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To describe the source of and treatment for encopresis in a series of 40 children under age 9 years. Referral for psychological based treatment followed upon limited success of standard gastroenterologic intervention. The treatment provided is defined as interactive parent-child family guidance. This includes a variety of specific psychologically based recommendations offered to parents, and, when indicated, direct interventions with the symptomatic child. These are different from various forms of behavioral corrective reward-punishment interventions frequently recommended for young children with encopresis. The pediatric and the psychological literature offer few reports of successful treatment of young children with this syndrome. Also, there are few specific descriptions of psychologically based interventions. The results reported here are of the successful treatment of 38 of 40 cases referred specifically for psychologically based intervention following the prior limited success of standard gastroenterologic treatment. The interactive parent-child family guidance intervention described in this report, differentiated from typical behavior therapies, is a notably successful mode of psychologically based therapy for these children. It offers an important alternative to standard pediatric gastroenterological treatment for encopresis, as well as to reward-punishment oriented behavioral therapies. [ABSTRACT FROM AUTHOR]

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A growing number of Web sites provide personalized health interventions using the technological advances afforded by the Internet. It is critical to determine how to best develop these applications to obtain positive outcomes. Several small studies are presented here to determine whether 3 Web components-audio, graphics, and interactivity-should be incorporated. Forty-nine children and their parents presenting to a pediatric gastroenterology clinic for treatment of encopresis participated. They were shown modules of an encopresis Internet intervention both with and without the study components to examine pre to post changes in knowledge, motivation, and readiness to change. Multivariate analyses indicated highly significant pre-post effects for each of the 3 components. To our knowledge, this is the first time specific Web-based components of an Internet intervention were empirically evaluated to determine incorporation in the development of an online treatment program. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the relation between the diagnosis of encopresis at 8 and 10 years of age, and mental and somatic health 10 years later. The importance of type of encopresis (primary or secondary) at 8 years was also studied. Subjects were a non-clinical encopretic sample (N=73) and control subjects (N=75) [2]. Seven assessment variables from conscription surveys provided information about mental and somatic health status at 18 years of age. Former encopretics (n=66) did not differ significantly from the controls (n=67) at 18 years of age, although there were consistent, small negative differences. The boys who at 10 years of age had still been encopretic did not differ significantly at 18 years of age from the boys who at 10 years had recovered from encopresis, and the signs indicating the small differences varied. For former primary and secondary encopretic boys, there were two significant differences, the men in the secondary group being more often exempted from conscription than the primary group and the control cases. The results indicate that boys with non-clinical encopresis show only small, if any, mental and somatic disturbances at the beginning of adulthood. Comprehensive investigations of encopretic patients are recommended as important clinical problems, in addition to encopresis, might be present. [ABSTRACT FROM AUTHOR]

Presents the table of contents for the November 2005 issue of the online section of the journal "Pediatrics."

Objective: To examine the prevalence of encopresis/enuresis, relationship between maternal hostility and encopresis, parent-child concordance of reporting encopresis/enuresis, and familial aggregation of enuresis in subjects with a prepubertal and early adolescent bipolar-I disorder phenotype (PEA-BP), attention-deficit/hyperactivity disorder (ADHD), and healthy controls (HC). Method: There were 268 consecutively ascertained subjects (93 PEA-BP, 81 ADHD, and 94 HC). PEA-BP was defined as DSM-IVBP-I (manic or mixed phase) with elation and/or grandiosity. The WASH-U-KSADS and Psychosocial Schedule for School-Age Children-Revised were administered to parents about their children and separately to children about themselves. Results: Encopresis was more prevalent in PEA-BP versus HC subjects (15.1% versus 3.2%, χ² = 6.4, p = .012). Enuresis was more common in PEA-BP versus HG (21.5% versus 6.4%, χ² 7.8, p=.005) and ADHD versus HC (22.2% versus 6.4%, χ² = 6.1, p = .014) subjects. All enuresis onset in subjects not receiving lithium. Most encopresis (81.8%) and enuresis (75.0%) onset before mania. Familial aggregation of enuresis was more frequent in enuretics than nonenuretics (47.7% versus 5.4%, χ² = 41.2, p < .0001). Maternal hostility was more prevalent in encopretic versus nonencopretic subjects (91.7% versus 55.6%, χ² = 8.3, p = .004). Parent-child concordance on reporting encopresis and enuresis was poor to fair. Conclusions: Children with PEA-BP need to be evaluated for encopresis, enuresis, and mother-child relationships. [ABSTRACT FROM AUTHOR]

