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Faecal soiling (Pathophysiology (Complex, may be voluntary or not,…
Faecal soiling
Pathophysiology
Complex, may be voluntary or not
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Psychosocial factors
Fear of punishment for incontinence
Anxiety about using toilet
Abuse (e.g. sexual)
Mechanism
Retention of faeces and hard faecal bolus in rectum
Dilation and habituation of rectum (child unaware when to empty)
Stool may seep out spontaneously
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Diagnosis
Examination
Abdo - faecal mass
PR - hard/soft faecal mass, any fissures
Developmental - any delay
History
Predisposing, precipitating, perpetuating factors
Social setup at home
Management
Conservative
Information, advice, support
Dietary fibre intake
Encourage regular defaecation (star chart)
Psychiatric referral if conservative and medical not helping
Medical
Laxatives
Indication: retention
E.g. macrogol, senna
MOA: softeners, stimulants
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