Encopresis, also termed fecal soiling, means involuntary passage of feces. Until the age of 4 to 5 years, it may well be a developmental variation. Thereafter, it is considered indicative of a disorder such as severe chronic constipation, mental retardation, neurologic defects like progressive degenerative disease, or anal and rectal abnormalities.
History should seek information whether fecal incontinence is of recent onset or it has been like that since long as a part of unsuccessful toilet training. What is its frequency? Is there any relationship with time of the day? Is the child constipated? Is the constipated stool accompanied by streaks of blood? Is constipation indeed painful? Is the child mentally normal? Any neurologic disease he is known to suffer from?
Clinical examination should focus on psychological, developmental and neurological evaluation. Rectal examination is imperative.
In severe chronic constipation, associated with fecal impaction or painful defecation, the mother may complain that the child simply soils or that he has diarrhea with soiling. In actuality, the so-called “diarrhea” is the liquid fecal matter that spills round the edges of a solid fecal mass situated either in the rectum or low in the colon. Rectum is found to be full of large fecal lumps.
This type of encopresis (the so-called “overflow” type) is responsible for a vast majority of the cases encountered in pediatric practice. For some unexplained reason, it occurs dominantly in boys.
In some children, such emotional disturbances as separation from parents (usually the mother), starting school, or arrival of a younger sibling, may manifest with fecal soiling. There is evidence that these children seldom have had right bowel training. In fact, they rarely, if ever, have controlled the bowel.
Encopresis in these children reflects uncontrolled anger and defiance at the subconscious level.
The offensive odor from the child makes him a target of rebuke and scorn at home as well as at school. Naturally, his social relationship as also school performance and attendance suffer considerably.
Adequate bowel control needs normal anatomical relationships, an intact voluntary and involuntary nervous system, and consciousness of the urge to defecate.
Since all these requirements may not be met with in many mentally retarded children, encopresis is a common observation in them.
Fecal soiling may well be an important manifestation of such neurological abnormalities as degenerative diseases, meningomyelocele, lipoma of the spinal cord, tumors of the spinal cord and trauma to the spinal cord. In such lesions, the urge to defecate is simply absent.
Absence of external and internal sphincter mechanisms may be responsible for encopresis in a small proportion of cases.