Nonretentive Encopresis And
Toilet Training Refusal
An inappropriate soiling without evidence of fecal constipation and retention
is referred to as nonretentive encopresis. Signs and symptoms of
nonretentive encopresis include:
*Soiling accompanied by daily bowel movements that are normal in size and
consistency
There is rarely an identifiable organic cause for nonretentive encopresis. A
medical assessment is usually normal. A full developmental and behavioral
assessment is
necessary to determine if the child is ready for intervention to correct
encopresis. The assessment is also necessary to identify any barriers to success
of correcting encopresis, particularly disruptive behavior problems.
Successful therapy depends upon:
*The
presence of soft, comfortable bowel movements
*Addressing
toilet refusal behavior
Before therapy:
*Daily
scheduled positive toilet sits are recommended
*A
plan for management of stool withholding agreed on by parents/caretakers and the
family physician
Encopresis affects boys more than girls and may go undetected unless health
professionals directly inquire about toileting habits.
About 80 to 95 percent of encopresis cases involve fecal constipation and
retention. It is estimated that encopresis in which fecal retention is not a
primary
etiologic component is under-represented in the literature. Most of the time,
children with the latter condition have daily, normal size and consistency bowel
movements.
Terms used to describe this problem include:
*Functional encopresis
*Primary nonretentive encopresis
*Stool toileting refusal
There are four subgroups these children may be further divided into:
*Those who fail to obtain initial bowel training
*Those who exhibit toilet
"phobia"
*Those
who use soiling to "manipulate" their environment
*Those who
have irritable
bowel syndrome
Behavioral characteristics and toileting dynamics of children with nonrententive
encopresis are well described; however, few specific treatment guidelines are
available for family physicians.
Research of retentive encopresis
Over the past 20 years the treatment of retentive encopresis has progressed
impressively, however, less attention has been paid to the 5 to 20 percent of
cases in
which constipation is not contributory, or where a child refuses the
toilet-training process.
Evaluation for retentive encopresis
In most cases, the family physician is who first identifies the problem of
retentive encopresis and provides an intervention. If the problem is due to the
child not being mature enough for toilet training, waiting until the child matures is the
sensible answer. Many times, a lack of maturity is not the cause, but it is a
child who is behaviorally resistant or parents who need information on effective behavior
management or toilet-training techniques.
Possible causes for retentive encopresis
The cause for a child's resistance must be identified first. When the cause is
determined, specific therapy can be started.
*If the problem is related to a skill deficit such as opening the bathroom
door, seating self on toilet or wiping then teaching and reinforcement of those
skills the
child lacks is preferred to passive waiting.
*If the child is noncompliant with adult instructions, the physician may refer
the family to a pediatric psychologist familiar with compliance training
techniques.
In either of the two above cases, without active intervention, a strong-willed
child may refuse toilet training and create unnecessary stress on the
parent-child
relationship, which may in turn increase the risk of abuse.
If you have a toddler who exhibits any of the characteristics of retentive
encopresis consult with your toddler's pediatrician for an appropriate
evaluation and
treatment plan.
Disclaimer: *This article is not meant to diagnose, treat or cure any kind of
a health problem. These statements have not been evaluated by the Food and Drug
Administration. Always consult with your health care provider about any kind of
a health problem and especially before beginning any kind of an exercise
routine.