The paper aims at investigating the prerequisites for the process of symbolisation to develop and to be used by the personality. The starting point for this exploration is the psychoanalysis with a little boy of four and a half, who started analysis because of an encopresis that was an expression of an overwhelming and concrete annihilation anxiety. It is argued that the symbolisation process has its basis in the relation to a real, reliable object and that this relation is a prerequisite for the child to start trying to transmit his experiences. The clinical material shows the boy's efforts to find an object capable of containing his anxiety and giving words to his unbearable affects, and the way this is worked through in the transference. This process contributed to his growing capacity to use symbols as an expression of his emotional experiences and it offered him a way of thinking about them instead of acting them out concretely. [ABSTRACT FROM AUTHOR]

This paper provides a clinical illustration of the symbolic use of play in the treatment of an encopretic boy of eight. The historical and contemporary literature relating to both play and to encopresis are reviewed. Process material and case formulation are presented to provide examples of the way in which intrapsychic conflict is interpreted. [ABSTRACT FROM AUTHOR]

Background: Population-based studies on the prevalence of encopresis in children are scarce and generally outdated. Prevalence estimates based on clinical studies are unreliable because parents tend to be reticent to seek medical help for this problem. Professional help is necessary, however, because encopresis can lead to serious psychosocial health problems. The authors examined the prevalence of encopresis in children, the frequency of visits made to general practitioners for encopresis and the psychosocial health problems of encopretic children.Methods: This population-based study involved 13,111 parents and their 5- to 6-year-old children and 9,780 parents and their 11- to 12-year-old children, all residents of Amsterdam, the Netherlands.Results: The prevalence of encopresis was 4.1% in the 5-to-6 age group and 1.6% in the 11-to-12 age group. Encopresis was more frequent among boys and children from the very depressed areas of the city. Encopresis was less frequent among Moroccan and Turkish children. A defecation frequency of less than three per week was found in 3.8% of the 5- to 6-year-olds and 10.1% of the 11- to 12-year-olds with encopresis. Only 37.7% of the 5- to 6-year-olds and 27.4% of the 11- to 12-year-olds who had encopresis had ever been taken to see a doctor for this problem. Psychosocial problems were far more common among children with encopresis than among normal children.Conclusions: Encopresis is a common condition that is often associated with psychosocial health disorders but only a small proportion of the children with encopresis are taken to a general practitioner to discuss their problem. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine whether biofeedback benefits children with dyssynergic defecation and constipation/encopresis, and whether home biofeedback improves long-term outcomes. Thirty-six patients with chronic constipation who had failed at least 6 months of conventional treatment and demonstrated dyssynergic defecation at anorectal manometry were randomized to biofeedback in the laboratory alone (group 1, n=24) or in the laboratory and at home (group 2, n=12) and followed up at 2, 4, and a mean of 44 months. Thirty patients were available for long-term follow-up. Bowel movements increased in all from a mean of 1.4/week to 5.1, 5.8, and 5.1 per week at 2 months, 4 months, and long-term, respectively (p&les;0.001). Soiling decreased in all from a mean of 5.5/week to 0.6, 0.1, and 1 per week at 2 months, 4 months, and long-term, respectively (p&les;0.001). Laxative use decreased from a mean of 4.1 days/week to 0.6, 0.3, and 0.7 per week at 2 months, 4 months, and long-term, respectively (p&les;0.001). Twenty-seven of 30 parents ranked their satisfaction a mean of 2.2 (range l-excellent to 3-good). There were no significant differences in outcomes between the laboratory alone group and the laboratory plus home group. Biofeedback is beneficial for some children with chronic constipation and dyssynergic defecation. Supplemental home biofeedback does not improve long-term outcomes. [ABSTRACT FROM AUTHOR]

Constipation and soiling are common complaints in childhood and often cause distress to the children and their parents. The treatment for these symptoms is oral and sometimes rectal laxatives or behavioural therapy. Until now, there have been few randomized controlled trials to evaluate the efficacy of the different treatment regimens. Moreover, there is a lack of information regarding what happens to these children with constipation when they grow up. A recent long-term follow-up study in The Netherlands showed that 30% of the children followed beyond puberty continued to have severe complaints of constipation such as a low defecation frequency and soiling. Long-lasting support and the development of improved therapeutic regimens are necessary to treat these difficult patients more effectively. [ABSTRACT FROM AUTHOR]

