Trends in Referral to a Single Encopresis Clinic Over 20 Years

Abstract

ABSTRACT. Objective. To compare the characteristics of children with encopresis referred to a single encopresis clinic over the course of 20 years, including symptoms, previous diagnostic and therapeutic interventions, and parental attitudes.Methods. A retrospective study was conducted of an encopresis clinic at a tertiary care pediatric hospital. Questionnaires at initial evaluation elicited information about bowel habits, soiling, previous evaluations, previous treatments, and parental attitudes.Results. In 503 children with encopresis, the average age of referral dropped from 115 months during the earliest 5 years to 77 months during the most recent 5 years. Children who had soiling for >3 years before referral decreased from 63% to 12%. The use of barium enema before referral decreased from 14% to 5%, as did psychological evaluation, from 25% to 14%. Previous therapy with enemas decreased from 45% to 27%. Mineral oil use remained at approximately 50%, and 20% of children had no previous treatment. Symptoms at referral and parental attitudes did not change across the years.Conclusions. Children are now referred at an earlier age to our tertiary encopresis clinic. The number of invasive and psychological evaluations has decreased before referral. However, treatment by many primary care providers before the referral has not changed. These data may suggest that pediatricians have increased awareness of encopresis and greater appreciation of its primarily physical rather than psychological nature. Additional studies will be needed to determine how these factors affect outcome. Pediatrics 2003;111:e604 -e607. URL: http: //www.pediatrics.org/cgi/content/full/111/5/e604; toilet training, encopresis, constipation, children. E ncopresis remains a significant problem in children. It is estimated to afflict 1% to 3% of the general pediatric population. [1][2][3] In 1975, Levine 4 wrote a classic paper outlining the descriptive characteristics of 102 children with encopresis seen at Children's Hospital in Boston. He described age of onset, type and timing of fecal accidents, and patient demographics. These data helped to corroborate his formulation of a relatively new approach to encopresis, using disimpaction, training, and education as treatment for this disorder. Although his approach is now widely used 5-10 and his descriptions of a typical child with encopresis are often quoted, there has been little reevaluation of his findings. 1,2,[11][12][13][14][15][16] We examined the characteristics of 503 children who over the next 20 years attended the encopresis clinic that Levine founded to determine whether the classic descriptions still were valid. We also wanted to explore whether there were changes in the age of referral, type and duration of symptoms, and parental attitudes about encopresis. Furthermore, we looked at the evaluations and treatments that the children had undergone before referral as an indirect reflection of primary care practice at that time. METHODSThe study population consisted of children who were ...

Enkoprezisi olan çocuklarda davranış sorunları ve bazı ailesel özellikler

“…It was reported that the risk of defacation problems is high in the future in children whose mothers experience anxiety and depression during the period of the child's toilet education (2). It was stated that a part of children with encopresis might not have taken, might have refused or forgotten the treatment reccomended at the first presentation and the attitude of the families on this subject should be examined (22). In some studies, it was reported that encopresis might be considered as a psychosomatic disorder (23), marriage problems were observed frequently in families of children with psychosomatic symptoms and physical symptoms played a role in distracting the family from conflict and in providing the balance of the family (24)(25)(26).…”

“…Since encopresis is a disorder which may lead to distress in the whole family, it may be considered that marriage problems occur related to the disruption of the family's general functionality by encopresis symptoms. However, it has been reported in the literature that familial factors prevent treatment compliance and play a role in maintenance of the symptoms (20,22). Because of high risk of comorbidity and chronicity and insufficiency of behavioral treatment methods in many cases the significance of family focused approaches has been emphasized (27).…”

Primary Care

“…Fishman, Rappaport, Schonwald, and Nurko (2003) found medications and regular sitting times to be the most common encopresis management strategies used by providers. Eighteen to 23% of patients, however, reported that a specialty referral was made without first receiving encopresis treatment.…”

Chronic childhood constipation: A review of the literature and the introduction of a protocolized behavioral intervention program

“…The majority of children with chronic constipation show reduced frequency of bowel movements in combination with fecal incontinence; passage of large stools that clog the toilet; hard stools; painful defecation; stool-withholding behavior; stool toileting refusal; and large stools in the rectum, palpable on abdominal or rectal examination [11,[23][24][25]. Rectoanal examination often reveals perianal feces [3].…”

“…Fecal incontinence in a child triggers a lot of parental stress because of dishonesty of the child about their fecal accidents [52] and the burden of cleaning clothes [6]. The majority of the parents assume that fecal incontinence is caused by the child's laziness, carelessness and stubbornness [24]. Furthermore, parents are imposed by a heightened awareness of bowel function, prompting their incontinent child to toilet more frequently than parents of children without fecal incontinence [53].…”