5-Minute Clinical Consult : Encopresis

Encopresis

Etiology

Psychological:
- Stool withholding, fear, anxiety
- Difficulty with toilet training, including unusual anxiety or conflict with parent
- Resistance to using public toilet facilities, such as school bathrooms or outdoor toilets
- Known association with sexual abuse in boys; likely similar association in girls as well
- Developmental delay
Anatomic:
- Rectal distension and desensitization
- Anal fissure or painful defecation
- Muscle hypotonia
- Slow intestinal motility
- Hirschsprung disease
- Cystic fibrosis
- Spinal cord defects (e.g., spina bifida)
- Congenital anorectal malformations
- Anal stenosis
- Anterior displacement of the anus
- Postoperative stricture of anus or rectum
- Pelvic mass
- Neurofibromatosis
Dietary or metabolic:
- Lack of fiber
- Excessive protein or milk intake
- Inadequate water intake
- Hypothyroidism
- Hypercalcemia
- Hypokalemia
- DI or DM
- Food allergy
- Gluten enteropathy
Medication side effects

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