome (Murphy & Carney, 2004). Soiling and encopresis are physical issues that can sometimes be linked to psychological problem or trauma. In order to find the correct treatment for any specific child, a treatment pathway should be created to assess if soiling or encopresis are primary (has never had bowel control), secondary (had bowel control for at least 6 months), active (consciously withholding or soiling due to fear or stress) or physical (anatomical problems, irritable bowel syndrome). This research suggests that a child experiencing only encopresis may benefit from only psychological management, while a child experiencing soiling or a combination of both may require a combination medical and psychological approach (Murphy & Carney, 2004). This treatment protocol suggests the use of a flow chart to determine appropriate therapies for soiling and encopresis. 

• Reference: Murphy, S. & Carney, T. (2004) The classification of soiling and encopresis and a possible treatment protocol. Child and Adolescent Mental Health, 9(3), 125-129.  

• Submitted by: Ceara Tapin