The Classification of Soiling and Encopresis and a Possible Treatment Protocol

Abstract

Background: It is proposed that the classification of paediatric bowel elimination disorders is central to their effective treatment. Method: By separating the terms soiling and encopresis and clearly defining the aetiologies behind both, a treatment pathway begins to emerge. Results: The theoretical model described suggests that encopresis may require only psychological management, whereas soiling (caused by constipation) is more complex, and although it needs medical management, it may or may not require psychological input. Conclusions: By using such a functional classification to define a treatment protocol, the roles of both medical and psychological services could be more clearly understood from the outset.

Encopresis: A guide for Psychiatric Nurses

“…There are various explanations of the pathophysiologic processes involved in the development of constipation and incontinence (Field & Friman, 2006;McGrath et al, 2000;Mikkelsen, 2001;Murphy & Carney, 2004). The mechanisms involved in the entire process of socially acceptable defecation are complex and require a sufficient developmental level and the ability to regulate various stimuli and behaviors.…”

“…Some authors also identify other classification schemata for encopresis. Murphy and Carney (2004) suggested that a model differentiating soiling and encopresis would be more appropriate. In this model, soiling would be defined as passage of semisolid stool into clothing, and encopresis would be limited to children who pass normal stool in inappropriate places.…”

The Importance of Developing Rapport When Attempting to Treat an Oppositional-Defiant, Teenage Soiler in a Residential Setting

“…Encopresis, the repeated passage of feces into inappropriate places, is an underreported elimination disorder diagnosed primarily in children who have already been toilet trained (Murphy and Carney 2004). Understanding that this is an uncommon diagnosis for physically healthy individuals of average intelligence who have progressed beyond childhood, we hope to show the importance of conceptualizing and approaching a difficult case of this kind from a psychodynamic stance in order to develop rapport and a solid working relationship.…”