Background: Constipation and encopresis frequently cause problems with respect to emotional wellbeing, and social and family life. Instruments to measure Heakh Related Quality of Life (HRQoL) in these disorders are not available. Methods: A disease specific HRQoL instrument, the "Defecation Disorder List" (DDL) for children with constipation or functional non-retentive faecal soiling (FNRFS) was developed using accepted guidelines. For each phase of the process, different samples of patients were used. The final phase of development included 27 children. Reliability was assessed in two ways: internal consistency of domains with Cronbach's alpha, and test-retest reliability with intra-class correlation coefficients (ICC). To assess validity, comparable items and domains were correlated with Tacqol, a generic HRQoL instrument for children (TNO-AZL). Results: In the final phase of the development, 27 children completed the instrument. It consisted of 37 items in four domains. The response rate was 96%. Reliability was good for all domains, with Cronbach's alpha values ranging from 0.61 to 0.76. Measures of test-retest stability were good for all four domains with ICCs ranging from 0.82 to 0.92. Validity based on comparison with the Tacqol instrument was moderate. Conclusion: The DDL is promising as a measure of HRQoL in childhood defecation disorders. [ABSTRACT FROM AUTHOR]

Background: Recently, polyethylene glycol (PEG 3350) has been suggested as a good alternative laxative to lactulose as a treatment option in paediatric constipation. However, no large randomised controlled trials exist evaluating the efficacy of either laxative. Aims: To compare PEG 3350 (Transipeg: polyethylene glycol with electrolytes) with lactulose in paediatric constipation and evaluate clinical efficacy/side effects. Patients: One hundred patients (aged 6 months-15 years) with paediatric constipation were included in an eight week double blinded, randomised, controlled trial. Methods: After faecal disimpaction, patients <6 years of age received PEG 3350 (2.95 g/sachet) or lactulose (6 g/sachet) while children ⩾6 years started with 2 sachets/day. Primary outcome measures were: defecation and encopresis frequency/week and successful treatment after eight weeks. Success was defined as a defecation frequency ⩾3/week and encopresis (1 every two weeks. Secondary outcome measures were side effects after eight weeks of treatment. Results: A total of 91 patients (49 male) completed the study. A significant increase in defecation frequency (PEG 3350: 3 pre v 7 post treatment/week; lactulose: 3 pre v 6 post/week) and a significant decrease in encopresis frequency (PEG 3350: 10 pre v 3 post/week; lactulose: 8 pre v 3 post/week) was found in both groups (NS). However, success was significantly higher in the PEG group (56%) compared with the lactulose group (29%). PEG 3350 patients reported less abdominal pain, straining, and pain at defecation than children using lactulose. However, bad taste was reported significantly more often in the PEG group. Conclusions: PEG 3350 (0.26 (0.11) g/kg), compared with lactulose (0.66 (0.32) g/kg), provided a higher success rate with fewer side effects. PEG 3350 should be the laxative of first choice in childhood constipation. [ABSTRACT FROM AUTHOR]

It is proposed that the classification of paediatric bowel elimination disorders is central to their effective treatment. By separating the terms soiling and encopresis and clearly defining the aetiologies behind both, a treatment pathway begins to emerge. The theoretical model described suggests that encopresis may require only psychological management, whereas soiling (caused by constipation) is more complex, and although it needs medical management, it may or may not require psychological input. By using such a functional classification to define a treatment protocol, the roles of both medical and psychological services could be more clearly understood from the outset. [ABSTRACT FROM AUTHOR]

Background: Measurement of colonic transit time (CTT) is sometimes used in the evaluation of patients with chronic constipation. Aim: To investigate the relation between symptoms and CTT, and to assess the importance of symptoms and CTT in predicting outcome. Methods: Between 1995 and 2000, 169 consecutive patients (median age 8.4 years, 65% boys) fulfilling the criteria for constipation were enrolled. During the intervention and follow up period, all kept a diary to record symptoms. CTT was measured at entry to the study. Results: At entry, defecation frequency was lower in girls than in boys, while the frequency of encopresis episodes was higher in boys. CTT values were significantly higher in those with a low defecation frequency (&les;/week) and a high frequency of encopresis (&ges;2/day). However, 50% had CU values within the normal range. Successful outcome occurred more often in those with a rectal impaction. CTT results <100 hours were not predictive of outcome. However, those with CTT >100 hours were less likely to have had a successful outcome. Conclusion: The presence of a rectal impaction at presentation is associated with a better outcome at one year. A CTT >100 hours is associated with a poor outcome at one year. [ABSTRACT FROM AUTHOR]

Presents information on pediatric constipation. Incidence of constipation among children; Definition of constipation and encopresis; Physical examination of a child with chronic constipation; Various treatment for constipation.

