ENCOPRESIS (307.7) Encopresis involves the repetitious passage of stool into inappropriate places (the floor or when dressed in clothing). It can be intentional or involuntary. Involuntary passage is often related to fecal impaction/constipation with diarrhea overflowing past the impaction. Things that are symptomatic of encopresis include the following: A. Secretive behavior about having a bowel movement B. Bowel incontinence C. Occasional passage of large stools D. Passage of stool in inappropriate places E. Hard stools or constipation The criteria for the disorder must all be met in order to make the diagnosis of encopresis: A. The child must be at least four years of age B. There must be repeated passage of stool in inappropriate places (clothing or floor, for example) C. One event per month must be present for a minimum of three months D. There cannot be laxative abuse or another medical disorder other than constipation There are two specifiers that must be used when making the diagnosis: 1) with constipation and overflow incontinence (as identified by physical exam or history) or 2) without constipation and overflow incontinence. The prevalence of encopresis in children aged five is about 1 percent, more commonly seen in boys than in girls. A mental age of four years must be reached. Children may have primary encopresis, in which they were never continent, or secondary incontinence, where it occurs after a period of continence. Voluntary encopresis is seen in conduct disorder and in oppositional defiant disorder. Soiling is done in anger toward authority figures. Children who play with feces tend to have deeper psychiatric issues.
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