PSYCHOLOGICAL ASPECTS OF ENCOPRESIS WITHOUT ORGANIC ETHIOLOGY
Encopresis is defined as a voluntary or involuntary passage of stool in inappropriate places, causing soiling of clothes by a child aged four years or above whenbowelcontrolcannormally be expected. It affects 1 to 3% of paediatric population. This article focuses on retentive encopresis that is related to chronic constipation and overflow incontinence. Absence of bowel control has an important impact on physical health, psychosocial functioning and family life. Personal and contextual predisposing, precipitating, maintaining and protective factors for encopresis in a context of etiological hypotheses are discussed.Most children with encopresis have no physical problems to explain the disorder. Text is focusingon chronic constipation, chaotic family environment, parent-child interaction, developmental delay, and avoidance of defecation, the role of family, stressors and anxiety over toileting. Common causes of encopresis include a low fibre diet, lack of hydration, little or no exercise and premature toilet training.There is comorbidity with cognitive delays, learning disabilities, attention deficit disorder, conduct or oppositional disorders. In treatment the most effective outcome is shown cases where medical and psychological treatment programmes are used in conjoint manner. The main components are psychoeducation, clearing the faecal mass with laxative use and bowel retraining with toileting, accident management, diet and exercise. In cases, where children don't recognise when they are about to defecate, biofeedback may be a useful adjunct. With effective strategies encopresis can be eliminated, but relapses may occur.
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