Objective—To determine frequency of house soiling, aggression toward people, and aggression toward other cats among kittens adopted from an animal shelter and whether frequency of these behaviors was associated with age at the time of neutering. Design—Survey. Animals—126 kittens adopted from a humane society at 6 to 13 weeks of age. Procedure—Owners of the kittens were contacted by telephone approximately 4, 18, and 52 weeks after kittens were adopted, and a behavioral assessment questionnaire was administered. Owners were asked to indicate whether the kitten had displayed the specific behavior in the preceding 30 days. Sixty-three kittens were neutered prior to adoption; the remaining 63 were neutered at 5 to 7 months of age, after the second behavioral assessment. Results—In the month following adoption, 64 (50.8%) kittens were reported to have at least 1 of the 3 behaviors. There was no evidence that the 3 behaviors were related. The percentage of kittens reported to urinate or defecate outside the litter box decreased from the first to second evaluation and remained Iow at the third evaluation. The percentage of kittens reported to show aggression toward people and the percentage reported to show aggression toward other cats decreased from the first to second evaluation, but increased again at the third evaluation. There was no significant association between age at the time of neutering and any of the 3 behaviors. Conclusions and Clinical Relevance—Results suggest behavior problems may be common in kittens adopted from a humane society, particularly during the first month after adoption. [ABSTRACT FROM AUTHOR]

Aim: To investigate the coexistence of urine and faecal incontinence in Swedish schoolchildren.Methods: Cohort study of all schoolchildren in the first and fourth grades in the city of Eskilstuna. A questionnaire was used, in which parents reported the prevalence of urine and faecal incontinence for their children. with a response rate of 67%. Data were analysed with multiple logistic regression.Results: Daytime urinary incontinence (at least once a month) was reported in 6.3% of the first graders and 4.3% of the fourth graders, while bedwetting (at least once a month) was reported in 7.1% and 2.7% and faecal incontinence in 9.8% and 5.6%, respectively. Daytime urinary incontinence was strongly associated with faecal incontinence; adjusted odds ratio (OR) 7.2 (p < 0.001) as well as with bedwetting; OR 4.1 (p < 0.001), whereas faecal incontinence and bedwetting lacked a significant association (OR 1.2).Conclusion: This study demonstrates that soiling and daytime urinary incontinence often coexist in Swedish schoolchildren. Collaborative treatment strategies with gastroenterological and urological content need to be developed for these children. [ABSTRACT FROM AUTHOR]

In this paper, a novel secret-revealing system is proposed. The proposed system directly embeds a secret message in an encoded cover image. The set partitioning in hierarchical trees (SPIHT) technique is employed to encode the cover image. The bit stream of a list of significant pixels encoded during the SPIHT encoding process is exploited to hide the secret message. The hiding capacity of each SPIHT encoding stage is determined according to the number of extracted significant coefficients. In addition, an adaptive embedding mechanism is designed to increase the hiding capacity with little loss of image quality.To sum up, three characteristics are achieved in this system. First, a secret message is directly embedded in a SPIHT-encoded cover image. Second, the compression rate of the cover image is adaptive. Third, the hidden secret message is extracted progressively during the SPIHT decoding process. [Copyright &y& Elsevier]

The entity of an occult tight filum terminale syndrome, characterized by clinical findings consistent with a tethered cord syndrome, but with the conus ending in a normal position, has been recognized recently. The indications for sectioning the filum terminale in this situation are not well characterized and are controversial. We report a retrospective review of a consecutive series of 60 children (ages 3–18 years) with a diagnosis of occult tight filum terminale syndrome who underwent section of the filum and were followed for more than 6 months (mean 13.9 months). The criteria for surgical intervention were (1) spina bifida occulta, (2) progressive bladder instability unresponsive to conservative measures, (3) urological/nephrological evaluation to confirm or rule out nonneurogenic etiology, and (4) two or more of the following: (a) bowel involvement (fecal incontinence or chronic constipation), (b) lower extremity weakness, (c) gait changes, (d) reflex/tone abnormalities, (e) sensory disturbances, (f) back/leg pain, (g) orthopedic abnormalities/limb length discrepancy, (h) scoliosis/lordosis, (i) recurrent urinary tract infections, (j) abnormal voiding cystourethrogram/ultrasound, (k) syringomyelia, and (l) neurocutaneous stigmata. Postoperatively, urinary incontinence/retention showed complete resolution in 52%, marked improvement (>95% resolution) in 35%, moderate improvement (>75%) in 6%, minimal improvement (> 50%) in 6%, and no improvement (<50%) in 2%. Fecal incontinence completely resolved in 56%, improved in 41%, and was unchanged in 3%. Weakness, sensory abnormalities, and pain improved or resolved in all patients. Copyright © 2004 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective. Constipation and encopresis are common problems in children. Still today, the role of fiber in the treatment of chronic constipation in childhood is controversial. The aim of our study was to evaluate whether fiber supplementation is beneficial in the treatment of children with functional constipation with or without encopresis. We used glucomannan as the fiber supplement. Methods. We evaluated the effect of fiber (glucomannan, a fiber gel polysaccharide from the tubers of the Japanese Konjac plant) and placebo in children with chronic functional constipation with and without encopresis in a double-blind, randomized, crossover study. After the initial evaluation, the patients were disimpacted with 1 or 2 phosphate enemas if a rectal impaction was felt during rectal examination. Patients continued with their preevaluation laxative. No enemas were given during each treatment period. Fiber and placebo were given as 100 mg/kg body weight daily (maximal 5 g/day) with 50 mL fluid/500 mg for 4 weeks each. Parents were asked to have children sit on the toilet 4 times daily after meals and to keep a stool diary. Age, frequency of bowel movements into the toilet and into the undergarment, presence of abdominal pain, dietary fiber intake, medications, and the presence of an abdominal and/or a rectal fecal mass were recorded on a structured form at the time of recruitment and 4 weeks and 8 weeks later. Children were rated by the physician as successfully treated when they had ≥3 bowel movements/wk and ≤1 soiling/3 weeks with no abdominal pain in the last 3 weeks of each 4-week treatment period. Parents made a global assessments to whether they believed that the child was better during the first or second treatment period. Results. Forty-six chronically constipated children were recruited into the study, but only 31 children completed the study. These 31 children (16 boys and 15 girls) were 4.5 to 11.7 years of age (mean:... [ABSTRACT FROM AUTHOR]

