Encopresis: developmental, behavioral and physiological considerations for treatment.

Encopresis (soiling in the clothing) is a complex condition presenting a treatment challenge for health care providers. It is a disruptive event, placing both the child and family at risk for crisis. The definition, incidence, etiology and relevant medical, behavioral and developmental theory are discussed. A multi-dimensional encopretic evaluation and management model is presented that addresses encopresis at developmental, behavioral and physiological levels. This system includes a detailed historical, demographic, behavioral and school-performance profile of the child; appropriate physical and laboratory examinations; and a treatment approach that incorporates bowel evacuation, a high-fiber diet, techniques of behavior modification, and maintenance on either contingent rectal cathartics or oral laxatives. If there are significant behavioral concerns and/or the family is dysfunctional, collaborative psychiatric management can be arranged.