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Encopresis due to constipation — DCH MCQ

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ModerateBehavioural and emotionalEncopresis due to constipationDCH

A toilet-trained 4-year-old has painful defaecation, stool-withholding behaviour and recurrent faecal soiling. There are no red-flag features. His abdomen is soft, with a palpable faecal mass in the left iliac fossa. His parents believe that the soiling is defiant behaviour. What is the most appropriate advice?

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Correct answer: C — Explain that the soiling is involuntary overflow from retained stool and avoid blaming him

The correct answer is C. Painful defaecation, withholding, a palpable faecal mass and soiling indicate constipation with involuntary overflow around retained stool. Parents should understand that this is not deliberate and should use calm, non-punitive encouragement. The child should be assessed for disimpaction and then receive maintenance laxative treatment. Restricting fluids may worsen constipation. Treatment should not be delayed for toilet training, and punishment increases distress without addressing faecal loading. Macrogol should not be stopped as soon as stools improve: maintenance treatment is usually continued for weeks to months after a regular bowel habit is established and then reduced gradually.

Reference: NICE. Constipation in children and young people: diagnosis and management, CG99, sections 1.4–1.5. Published 2010; updated 2017, prescribing note updated 2021. https://www.nice.org.uk/guidance/cg99/chapter/Recommendations