Seventy-four children (43 with chronic constipation, 31 with constipation and encopresis) treated with polyethylene glycol 3350 (PEG) for longer than 3 months were studied to assess long-term efficacy. The mean duration of PEG therapy was 8.4 months (range, 3-30). Weekly stool frequency, stool consistency, and symptoms associated with constipation improved significantly with PEG therapy in all 74 patients. In 31 children with encopresis, soiling ceased completely in 16 patients and frequency of soiling decreased significantly in all others. The average effective longterm dose of PEG was 0.7 g/kg/day. Long-term PEG therapy is effective for the treatment of chronic constipation with and without encopresis in children. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Some children with fecal incontinence respond to biofeedback therapy. However, whether they can achieve fecal continence posttherapeutically has not been clarified. We studied the serial results of biofeedback therapy and discuss the necessity' of providing repeated biofeedback therapy at home. METHODS: Nineteen children with encopresis underwent one session of biofeedback therapy. Seven of 15 children with fecal incontinence that developed after surgery for anorectal malformations underwent three to eight sessions of biofeedback therapy; the remaining 8 underwent one (mean, 2.9) session only. The patients were hospitalized for one session of biofeedback therapy. To monitor the clinical outcome of intervention, we used serial score assessments from three months to two years posttherapeutically. RESULTS: Seventeen of 19 (90 percent) patients with encopresis showed clinical improvement after one session of therapy (P < 0.0001). Six months after treatment, however, six of ten (60 percent) patients with encopresis reported recurrent fecal incontinence after one therapeutic session. Clinical improvement was noted in 5 of 15 (35 percent) patients who had fecal incontinence after surgery for anorectal malformations. All five patients showed clinical improvement from six months to two years after several sessions of biofeedback therapy (P < 0.05). CONCLUSIONS: Biofeedback therapy is effective in most children with encopresis and in some children with anorectal malformations. However, some patients need repeated sessions of biofeedback therapy to achieve fecal continence. Therefore, a new portable biofeedback apparatus for the treatment of fecal incontinence at home may be helpful. [ABSTRACT FROM AUTHOR]

This study evaluated the benefits of enhanced toilet training delivered through the Internet for children with encopresis. Twenty-four children with encopresis were randomly assigned to the Internet intervention group (Web) or no Internet intervention group (No-Web). All participants continued to receive routine care from their primary care physician. Tho Web participants demonstrated greater improvements in terms of reduced fecal soiling increased defecation in the toilet, and increased unprompted trips to the toilet (ps < .02). Both groups demonstrated similar improvements in knowledge and toileting behaviors Internet interventions may be an effective way of delivering sophisticated behavioral interventions to a large and dispersed population in a convenient format. [ABSTRACT FROM AUTHOR]

