Infantile encopresis (incontinence): causes and treatment

Many boys and girls, and even some adults, have ever suffered from some type of incontinence, be it urinary or fecal. Regarding fecal incontinence, in a large number of cases we can find that said loss of control may be due to a disease such as gastroenteritis or epilepsy, the loss of muscle tone in the sphincters due to age, the presence of alterations such as those caused by 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 the fact that at least a part of our organic waste cannot be retained (there are even popular expressions when regard). When this occurs in the absence of pathology and frequently we are talking about a problem or disorder called encopresis, and if it occurs in children it is called infantile encopresis.

• Related article: "Enuresis (urinating on oneself): causes, symptoms and treatment"

A disorder of excretion

Encopresis is understood to be the disorder characterized by the

repeated and frequent passing of stool throughout at least three months in unsuitable places such as clothing or the ground, said deposition being involuntary or voluntary.

To diagnose this disorder, classified as disorder of excretion together with enuresis or urinary incontinence, it is necessary that the subject is at least four years old (by which time a large number of children already have control of their sphincters) and the incontinence is not due to the presence of a disease or physiological alteration beyond possible constipation, nor to the consumption of substances such as laxatives or food in bad shape

This disorder can cause the presence of deep feelings of shame or guilt in the child, which sometimes ends up leading to problems bonding with others, as well as concealing bowel movements when they occur involuntarily.

Types of encopresis according to sphincter control

Infantile encopresis can be classified into primary and secondary depending on whether the problem is that the men has not controlled the excretion process at any time or is due to a lack of control produced by a specific element.

primary encopresis

Primary or continuous encopresis is one in which the minor has not declared at any time to be able to control the emission of feces, despite already having a sufficiently advanced level of development as to be able to do it.

secondary encopresis

Also called discontinuous encopresis, in it the subject in have previously acquired good control of their 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 minor has not yet been able to control defecation beforehand.

Types of encopresis according to the level of feces retention

Infantile encopresis can be divided into two depending on whether the excretion is carried out due to an 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 overflow incontinence occurs when the minor retains the emission of feces for a long time, and can go up to two weeks without defecating. The boy or girl ends up making their bowel movements due to the overflow, first expelling loose stools and later hard stools of great consistency. that supposes a certain level of pain to expel.

non-retentive encopresis

In this type of encopresis without constipation or overflow incontinence there is no excessively long retention, not having 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 the encopresis is primary, it is considered that it may be due to the fact that the minor has not been able to reach a incorrect learning of sphincter control, the minor not being 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 minor to retain the feces or lose control over them. fear and anxiety are some of the emotions that can elicit such 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 by 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 facing the world abroad. In cases where defecation in inappropriate places is voluntary, we may be facing a display of rebellion on the part of the minor.

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Treatment

The treatment of encopresis usually incorporates a multidisciplinary methodology, incorporating psychological, medical and nutritional aspects.

With regard to psychological treatment, this will focus on carrying out a training in defecation habits that is going to be enhanced through the use of positive reinforcements. In the first place, it must be evaluated if there is an emotional reason behind the defecation and/or retention of feces, and if so, they must be treated by the appropriate means. For example, systematic desensitization or relaxation in anxiety cases.

As for the defecation process itself, the child will be taught first of all to identify the signs that warn of the need to evacuate, to subsequently shape and model the practice of appropriate habits so that the child is increasingly more autonomous.

At all times the acquisition of behaviors will be reinforced, being able to use techniques such as the economy of cards, both before and during and after defecating (when the child goes to the bathroom, evacuates in the toilet and stays clean). Punishment has also been occasionally used as part of the process, such as making him clean the dirty clothes, but it is essential not to provoke guilt or diminish the minor's self-esteem.

Nutritional and medical intervention

With regard to nutrition and medical aspects, apart from evaluating whether the incontinence is not due to organic causes drugs may be prescribed to aid evacuation in specific situations or enemas that soften the stool in case of constipation. In fact, the doctor and the psychologist should guide the use of laxatives while the 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 their evacuations in a normative manner, together with abundant hydration.

Bibliographic references:

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Massón, Barcelona.

• thief, a. (2012). Child Clinical Psychology. CEDE PIR Preparation Manual, 03. CEDE: Madrid.