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Child Abuse

Child Abuse and Encopresis

04/06/2001

Question:

My husband and I do foster care. We have been asked to take a 12yr old boy that has a history of abuse and neglect, and encopresis. He has a 14yr old brother in residential treatment because of encopresis. What is the connection between abuse and encopresis? Is there effective treatment for this problem at his age, or will it be an on going thing? We have been told he`s seeing a medical doctor for this condition. Would sexual abuse cause this kind of problem?

Answer:

Encopresis is a very complex disorder that can have multiple causes including: anatomic abnormalities, chronic constipation with stool leakage, and/or psychological concerns. Encopresis can be primary (child has never able to stool properly) vs. secondary (child used to be toilet-trained, but now regressing to a pre-toilet trained state). Encopresis can be associated with physical or sexual abuse, but is also common in non-abused children and is therefore, in and of itself, not diagnostic for abuse. If sexual abuse may be a possible cause for this child`s secondary encopresis he should be evaluated by a child abuse diagnostic center. The treatment for encopresis includes: 1) medical management: initial "clean out" enema (routine enemas are not recommended, because they make the bowel "dependent" on enemas, stool softeners, high fiber diet, and scheduled toileting 2) behavior management: rewards instead of punishments, no shaming or ridiculing of the child, and professional psychological services (to both discuss past issues and to learn biofeedback techniques to help increase body awareness) It is therefore important for older children with encopresis to have a primary physician, a consulting pediatric gastroenterologist, and appropriate pyschological services. With appropriate management, encopresis will slowly improve in most children. Dr. Neha Mehta

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Response by:

Robert Shapiro, MD
Professor of Clinical Pediatrics
College of Medicine
University of Cincinnati