Encopresis medical therapy: Difference between revisions
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{{CMG}} | {{CMG}} | ||
==Medical Therapy== | ==Medical Therapy== | ||
Soiling should always be treated as secondary to constipation (even if in doubt of another cause): 70-75% success | |||
#Education and Reassurance: (Relieves anger and anxiety from parents and child.) | |||
#* Soiling is not intentional. (Child doesn't notice until soiling has occurred.) | |||
#* Child is not psychologically abnormal. (Behavioral problems will resolve once soiling has been treated successfully.) | |||
#* It can be treated successfully. | |||
#* Explain mechanisms of overflow-[[Fecal incontinence|incontinence]] with picture (It is important for parents to understand the mechanisms of soiling well, as they might otherwise not comply with treatment, leading to treatment-failure) | |||
#* Involve Children if old enough. (Parents of children who have been toilet-trained for a few years have little idea about their child’s bowel habits, although they often assume great authority on the issue) | |||
# | # Dissimpaction: Removal of the hard impacted stools in the [[rectum]] with a strong [[Laxative]] (start when child is off school or nursery.) - e.g.: | ||
#*[[Bisacodyl]] orally 5 mg in mornings for 3 days (10 mg if over 5 years of age) | |||
#* (Enemas or Suppositories are invasive and are usually not needed. Success of treatment depends on its consequent and prolonged application, not on its invasiveness) | |||
# Prevention of Re-accumulation: with a stool softener (start simultaneously with dissimpaction) For 6-12 months for child to regain confidence and colon to return to original tone and shape. It is important to do this consequently, in sufficiently high doses and for a sufficient length of time. Taper off treatment gradually after. - e.g.: | |||
#* [[Liquid Paraffin]] (= mineral oil) (10 - 60 mls at night) titrated to effect (directly from fridge, with yoghurt or ice-cream) (Contraindications: Children <1 year and children with neurological abnormalities or learning difficulties should not take Liquid Paraffin, because of risk of [[pulmonary aspiration]]) | |||
#*[[Lactulose]] may be used in infants <1 year of age (It is less suitable because of day-to-day inconsistency of efficacy, making it difficult to titrate and possibly counterproductive to establish regular bowel pattern) | |||
#* [[Dietary fibre]] (e.g. fruits) + Plenty of Fluids are important, but on its own these measures will not be sufficient enough once stool withholding and soiling have established!) | |||
#* (NO [[enema]]s or [[suppositories]]. These are for Dissimpaction only. If hard stools have formed again, it means that reaccumulation has occurred and higher doses for its prevention are needed.) | |||
# Establishing regular bowel pattern: (start after successful dissimpaction) | |||
#* Encourage the child to sit on toilet regularly, at the same time of day, at least once a day, for at least 5 min. Ideally done after breakfast ([[Gastrocolic reflex]]) | |||
#* Continue on daily basis irrespective on whether or not child has passed stools. | |||
#* Footstool or other support to ensure hips can be fully flexed, and child can sit comfortably on toilet | |||
==References== | ==References== | ||
Revision as of 13:49, 3 April 2013
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Encopresis Microchapters |
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Risk calculators and risk factors for Encopresis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
Soiling should always be treated as secondary to constipation (even if in doubt of another cause): 70-75% success
- Education and Reassurance: (Relieves anger and anxiety from parents and child.)
- Soiling is not intentional. (Child doesn't notice until soiling has occurred.)
- Child is not psychologically abnormal. (Behavioral problems will resolve once soiling has been treated successfully.)
- It can be treated successfully.
- Explain mechanisms of overflow-incontinence with picture (It is important for parents to understand the mechanisms of soiling well, as they might otherwise not comply with treatment, leading to treatment-failure)
- Involve Children if old enough. (Parents of children who have been toilet-trained for a few years have little idea about their child’s bowel habits, although they often assume great authority on the issue)
- Dissimpaction: Removal of the hard impacted stools in the rectum with a strong Laxative (start when child is off school or nursery.) - e.g.:
- Bisacodyl orally 5 mg in mornings for 3 days (10 mg if over 5 years of age)
- (Enemas or Suppositories are invasive and are usually not needed. Success of treatment depends on its consequent and prolonged application, not on its invasiveness)
- Prevention of Re-accumulation: with a stool softener (start simultaneously with dissimpaction) For 6-12 months for child to regain confidence and colon to return to original tone and shape. It is important to do this consequently, in sufficiently high doses and for a sufficient length of time. Taper off treatment gradually after. - e.g.:
- Liquid Paraffin (= mineral oil) (10 - 60 mls at night) titrated to effect (directly from fridge, with yoghurt or ice-cream) (Contraindications: Children <1 year and children with neurological abnormalities or learning difficulties should not take Liquid Paraffin, because of risk of pulmonary aspiration)
- Lactulose may be used in infants <1 year of age (It is less suitable because of day-to-day inconsistency of efficacy, making it difficult to titrate and possibly counterproductive to establish regular bowel pattern)
- Dietary fibre (e.g. fruits) + Plenty of Fluids are important, but on its own these measures will not be sufficient enough once stool withholding and soiling have established!)
- (NO enemas or suppositories. These are for Dissimpaction only. If hard stools have formed again, it means that reaccumulation has occurred and higher doses for its prevention are needed.)
- Establishing regular bowel pattern: (start after successful dissimpaction)
- Encourage the child to sit on toilet regularly, at the same time of day, at least once a day, for at least 5 min. Ideally done after breakfast (Gastrocolic reflex)
- Continue on daily basis irrespective on whether or not child has passed stools.
- Footstool or other support to ensure hips can be fully flexed, and child can sit comfortably on toilet
References