Encopresis

Essential (Required) Features:

• Repeated and persistent passage of faeces in inappropriate places (e.g., at least once per month over a period of several months).
• The individual who has reached the developmental age when faecal continence is ordinarily expected (approximately equivalent to a chronological age of 4 years).
• Faecal soiling is not better accounted for by the physiological effects of a substance (e.g., excessive use of laxatives) or another medical condition (e.g., aganglionic megacolon, spina bifida, anal stenosis, chronic diarrhoea, congenital or acquired abnormalities of the bowel, or gastrointestinal infection).

Specifiers for the presence of constipation and overflow:

6C01.0 Encopresis with constipation and overflow incontinence

• Encopresis with constipation and overflow incontinence is the most common form of faecal soiling, and is characterized by retention and impaction of faeces. Stools are typically—but not always—poorly formed (loose or liquid) and leakage may range from occasional to continuous.
• There is often a history of toilet avoidance leading to constipation.

6C01.1 Encopresis without constipation and overflow incontinence:

• Encopresis without constipation and overflow incontinence is not associated with retention and impaction of faeces, but rather is characterized by reluctance, resistance, or failure to conform to social norms in defecating in acceptable places in the context of normal physiological control over defecation.
• Stools are typically of normal consistency and inappropriate defecation is likely to be intermittent.

6C01.Z Encopresis, Unspecified

Additional Clinical Features:

• Encopresis is most often involuntary but, in some cases, may appear to be voluntary. The diagnosis can be assigned in either case. Involuntary passage of faeces is most often associated with Encopresis with constipation and overflow incontinence.
• Encopresis that is intentional may be associated with Oppositional Defiant Disorder or Conduct-Dissocial Disorder.
• Stool withholding, or retentive behaviours, may be the result of avoidance of bowel movements especially in those individuals with a history of difficulty or pain in passing stools. Individuals with chronic constipation and stool retention may go on to develop acquired megacolon.
• Specific Phobias or Social Anxiety Disorder (e.g., fear of using public bathrooms) may also contribute to retentive behaviours.
• Encopresis is common among individuals with Disorders of Intellectual Development. The diagnosis should only be assigned if all diagnostic requirements are met and the individual’s developmental age is equivalent to that of the age at which faecal continence in normally expected (approximately equivalent to a chronological age of 4 years).
• Encopresis can occur among individuals with Neurocognitive Disorders (e.g., Dementia). The additional diagnosis of Encopresis can be assigned if all diagnostic requirements are met and the condition requires separate clinical attention.
• Individuals diagnosed with Encopresis may experience embarrassment and reduced self-esteem. Older children diagnosed with Encopresis may experience impairments in social functioning due to peer teasing and possible social isolation. Furthermore, individuals with Encopresis may avoid social situations for fear of passing faeces in the presence of other people.
• Individuals with Encopresis and chronic constipation may also experience co-occurring symptoms of Enuresis. If all diagnostic requirements are met for both disorders both can be diagnosed.

Boundary with Normality (Threshold):

• It is not uncommon for children to experience an occasional soiling accident during early childhood. Faecal incontinence must occur frequently and persistently to warrant a diagnosis.

Course Features:

• Encopresis can persist for years, with recurrent episodes of worsening symptoms.

Developmental Presentations:

• Faecal incontinence may have been present from birth (i.e., an atypical extension of normal infantile incontinence), or may have its onset following a period of acquired bowel control.
• Encopresis has a high prevalence (between 1.5 to 7.5%) among school-age children between the ages of 6 to 12 years.

Sex- and/or Gender-Related Features:

• Encopresis is more common in males.
• Females may be more likely to experience urinary tract infections co-occurring with Encopresis due to contamination of the urethra with faecal bacteria.