Encopresis

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Summary of Encopresis

Encopresis, also known as paradoxical diarrhea, is voluntary or involuntary fecal soiling in children who have usually already been toilet trained. Persons with encopresis often leak stool into their undergarments. May be caused by constipation or fecal impaction with overflow incontinence.

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Encopresis

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NOTES NOTES ELIMINATION DISORDERS GENERALLY, WHAT ARE THEY? PATHOLOGY & CAUSES DIAGNOSIS ▪ Repeated voluntary/involuntary passage of feces/urine into inappropriate places ▫ Encopresis: feces ▫ Enuresis: urine ▪ Disorders can be functional; often explained by/causing distress ▪ Repeated voluntary/involuntary passage of feces/urine into inappropriate places ▪ > ﬁve years old ▪ Not caused by other condition/substance CAUSES MEDICATIONS ▪ Genetic, environmental TREATMENT ▪ Laxatives, desmopressin, to manage elimination SIGNS & SYMPTOMS ▪ Repeated voluntary/involuntary passage of feces/urine into inappropriate places PSYCHOTHERAPY ▪ E.g. cognitive behavioral therapy ENCOPRESIS osms.it/encopresis PATHOLOGY & CAUSES ▪ Repeated voluntary/involuntary passage of feces into inappropriate places ▪ Often functional, caused by overﬂow due to withholding feces (e.g. fear of defecation); constipation-related ▪ When feces deposited in abnormal places, may be neurodevelopmental/induced by fear of toilets CAUSES ▪ Genetic, environmental ▪ Often associated with psychiatric comorbidities SIGNS & SYMPTOMS ▪ Repeated passage, voluntary or uncontrolled, of feces into inappropriate places DIAGNOSIS ▪ Repeated passage, voluntary or uncontrolled, of feces into inappropriate places ▪ Occurs at least once a month for three months in a row OSMOSIS.ORG 705

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Encopresis

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USMLE® Step 1 style questions USMLE

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A 5-year-old boy is brought by his grandmother to the pediatrician's office after being dismissed from school due to inappropriate behavior. His medical history is relevant for emotional detachment from his mother and chronic constipation. The mother works as a flight attendant and travels often. His toilet training was completed when he was 3. Upon medical interrogation with the grandmother, the boy feels very embarrassed and can barely establish eye contact. The school reports that the boy was found to be hiding dirty and foul-smelling underwear under his classmates’ desks. The physical exam is noncontributory. The grandmother claims concerned that he's been doing this type of behavior around the house for a while, but she omits punishment because she has noticed that his actions are involuntary and he hides the evidence out of embarrassment. Which of the following is the most likely diagnosis?

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