Objective: To develop and test a scale for parent and child, evaluating theoretical and clinical parameters relevant to children with encopresis. Encopretic children were hypothesized to have more bowel-specific, but not more generic, psychological problems, as compared with nonsymptomatic control children. In addition, mothers were also believed to be more discerning than children.Methods: The Virginia Encopresis-Constipation Apperception Test (VECAT) consists of 9 pairs of bowel-specific and 9 parallel generic drawings. Respondents selected the picture in each pair that best described them/their child. It was administered to encopretic children (N = 87), nonsymptomatic siblings (N = 27), and nonsymptomatic nonsiblings (N = 35). The mothers of all the participants also completed the VECAT. Encopretic children were retested 6 and 12 months posttreatment with Enhanced Toilet Training.Results: The VECAT demonstrated good test-retest reliability and internal consistency. Encopretic children and their mothers reported more bowel-specific, but not more generic, problems. Bowel-specific scores improved significantly posttreatment only for those patients who demonstrated significant symptom improvement. Mothers were significantly more discerning than children.Conclusion: The VECAT is a reliable, valid, discriminating, and sensitive test. Bowel-specific problems appear to best differentiate children with and without encopresis. [ABSTRACT FROM AUTHOR]

Relatively little attention is given to the issue of encopresis in the professional literature but it is of great concern to parents of and practitioners working with children on the autistic spectrum. Toilet training in itself can be a difficult area for some children on the spectrum, but a perplexing complication to the whole issue arises when children refuse to defecate into a potty or toilet. No data for children on the spectrum were found in the literature search, and indeed very little research related to this topic. Thus, this article aims to: outline the problems faced by parents/carers with a child with encopresis; differentiate between knowledge, skill and volition issues when dealing with the encoprectic child; suggest some possible causal frameworks for the behaviour; and give practical advice in managing the teaching/learning situation arising from this distressing behaviour. [ABSTRACT FROM AUTHOR]

ABSTRACT. Objective. To compare the characteristics of children with encopresis referred to a single encopresis clinic over the course of 20 years, including symptoms, previous diagnostic and therapeutic interventions, and parental attitudes. Methods. A retrospective study was conducted of an encopresis clinic at a tertiary care pediatric hospital. Questionnaires at initial evaluation elicited information about bowel habits, soiling, previous evaluations, previous treatments, and parental attitudes. Results. In 503 children with encopresis, the average age of referral dropped from 115 months during the earliest 5 years to 77 months during the most recent 5 years. Children who had soiling for >3 years before referral decreased from 63% to 12%. The use of barium enema before referral decreased from 14% to 5%, as did psychological evaluation, from 25% to 14%. Previous therapy with enemas decreased from 45% to 27%. Mineral oil use remained at approximately 50%, and 20% of children had no previous treatment. Symptoms at referral and parental attitudes did not change across the years. Conclusions. Children are now referred at an earlier age to our tertiary encopresis clinic. The number of invasive and psychological evaluations has decreased before referral. However, treatment by many primary care providers before the referral has not changed. These data may suggest that pediatricians have increased awareness of encopresis and greater appreciation of its primarily physical rather than psychological nature. Additional studies will be needed to determine how these factors affect outcome. Pediatrics 2003;111:e604-e607. URL: http: //www.pediatrics.org/cgi/content/full/111/5/e604; toilet training, encopresis, constipation, children. [ABSTRACT FROM AUTHOR]

Discusses the experiences of a clinical social worker in her researches regarding encropesis in children. Definition of encropesis as a disorder with the absence of organic difficulties; Suffering of families due to encropesis; Traditional psychological notions on encropesis.

The article features a thirteen-year-old girl with anemia. The girl had a hemoglobin level of 8.0 g/dL with MCV 80 and an erythrocyte sedimentation rate of 80 mm/h. No symptoms of vomiting, diarrhea, fever or abdominal pain were seen in her. She had a history of constipation, encopresis and enuresis. She also had Tanner II breasts and a Tanner I perinium. Timothy Sentongo, Earl Cheng and Alexis Thompson were among the group of pediatricians who studied ad discussed her case.

Objective: To validate a theoretical model of encopresis in terms of psychological factors that differentiates children with and without chronic encopresis and to identify scales that demonstrate these differences.Methods: Eighty-six children with encopresis were compared to 62 nonsymptomatic children on five psychometric instruments. Differences in the mean scores and the percentages of children falling beyond preselected clinical thresholds were compared across the patient-control groups.Results: Children with encopresis were found to have more anxiety/depression symptoms, family environments with less expressiveness and poorer organization, more attention difficulties, greater social problems, more disruptive behavior, and poorer school performance (ps =.01 < or =.001 on 15/20 subscales). There were no differences in self-esteem. On those subscales where proportionately more encopretic children exceeded clinical thresholds, approximately 20% more of the encopretic children exceeded thresholds than control children.Conclusions: As a group, children with encopresis differ from children without encopresis on a variety of psychological parameters. However, only a minority of children with encopresis demonstrated clinically significant elevations in these parameters. Identification and treatment of such clinical issues may enhance treatment efficacy. [ABSTRACT FROM AUTHOR]

Presents a case study on the response of pediatric fecal incontinence while under chiropractic care. Etiology and treatment of encopresis; Medical history of the patient; Limitations of the case study.

