Infantile Encopresis (incontinence): Causes, Types And Treatment
Many boys and girls, and even some adults, have suffered some type of incontinence, whether urinary or fecal. Regarding fecal incontinence in a large number of cases we can find that said loss of control can be due to a disease such as gastroenteritis or epilepsy, loss of muscle tone in the sphincters due to age, the presence of alterations such as those caused due to surgery or the consumption of some substances.
But the cause is not always organic: sometimes sensations and emotions such as fear or anxiety, or even laughter, can culminate in at least a part of our organic waste not being able to be retained (there are even popular expressions about it). When this occurs in the absence of pathology and is common, we are talking about a problem or disorder called encopresis, and If it occurs in children it is called infantile encopresis.
Encopresis is understood to be the disorder characterized by passing stool repeatedly and frequently for at least three months in inappropriate places such as clothing or the floor, and said deposition may be involuntary or voluntary.
For the diagnosis of this disorder, classified as an excretion disorder along with enuresis or urinary incontinence, it is necessary that the subject be at least four years of age (at which time a large part of children already have control of their sphincters) and the incontinence is not due to the presence of a disease or physiological alteration beyond of possible constipation, nor the consumption of substances such as laxatives or spoiled food.
This disorder can cause the presence of deep feelings of shame or guilt in the minor which sometimes ends up leading to problems bonding emotionally with others, as well as hiding bowel movements when they occur involuntarily.
Types of encopresis according to sphincter control
Infantile encopresis can be classified as primary and secondary. depending on whether the problem is that the meno has not controlled the excretion process at any time or is due to a lack of control caused by a specific element.
Primary encopresis
Primary or continuous encopresis is one in which the minor has not at any time expressed being able to control the emission of feces, despite already having a sufficiently advanced level of development like to be able to do it.
Secondary encopresis
Also called discontinuous encopresis, in it the subject in has previously acquired good control of his sphincters and the emission of feces, but for some reason at present it has stopped doing so. In other words, in secondary encopresis, incontinence is not due to the fact that the child has not yet been able to control defecation previously.
Types of encopresis depending on the level of fecal retention
Infantile encopresis can be divided into two depending on whether excretion occurs due to excessive retention of feces by the child. or if it occurs in the absence of any type of constipation.
Retentive encopresis
Retentive encopresis or with constipation and incontinence due to overflow occurs when the child retains the emission of feces for a prolonged period, and can go up to two weeks without defecating. The boy or girl ends up passing stools due to overflow, first expelling weak stools and later hard, highly consistent stools. which involves a certain level of pain to expel.
In this type of encopresis without constipation or overflow incontinence there is no excessively long retention there being no serious constipation. The child’s stools are normal.
Possible causes (etiology)
Over time, the possible causes of this disorder have been explored, finding that the main causes of childhood encopresis are psychological. However, There are organic factors that can influence in its presence such as the tendency to constipation.
When encopresis is primary, it is considered that it may be due to the fact that the child has not managed to achieve incorrect sphincter control learning, and the child is not able to recognize the signs that warn of the need to defecate.
In the case of secondary encopresis, the main etiology is the existence of some type of sensation that causes the child to retain stool or lose control over it. Fear and anxiety These are some of the emotions that can trigger this loss of control. Living in conflictive situations, with domestic violence or in precarious conditions can cause some children to react by suffering from this disorder.
Another closely related aspect has to do with the type of education given to the boy or girl : overdemanding parents who provide an education that is too rigid can generate fear of failure and punishment that can translate into a loss of control, or in the case of an excessively permissive or ambivalent education that causes insecurity or fear of face the outside world. In cases where defecation in inappropriate places is voluntary, we may be facing a sign of rebellion on the part of the minor.
Treatment
The treatment of encopresis usually incorporates a multidisciplinary methodology, incorporating psychological, medical and nutritional aspects.
Regarding psychological treatment, this will focus on carrying out training in defecation habits which will be enhanced through the use of positive reinforcement. First of all, it must be evaluated if there is any emotional reason behind the defecation and/or retention of feces, and if so, they must be treated by appropriate means. For example, systematic desensitization or relaxation in cases of anxiety.
As for the defecatory process itself, the child will first be taught to identify the signs that warn of the need to evacuate, and then mold and model the practice of appropriate habits so that the child becomes increasingly autonomous.
At all times, the acquisition of behaviors will be reinforced, using techniques such as token economy, both before, during and after defecating (when the child goes to the bathroom, he evacuates into the toilet and stays clean). Punishment has also occasionally been used as part of the process, such as making them clean dirty clothes, but it is essential not to cause guilt or reduce the minor’s self-esteem.
Nutritional and medical intervention
Regarding nutrition and medical aspects, apart from evaluating whether incontinence is not due to organic causes drugs may be prescribed to aid evacuation in specific situations or enemas that allow the stool to soften in case of constipation. In fact, the doctor and psychologist should prescribe the use of laxatives while training in defecation habits is carried out.
It is also advisable to provide the infant a balanced diet rich in fiber that helps the minor to carry out his evacuations in a normative manner, along with abundant hydration.
