Encopresis Clinical Presentation

Updated: Oct 20, 2017
  • Author: Stephen M Borowitz, MD; Chief Editor: Carmen Cuffari, MD  more...
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Presentation

History

Approximately 80-95% of children with encopresis have a history of constipation or painful defecation. In many patients, the history of constipation or painful defecation is remote, occurring years before the child presents with encopresis. On average, children who have encopresis are symptomatic 5 years before the problem is brought to medical attention.

Most children with encopresis deny the urge to defecate associated with their soiling episodes. Sometimes, affected children contend that they are unable to differentiate between passing gas and passing feces.

In most cases, soiling episodes occur during the daytime, when the child is awake and active. Soiling at night, when the child is asleep, is uncommon.

As evidence of functional megacolon, many children with retentive encopresis intermittently pass extremely large bowel movements.

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Physical Examination

Physical findings, other than those obtained from the abdominal and rectal examinations, are usually normal. Unless a physical or psychological contraindication is noted, a digital rectal examination should be performed on every child with encopresis to exclude any underlying anatomic or neurologic abnormality that might account for the encopresis (eg, imperforate anus with perineal fistula, low or unsuspected meningomyelocele, or ultrashort-segment Hirschsprung disease).

In many patients, stool can be palpated throughout the distribution of the colon, most notably in the left lower quadrant. On rectal examination, stool is often found smeared around the anus. The anal sphincter may appear somewhat lax and patulous because chronic rectal distention is associated with reflex relaxation of the internal sphincter. The rectum is typically enlarged and filled with soft stool that yields negative results on fecal occult blood testing.

Neurologic findings should be normal. Patients should have a normal anal wink and normal sensation, strength, and reflexes in the lower extremities.

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