Objective: To review the progress made over the past decade with regard to the treatment of enuresis and encopresis, as well as advances in the understanding of etiological mechanisms.Method: Separate computerized literature (English language only) searches of Medline and PsycINFO databases were conducted under the parameter of enuresis and children-adolescents, as well as encopresis and children-adolescents.Results: There has been a substantial decrease in published research concerning the use of imipramine to treat enuresis compared with the prior two decades, accompanied by a corresponding increase in the number of papers concerning desmopressin acetate (DDAVP), which has become the primary pharmacological treatment. Genetic studies of large pedigrees have further confirmed the importance of heritable factors. With regard to encopresis, the research has focused primarily on pathophysiological factors related to the colon and anal sphincter.Conclusions: The widespread use of DDAVP has been the primary addition to treatment strategies over the past decade. The bell-and-pad method of conditioning, the only major treatment that has enduring benefit after being withdrawn, is the most cost-effective and appears to be underutilized. Research into etiological mechanisms has focused primarily on the mechanism of action of DDAVP and advances in the understanding of genetic factors. Advances in the treatment and etiological understanding of encopresis have been less impressive. [ABSTRACT FROM AUTHOR]

Patients with chronic constipation that fails to respond to treatment remain a challenge for paediatricians and surgeons. Ongoing work in our institution suggests that a number of children with intractable symptoms have slow transit constipation, which has only been described recently in paediatrics. Common features of slow transit are: delayed passage of the first meconium stool beyond 24 h of age, symptoms of severe constipation within a year, or treatment-resistant 'encopresis' at 2-3 years, soft stools despite infrequent bowel actions, and delay in colonic transit on a transit study. A proportion of children with slow transit constipation have an abnormality of intestinal innervation associated with the dysfunctional colonic motility, recognized as intestinal neuronal dysplasia (IND). Intestinal neuronal dysplasia type B, the most common variant of IND, is defined on rectal biopsy by hyperplasia of the submucosal plexus. On laparoscopic colon muscle biopsy, many specimens show reduced numbers of excitatory substance P-immunoreactive nerve fibres in the circular muscle. Functional markers of the nerves allow new diagnostic criteria to be developed which may also allow a more rational approach to treatment. The aetiology remains obscure and the optimal management poorly defined, although subtotal colectomy, proximal colostomy or appendicostomy (for antegrade enemas) have been tried. Once the anatomy and physiology of the colon in children with slow colonic transit is better understood, we will have defined not only a new form of constipation, but also will be able to consider new therapies. [ABSTRACT FROM AUTHOR]

Examines the use of Internet in teaching parents and children about constipation and encopresis in Virginia. Provision of health information; Importance of patient education; Determination of computer-based learning.

Liquid paraffin or mineral oil is a transparent, colourless, odourless, or almost odourless, oily liquid composed of saturated hydrocarbons obtained from petroleum. Petroleum was used as a medicine at least 400 years before Christ. The article analyzes the role of the liquid paraffin in treatment of constipation among children. The popularity of liquid paraffin as a treatment for constipation and encopresis stems primarily from its tolerability and ease of titration. Authors of the article describe properly designed randomized and controlled study for role of the paraffins.

The purpose of the present paper was to review research studies of faecal soiling (not linked to anatomical anomalies) in people with intellectual disabilities. The research studies were identified through: (1) computerized searches of the PSYCLIT and MEDICAL EXPRESS databases for journal articles published between 1975 and 2000; and (2) a hand search of the reference lists of the articles found through the computerized process. Twenty‐one studies were reviewed: 13 dealt with the treatment of non‐retentive faecal soiling (i.e. soiling occurring in the absence of constipation); and eight were on retentive faecal soiling (i.e. soiling occurring in the presence of constipation). Treatment and follow‐up data tended to be fairly encouraging, with clear performance changes. An analysis of the results, in relation to the treatment conditions and designs of the studies, underlined several procedural and practical questions. Possible research initiatives to clarify those questions are presented. [ABSTRACT FROM AUTHOR]

