Fecal incontinence is the voluntary or involuntary passage of stool in inappropriate places in children> 4 years (depending on the level of development) that have no organic defect or illness, excluding constipation.
Encopresis is a common problem in childhood. It occurs in about 3-4% of four-year-olds and decreases in frequency with age.
Fecal incontinence is the voluntary or involuntary passage of stool in inappropriate places in children> 4 years (depending on the level of development) that have no organic defect or illness, excluding constipation. Encopresis is a common problem in childhood. It occurs in about 3-4% of four-year-olds and decreases in frequency with age. Etiology encopresis is most commonly caused in children with predisposing factors (in behavior or physique) by constipation. This problem rarely occurs without bowel habits or constipation, and if so, other organic disorders (eg. As Hirschsprung’s disease, celiac disease) or psychological problems should be considered. Pathophysiology Darmverhaltung and constipation lead to dilatation of the rectum and the sigma that result in changes in the reactivity of muscles and nerves of the intestinal wall. These changes reduce the effectiveness of intestinal excretion and lead to further Darmverhaltung. When stool stays in the intestine, water is absorbed, making the stool hard, so that the passage is difficult and painful. Softer, loose stool can then flow around the hard stool and cause leakage. Both leakage and ineffective bowel control leading to involuntary movements. Diagnosis Clinical Investigation All organic processes that lead to constipation (1), can lead to fecal incontinence and should be considered. For most cases of encopresis a thorough medical history and physical examination can help to find the physical cause. However, should if further concerns arise, additional diagnostic tests (eg. As X-rays of the abdomen, rarely a biopsy of the rectal wall and, even rarer, Darmmotilitätsuntersuchungen) are considered. Note to diagnose the first Koyle MA, Lorenzo AJ: Management of defecation disorders. in Campbell-Walsh Urology, ed. 11, edited by wine A, Kavoussi L, Partin A, Peters C. Philadelphia, Elsevier, 2016, pp. 3317-3329. Treatment education and tranquilizers (for parents and child) easing of the chair maintenance (eg, behavior modification and dietary changes, laxatives.) Discontinuation of laxatives for more extensive behavioral and diet modification (see table: treatment of constipation) The disturbances underlying be treated causally. If no specific underlying pathology is present, the symptoms are treated. The initial treatment is to educate the parents and the child in terms of the physiology of Enkoprese to take the child to feel guilty and appease the emotional responses of the participants. The next goal is to loosen the stool induration. Chair hardening can be treated by a variety of therapies and drugs (constipation in children: Treatment); The choice depends on the child’s age and other factors. A combination of polyethylene glycol (PEG) with electrolyte as well as a laxative (z. B. Senna or bisacodyl) or a series of sodium phosphate enemas, and a 2-week therapy with oral medications (eg. B. bisacodyl tablets) and suppositories are often used. After defecation, a follow-up visit should take place to determine whether the stool is successful, the defecating has stopped and a treatment plan set up to maintain. This plan involves continuous maintaining a regular bowel movement (usually about laxatives) and behavioral interventions to promote defecation. There are many ways of therapy with laxatives (see table: treatment of constipation), but mostly a PEG tube is used without electrolytes, typically titrated in 1-2 doses of 17 g once daily. Sometimes a laxative can also be continued on the weekends in order to obtain an additional defecation. Behavioral measures include scheduled sessions on the toilet (z. B. so that children sit on the toilet in order to exploit the gastrocolic reflex after each meal for 5-10 min). When children defecating repeatedly at certain times of the day, they should go immediately before that time on dieToilette. Small rewards are often useful incentives. For example, children can get stickers that are placed on a chart when they were on the toilet (even if this was to no avail). So the motivation is encouraged to continue to stick to the plan. Often a gradual program is used in which the children small gifts (eg. As stickers) for each sitting to get on the toilet and greater rewards for continuous participation. Rewards need to be modified over time possibly to get the children’s interest upright. In the maintenance phase regular meetings are still needed on the toilet in order to promote the defecation before an urge is felt. This strategy reduces the likelihood of constipation and allows the rectum to return to its normal size. During the maintenance phase one of awareness among parents and children about the strategy of the toilet sessions is important in order to ensure success. Regular follow-up is necessary for further advice and support. A defecation training is a long process that can take months to years and includes a tapering off of laxatives and a further encouragement for regular meetings on the toilet. Relapses often occur at the end of maintenance therapy, so it is important to provide continuous support and advice in this phase. Encopresis may recur during times of stress or changes, so that the family members must be prepared for this possibility. The success rates are influenced by physical and psychosocial factors, but cure rates after one year are around 30-50%, and after 5 years at about 48-75%. The mainstay of treatment is educating the family that colon cleansing and maintaining a healthy intestine and continuous support. Important points encopresis is most commonly caused in children with predisposing factors (in behavior or physique) by constipation. For most cases of encopresis a thorough medical history and physical examination can help to find the physical cause. All organic processes that lead to constipation can lead to fecal incontinence and should be considered. The treatment is done by education, relief from constipation, maintain a healthy bowel movement and discontinuation of laxatives for more extensive behavioral and diet modification. A Stuhleinklemmung can be alleviated by a variety of treatments and medicines. Behavior strategies include structured toilet seat times. Encopresis may recur during times of stress or changes, so that the family members must be prepared for this possibility.