A pediatric treatment program for encopresis was established in a large medical center. This consisted of counseling and education, initial bowel catharsis, a supportive maintenance program to potentiate optimum evacuation, retraining, and careful monitoring and follow-up. A group of 127 children received care for this problem. At the end of one year, outcome data were obtained on 110 patients. Of these, 51% had not had "accidents" for more than six months. Another 27% showed marked improvement and were having only rare episodes of incontinence. 14% of these children showed some improvement, but continued to have incontinence, while 8% showed no improvement whatsoever during the treatment year. These four outcome groups were compared with respect to a large number of demographic, developmental, psychosocial, and clinical variables.
Dr. Fleisher's letter about our article on children with encopresis is certainly provocative and presents some alternative views about treatment. We would certainly agree that pediatricians need to understand this symptom in depth in order to treat it adequately. Further knowledge of the physiology of defecation can be quite valuable in this respect. Dr. Fleisher's own review in Pediatric Annals is certainly helpful. We agree that the distinction between nonretentive and retentive fecal soiling needs to be made.
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