Encopresis is a medical condition whereby a person defecates in an unsuitable location: they might soil their clothing, or have a bowel movement in a place other than a toilet. Encopresis can be involuntary or voluntary, and is more common in males. Involuntary encopresis is often the result of chronic constipation, but what causes voluntary encopresis and is there a treatment for the condition?
Children and adults with voluntary encopresis tend to soil their clothes with loose or liquid faeces whereas those with voluntary encopresis are more likely to smear well- formed faeces on walls or hide it in different locations around the house. Either way, it is a very unpleasant disorder and likely to lead to an awful lot of problems with family relationships.
Causes of voluntary encopresis in children
Voluntary encopresis occurs in about 2% of children and in young children it is often caused by power struggles over toilet training issues. The child might not be ready for toilet training and if he or she becomes stressed about the whole thing, the end result can be voluntary encopresis. In older children, voluntary encopresis is often linked to anxiety problems, sexual abuse and other causes of high psychological stress. It can also be associated with conduct disorder, oppositional defiant disorder, and obsessive compulsive disorder.
Children can sometimes go through a stage of voluntary encopresis as a result of a parent returning to work or the arrival of a new sibling—in such instances, the problem is similar to a temper tantrum and will resolve itself with sympathetic treatment. The condition can even develop as a result of a toilet phobia.
Voluntary encopresis in adults
Voluntary encopresis is less common in adults, although it can and does occur in adults suffering from behavioural problems and serious psychological disorders. The condition is sometimes seen in elderly patients in the later stages of dementia; it can also occur in adults suffering from severe psychological trauma and anxiety disorders.
How is voluntary encopresis diagnosed?
Voluntary encopresis will be diagnosed if a child or adult has had a voluntary bowel movement in an inappropriate location at least once in the month for a minimum of three months. If the patient is a child, he or she must be at least four years of age and there must be no underlying medical conditions causing the encopresis.
What is the treatment for voluntary encopresis?
Voluntary encopresis in younger children will be treated with a gentle program of behaviour modification designed to make toileting a pleasant and stress free activity. In older children, voluntary encopresis is usually a symptom of another psychological disorder, and once that is treated, the encopresis tends to resolve itself. However, in some cases, the prognosis is less promising and the patient may require a long term period of behaviour modification therapy and psychiatric intervention.
In adults, if the voluntary encopresis is anxiety related, medications to treat the anxiety can help to relieve the symptoms. If the encopresis is caused by ODD or conduct disorder, behavioural modification and other specialist help will be needed.