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Encopresis (Faecal incontinence / Soiling) - Coggle Diagram
Encopresis (Faecal incontinence / Soiling)
Intro
abnormal for a child >4 y/o
can be humiliating - may need psych referral
child may be intentionally defaecating as a hostile act - psych referral
2 broad categories
Faecal retention (loaded rectum)
will be able to palpate this abdominally
some children are prone to this happening due to poor anal sphincter relaxation
can be a/w...
constipation
dehydration
pain from fissure
fear of punishment
anxiety about using toilet
a large bolus of hard faeces will be beyond capacity of child to shift
rectum dilates, habituates to distension, child becomes unaware of feeling the need to empty - stool seeps out beyond child's control
tx
any reasons why this happened should be identified + txed
empty rectum asap
stool softener (macrogol) for 2 wks
stim (docusate, na picosulphate, senna) + osmotic (lactulose) laxatives after if needed
sometimes enema required
once rectum disimpacted maintenance tx required
may take a no of wks while rectum shrinks back to normal
present in most children who soil
Without faecal retention
urgency
neuropathic bowel
occult spinal abnormality
usually a/w urinary incontinence
diarrhoea
learning disability
Tx
encourage child to defaecate
star chart