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Children who experience enuresis and encopresis can face many difficulties, including social isolation, shame, embarrassment, anxiety, and depression. Due to the prevalence of enuresis and encopresis, it is essential for mental health professionals to understand the common symptoms and available treatment options for enuresis and encopresis, particularly to assist parents struggling to help their children overcome these challenges. Despite this need, there is very little clinical literature that incorporates a systemic approach for families who have a child diagnosed with enuresis and encopresis. Furthermore, common treatment approaches may unwittingly reinforce children’s perception that these problems are rooted in their identity. In an effort to address these concerns, the present case study aims to illustrate how a narrative therapy approach was utilized to effectively treat a child with enuresis and encopresis. Narrative therapy can uniquely assist children and their parents by helping them externalize the problem, overcome the problem-saturated view of their lives, and create new experiences where the problem is nonexistent.

Chronic functional constipation with or without encopresis is a common problem in the pediatric population, and the prevalence of encopresis may be underestimated. The aim of this study was to assess the prevalence and risk factors for overflow incontinence in patients with chronic constipation seen at a pediatric gastroenterology consultation. A retrospective study of 270 files of patients seen between 1997 and 2012 was conducted, and a classification according to Rome III criteria was done. Among 145 (53.7%) boys and 125 (46.2%) girls, 117 had overflow incontinence (43.3%) - 41 (35%) girls and 76 (65%) boys. The first symptoms of chronic constipation appeared at a median age of 30 and 33 months in encopretic and 16 and 12 months in nonencopretic girls and boys, respectively. The first specialized consultation took place after a median disease duration of 26.5 and 24 months in encopretic and 16 and 9 months in nonencopretic girls and boys, respectively. A history of stool retention and the presence of scybala at examination, but not of pain at defecation or anal fissure, were associated with encopresis. The onset of chronic constipation after the age of 2 years, a longer disease duration, male gender, and a history of stool retention were seen as risk factors for the development of encopresis in patients with chronic functional constipation.

Encopresis is a medical condition that is associated with incontinence in children. It leads to frustration and anxiety in both parents and children due to the presenting symptoms and the inability to control elimination patterns. There is overwhelming concern among families that a child with encopresis will be ostracized from peers and will suffer long-term psychological effects. It is therefore important to define encopresis to include the etiology, prevalence, and treatment measures in order to ensure a positive outcome. In addition, as a child enters elementary school, the school nurse plays a vital role in assisting the child to reach educational goals and managing health concerns. This article will guide the reader through the origin and diagnosis of encopresis as well as the principles of management. It will also delineate the school nurse role in managing encopresis in the school setting.

Objectives To assess the outcome of patients presenting with functional constipation in childhood during a 10-year period and to determine any risk factors for developing persistent constipation throughout adolescence and adulthood.Patients and Methods 72 children (mean age 4 years; 40 boys) referred for constipation were included in a longitudinal set of observations. Initial workup included segmental colonic transit time and anorectal manometry; 45 of the 72 patients could be reevaluated 10 to 12 years later.Results 21 of 45 patients (46%; 95% confidence interval 29% to 67%) remained constipated at follow-up. Encopresis and recurrent abdominal pain were present in 25% and 56% of patients, respectively. Patients with anorectal dyssynergia remained more frequently constipated at follow-up than the others: 61% versus 29% ( P < .05).Conclusion Almost 50% of patients presenting with constipation during childhood remained constipated on long-term follow-up. Anorectal dyssynergia is associated with a worse prognosis.

Clinical outcome studies have established cognitive-behavioral therapy (CBT) as an efficacious treatment for children and adolescents presenting with a variety of problems, such as anxiety and maladaptive behaviors. Findings to date are also very promising for the use of CBT techniques with children and adolescents who have chronic medical illnesses, including obesity, encopresis, severe and persistent feeding problems, recurrent headache, recurrent abdominal pain and acute procedural pain. This article provides an overview of behavioral/cognitive-behavioral theory, intervention and the important role outcome-based research plays in the development of this treatment modality. CBT interventions utilized with various pediatric populations are described, and the results of outcome-based research employing these techniques are examined. The Chambless criteria are used to determine the efficacy of specific interventions based upon the number, size and outcomes of studies utilizing CBT treatments with pediatric populations. Case examples are included to further illustrate the effectiveness of these interventions for children and adolescents with chronic medical conditions.

This article describes a working model in which an evaluation and intervention programme for child and adolescent psychiatric patients and their families is conducted in the family's home. To improve services for child psychiatric patients, a home-based evaluation, guidance and treatment programme was started in Satakunta Hospital District in 1995. Further goals were to improve connections between the child's environment and social network, to reduce the long waiting list for treatment and to offer an alternative to in-patient care. Conducting psychiatric care at home enables the clinical team to correct problematic forms of interaction in an effective and constructive manner. The whole family works with staff members, creating a strong therapeutic relationship and opportunities for therapeutic reflection. Parents' motivation to improve their parenting abilities is increased. The main benefits are comprehensiveness and a direct effect on the family's daily life. The largest numbers of patients, in both the home treatment and in-patient programmes (31 and 39%), were diagnosed with affective disorders. The second largest group in the home-treatment programme (18%) was diagnosed with developmental and organic disorders, and in the in-patient programme (33%) with conduct disorders. The number of patients in the home-treatment programme has steadily increased. By 2000,26% of patients were treated at home.

