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CASE 13.1

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A 6-year-old male presents to your office with his mom. He has been soiling his underwear frequently and it is causing stress at home and school. His parents are frustrated and think he is old enough to know better. At school, he is being teased and being called "stinky pants" and he reports feeling embarrassed. Mom asks you if there is something medically wrong with him.

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Question 13.1.1 What percentage of chronic encopresis is functional (meaning no underlying medical or organic cause)?

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A) 10%.

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B) 25%.

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C) 50%.

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D) 75%.

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E) 90%.

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Answer 13.1.1 The correct answer is "E." Ninety percent of chronic encopresis is functional. Functional encopresis is the repeated involuntary passage of stool into underwear in a child who is 4 years of age or older and at a developmental level appropriate for toilet training in the absence of an underlying medical cause. The most common reason is retentive constipation with overflow incontinence. Frequently, the child has an associated psychological problem. Boys are affected more often than girls. Children with this disorder withhold feces voluntarily thereby avoiding defecating. As stool stays in the colon, more water is absorbed creating harder stool that is more difficult to pass. This leads to a self-perpetuating cycle. The excess stool stretches the rectum with eventual loss of sensation to defecate. Liquid stool may leak around the impacted mass, which parents often mistake as diarrhea. In some, a triggering event such as passage of a painful stool leading to fear of stooling, forced toilet training before the child is ready, or dislike of using public toilets (starting school) may have occurred. A common theme is parental misunderstanding of the problem thinking it is due to an undiagnosed medical problem, attention-seeking behavior, or child laziness.

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Some definitions…Non-retentive encopresis is the voluntary stooling of one's pants. Once a medical cause has been ruled out, this is purely a behavioral or psychiatric problem. Primary encopresis is when stool continence has never been achieved. Secondary encopresis occurs when accidents began after a period of successful toilet training.

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Question 13.1.2 Which of the following conditions is associated with encopresis?

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A) Urinary tract infections.

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B) Enuresis.

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C) Social isolation.

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D) ADHD.

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E) All of the above.

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Answer 13.1.2 The correct answer is "E." Encopresis is an independent risk factor for urinary tract infections. Feces in the underwear allows for close ...

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