Summary Introduction Though bladder and bowel control are important developmental milestones in all cultures, the prevalence of enuresis and encopresis has rarely been studied in developing countries despite there being factors in these countries that could affect it. This study reports the prevalence and associations of enuresis and encopresis in children in Kerala, India. Method The parents of 1403 randomly selected 8–12-year-old children were interviewed. The prevalence of enuresis and encopresis was ascertained using Rutter’s A2 scale. Subsamples of children underwent psychiatric, physical and psychometric evaluations. Results Of the children, 18.6% had had an episode of enursis in the past year and 4.3% in the past week. Four per cent had had an episode of encopresis in the past year. Enuresis was associated with parents’ education, physical and psychiatric symptoms in the child, poor academic achievement and lax parental attitudes to toilet training. Encopresis was associated with male sex, physical and psychiatric symptoms, poor academic achievement, early separation and not having a toilet. Discussion The prevalence of enuresis compares with western countries, but encopresis is commoner. The associations of enuresis suggested a multifactorial model in which parental competence was prominent. This study de-emphasized the importance of neurodevelopmental factors in enuresis and encopresis in this age group. [ABSTRACT FROM AUTHOR]

PURPOSE: Fecal incontinence is a socially devastating disorder which affects at least 2.2 percent of community dwelling adults and 45 percent of nursing home residents. Most incontinent patients can be helped, but physicians are poorly informed about treatment options. The aim of this study was to develop a consensus on treatment options by convening a conference of surgeons, gastroenterologists, nurses, psychologists, and patient advocates. METHOD: A 1-1/2 day conference was held in April, 1999. Experts from different disciplines gave overviews, followed by extended discussions. Consensus statements were developed at the end of the conference. This summary statement was drafted, circulated to all participants, and revised based on their input. CONCLUSIONS: 1) Diarrhea is the most common aggravating factor for fecal incontinence, and antidiarrheal medications such as loperamide and diphenoxylate or bile acid binders may help. Fecal impaction, a common cause of fecal incontinence in children and elderly patients, responds to combinations of laxatives, education, and habit training in approximately 60 percent. These causes of fecal incontinence can usually be identified by history and physical examination alone. 2) In patients who fail medical management or have evidence of sphincter weakness, anorectal manometry and endoanal ultrasound are recommended as helpful in differentiating simple morphologic defects from afferent and efferent nerve injuries and from combined structural and neurologic injuries. 3) Biofeedback is a harmless and inexpensive treatment which benefits approximately 75 percent of patients but cures only about 50 percent. It may be most appropriate when there is neurologic injury (i.e., partial denervation), but it has been reported to also benefit incontinent patients with minor structural defects. 4) External anal sphincter plication with or without pelvic floor repair is indicated when there is a known, repairable structural defect without significant neurologic injury. It is effective in approximately 68 percent. 5) Salvage operations are reserved for patients who can not benefit from biofeedback or levator-sphincteroplasty. These include electrically stimulated gracilis muscle transpositions and colostomy. 6) Antegrade enemas delivered through stomas in the cecum or descending colon reduce or eliminate soiling in approximately 78 percent of children with myelomeningocele; this operation may come to be more widely applied. 7) Investigational treatments include implanted nerve stimulators, artificial sphincters, and anal plugs. 8) Patient characteristics which influence choice of treatment include mental status, mobility impairment, and typical bowel habits. 9) Additional research is needed to; better define the mechanisms responsible for fecal incontinence, to assess the efficacy of these treatments, to develop better treatments for nursing home residents, and to identify predictors of outcome. [ABSTRACT FROM AUTHOR]

Objective To analyse experience in treating young children (4–5 years old) with urodynamically confirmed voiding dysfunction, using a noninvasive training programme. Patients and methods Between January 1996 and October 1997, 20 children (all < 5 years old, mean age 4.45 years, 18 girls and two boys, mean ages 4.44 and 4.5 years, respectively) with voiding dysfunction were treated. Three children showed filling phase dysfunction alone (bladder instability), six emptying phase dysfunction alone (dysfunctional voiding) and 11 showed both filling and emptying phase dysfunction. Sixteen children had incontinence problems (three diurnal, two nocturnal and 11 diurnal and nocturnal). Eight children had a history of recurrent urinary tract infections and 12 girls had vaginal irritation. Four children were referred for perineal pain caused by spasms of the pelvic floor. Eight children had encopresis based on chronic obstipation. Therapy consisted of keeping a voiding and drinking chart, instructions on proper toilet posture, daily rules for application at home, and if possible relaxation biofeedback of the pelvic‐floor muscles. Therapy was considered successful if incontinence and other urological symptoms resolved. The treatment of encopresis is also discussed. Results Of the 20 children, 13 had a good result; they all became dry during the day and night, and encopresis resolved. Six children had moderate success; in one, nocturnal incontinence persisted, and in two diurnal and nocturnal incontinence continued. In two children encopresis persisted and in one the faecal incontinence ameliorated. In one child the therapy was prematurely interrupted because of lack of motivation. Conclusion This experience suggests that a noninvasive training programme is applicable in very young children with symptoms of dysfunctional elimination of urine and faeces. [ABSTRACT FROM AUTHOR]