This case study details limitations encountered while providing indirect and direct clinical services to children in applied settings through a behavioral mental health consultation model. Specifically, the case of AB, a 13-year-old male residing at a foster care facility, who demonstrates oppositional and defiant behavior problems and symptoms of both retentive encopresis and posttraumatic stress, is presented to illustrate potential pitfalls faced by a consultant providing multiple forms of intervention in applied settings. Although the provision of supportive, individual psychotherapy is reviewed, an emphasis is placed on the difficulties of implementing a behavior modification plan to treat AB's encopresis at his residential foster care facility. The challenges associated with providing individual psychotherapy to AB while serving as the behavioral consultant at his residence are highlighted. Finally, recommendations are presented regarding how mental health consultants can work with applied service agencies to promote effective therapeutic interventions within frameworks established by those agencies.

Cerebral folate deficiency presents during infancy with irritability, deceleration of head growth, seizures, and progressive cognitive and motor impairment. Although low serum folate levels have been found in patients with schizophrenia, we describe the first case of cerebral folate deficiency presenting as catatonic schizophrenia. A 13-year-old previously healthy boy presented to our hospital with a 17-month history of schizophrenic symptoms with progressively worsening catatonia. On admission, he demonstrated near-complete mutism, frequent enuresis and encopresis, and severe psychomotor retardation. Our initial diagnostic evaluations, including brain magnetic resonance imaging, electroencephalogram, and routine metabolic tests, were normal. A lumbar puncture done to look for neurotransmitter defects or cerebral folate deficiency revealed low levels of 5-methyltetrahydrofolate (31 nmol/L; reference range, 40-150 nmol/L). He also had elevated titers of folate receptor-blocking antibodies. He was treated for the next 9 months with 5-formyltetrahydrofolate (folinic acid), but his catatonia was unchanged.

Fecal soiling is common in childhood and can be caused by stool toileting refusal, fecal incontinence due to organic disease, or encopresis due to functional constipation. Anatomical, neurologic, and inflammatory causes for fecal soiling are ruled out by history and physical examination and, if necessary, by anorectal manometry, barium enema, and rectal biopsy. The initial treatment suggestion for children with stool toileting refusal is to put the child back into pull-ups or diapers. Most children with fecal soiling due to organic disease continue with some degree of incontinence despite optimal medical management. Antegrade enema administration helps those with severe fecal incontinence due to organic causes who do not respond to medical management. Successful treatment of constipation and encopresis requires a combination of medical therapy, nutritional intervention, behavioral intervention, and long-term compliance with laxative use. The combined treatment approach improves the constipation and encopresis in all patients who comply with the treatment program. In some children, cow's milk protein intolerance may be the cause. In them, coww's milk protein needs to be eliminated.

Current pediatric and psychiatric studies on encopresis and its treatment are heavily influenced by mechanical, physiological, and behavioral considerations. Although psychodynamic treatment has generally been considered to be of little benefit, and its findings suspect, the authors suggest that a psychodynamic approach adds substantially to the understanding of some cases of encopresis; that the anal sensations and anal erotic feelings reported by a number of encopretic children are intense, and that the encopretic symptom, soiling, in these children is the result of a conscious form of anal masturbation in which the fecal mass is used for stimulation; and that any study of encopresis is incomplete that does not include what encopretic children, engaged in a sound therapeutic relationship, know and say about their soiling. The authors further suggest that physical treatments of those children whose encopresis is psychologically driven may be contraindicated. The presence of a large stool does not in itself substantiate a physical illness. Further research is needed to elucidate the prevalence of anal masturbation in encopretic children.

The purpose of this study was to evaluate the effectiveness of a biobehavioral treatment approach for two encopretic children. Both subjects were evaluated and treated by a pediatric gastroenterologist, with behavioral interventions occurring subsequent to, and in conjunction with, the medical intervention. Results showed that the biobehavioral approach resulted in significant improvements for both subjects, and that the use of response cost may be a necessary intervention component for some children. A model is also presented to clarify the relationship between organic and nonorganic factors and their relationship to encopresis.

Aim To assess the outcome at one year of a cohort of patients referred to outpatient clinics with soiling. Method Retrospective case note audit of 34 children referred to hospital outpatients over a four month period with soiling stated as the main problem in the referral letter. Results After one year, 29% of the 34 children studied were discharged to patient satisfaction, 38% defaulted from follow up, 24% were still attending outpatient clinics and 9% had been referred back to source. Coexisting pathologies, in particular enuresis and family stress, were found in several of the children. At the time of referral, 44% of new patients and 89% of re-referrals had symptoms present for longer than 12 months. Only 18% of the children were receiving treatment at the time referral was made. Conclusion: Constipation is often undiagnosed until the problem is well established with soiling present, which makes treatment a long and often difficult process. It is necessary to consider the wider social and family issues when managing a child with constipation and soiling. Hospital based general medical and surgical outpatient clinics may not be the ideal setting in which to deal with these problems.

