50 Years Ago in The Journal of Pediatrics:
A review of twelve cases of encopresis
Article Outline
McTaggart A, Scott M: J Pediatr 1959;54:762-8
The term “encopresis” was coined in 1926 to denote the act of involuntary defecation not the result of organic causes. Fifty years ago “encopresis” was still believed to be primarily a psychiatric problem, and the article by McTaggart et al reports successful treatment with psychiatric interventions, which were then considered the “State of the Art” treatment. Their manuscript, however, shows that the clinical characteristics of patients with this problem have not changed over the years.
The fact that their treatment focused mainly on psychiatric interventions shows that the understanding of the pathophysiology of the problem and its treatment have truly changed over time.1, 2 Today the treatment of “encopresis” has shifted from the assumption that it is a psychiatric problem to the understanding that it is usually the result of stool retention in a child with functional constipation.1, 2 Given that the term “encopresis” has psychiatric connotations, it has recently been proposed that the term functional fecal incontinence be used instead. Most children with this problem do not have underlying primary psychiatric problems.
Today's treatment consists of education, behavior interventions, and laxatives.2 Recent years have seen the advent of prospective randomized studies, evidence-based guidelines, and algorithms for the treatment of children with functional constipation. Randomized controlled trials have also shown that the addition of laxatives to behavior modification is associated with a better response, and there are new and better tolerated laxatives.1, 2
Independently of the treatment used, only 50% to 70% of treated children with chronic functional constipation have long-term success.1, 2 Given their poor long-term response, that their main clinical characteristics seemed not to have changed over time, and that the problem starts many times around toilet training, our efforts need to focus in prevention, anticipatory guidance, and early treatment.
References
- . Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr. 2006;43:e1–e13
- . Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology. 2006;130:1527–1537
PII: S0022-3476(09)00098-5
doi:10.1016/j.jpeds.2009.01.047
© 2009 Mosby, Inc. All rights reserved.