We describe the long-term (mean 6.8 years) follow-up of 43 children treated medically for chronic constipation and encopresis. Overall outcome was quite good. Thirty children (70%) were entirely asymptomatic at follow-up. Intermittent mild constipation persisted in 13 patients; only two required persistent but infrequent laxative therapy. Encopresis persisted in three of 17 children who initially reported this symptom, and was associated with significant behavioral problems.

Idiopathic constipation and encopresis of childhood are thought to occur when children volitionally withhold stool. Withholding may be prompted by social pressures or by episodes of painful defecation. Repetitive withholding may result in colonic dilatation and colorectal dysfunction. Therapy involves removal of impacted stool, stool softening, and behavioral therapy. The use of enemas in this therapy is widespread but may be counterproductive. A retrospective review of patients treated without enemas revealed 45 patients whose course could be followed for six months. Ninety-eight percent of these had successful initial cleanouts without enemas; 94% had continued success at six months. These results, comparable with other treatment programs, demonstrate that therapy without enemas is a reasonable alternative in the treatment of childhood constipation and encopresis.

In this paper, fecal incontinence and constipation were treated in two mentally retarded individuals using a novel intervention wherein incontinent stools were first rewarded in order to increase the frequency of bowel movements. This intervention was implemented only after more traditional pediatric and behavioral treatments were unsuccessful. The reinforcement of incontinent stools procedure resulted in an increase in both the frequency and the number of continent stools for both individuals. Hypotheses regarding the failure of previous treatments and the success of the current treatment are discussed as well as directions for future research.

This study reports on some of the distinguishing characteristics of children with persistent encopresis who have proven, at long-term follow-up, to be resistant to intensive pediatric-based treatment at a referral outpatient clinic. Resistant children differed from responsive children primarily in two respects: they tended to have less stool retention at initial presentation, and their accidents occurred at all hours of the day. Additional information suggested that early success or failure did not presage long-term resistance and that parents' attributions of the cause of their child's soiling were related to outcome. Discussion centered on enumerating important high-risk factors that signal the need for more intensive intervention and follow-up.

A scoring method was developed to assess severity of stool retention using plain abdominal radiographs. To determine whether the technique was clinically valid in identifying chronic stool retention, the method was used to evaluate films taken of children with known stool retention before and after therapy. The method showed significant statistical differences between symptomatic pre-therapy films and controls and between pre- and post-therapy films of treatment "successes." No significant differences were found between pre- and post-therapy "failures." Use of radiographs is not a substitute for careful history taking and examination, but this scoring method for evaluating stool retention can be recommended prior to more extensive, invasive investigations in children presenting with functional abdominal complaints.

Such a program was used to treat 18 encopretic children; 17 improved and 14 became completely free of soiling. Most encopretic children can be man aged by pediatricians and only those children with severe emotional dis orders require psychiatric referral.

Two patients with persistent severe encopresis after surgery for Hirschsprung's disease were treated with a token economy type of behavior modification therapy. After eight weeks there was very marked improvement, which persisted after discharge home without relapse after four and eight months respectively.

The Azrin and Foxx toileting study published in 1971 represented a culmination of earlier research efforts regarding the toilet training of the severely and profoundly retarded client. This article uses the landmark study to provide a frame of reference for reviewing a decade of toilet training research. Efforts attempting to replicate the original study have been few in number and have yielded equivocal results. Modifications of the original study have added more information and have generated new areas of inquiry that give direction to toilet training research for the next decade.

A series of ten cases of encopresis, seen in psychiatric consultation over a period of two years, is reviewed from dynamic and technical aspects. These children were found to react by regression to a traumatic separation from their mothers, over a background of maternal deprivation. A consultation approach, rather than the usual intensive psychotherapy of child and parents, was used in most of these cases, for lack of therapeutic facilities and location of family. The results have been evaluated and were found to be surprisingly better than expected. It is suggested that such an approach (psychiatric interview, social history, and interpretation to the family of specific recommendations) should be used more often before psychotherapy is attempted, thus trying to use better the emotional resources of the family. Some organic factors of this condition are discussed, as well as the role of the paediatrician in the prevention of the illness at critical stages of the child's life: namely, toilet training and birth of a sibling. The timing of the hospitalization of the child is important, and the author suggests it should not occur before the age of four. Close collaboration of the paediatrician and the child psychiatrist is most essential in such cases.

A student and his problems were pin-pointed, recorded, and changed. The first 3 wk. were used to establish a base rate. S defecated in class, once every few days. After he was programmed with reinforcers (charting and coupons toward book purchases), he may have had one accident, only, for the remainder of the school year (8 wk.). Follow-up through the seventh month of the next school year (the time of this writing) indicates one accident only. During this 7-mo. period, he was not programmed with book coupons or any other specific reinforcer. He had internalized a previous external model of control.