Encopresis in Children: Psychological Assessment and Evaluation of Behavioral Training Program

Background: Encopresis (fecal incontinence) is a disorder which affects children worldwide. It is even more stigmatized than enuresis and urinary incontinence and is associated with high levels of distress for both children and parents. The aim of the psychological work is assessing of patients with Functional fecal incontinence and assessment of the effectiveness of behavioral training program for the patients and their parents.

Methods: This comparative cohort study was carried out at the Neuropsychiatry Department, Tanta University and Centre of Psychiatry, Neurology and Neurosurgery-Tanta University hospitals and pediatric surgery outpatient clinic of Tanta University Hospitals. Inclusions criteria were age group more than 4 years to 18 years, Both males and females and all patients with a diagnosis of functional encopresis. The study was performed on two groups: Group (A): include 30 patients diagnosed with functional encopresis (is defined as both voluntary and involuntary passage of feces in inappropriate places in a child aged four years or older, after organic causes have been ruled out), receiving a behavioral training program and medication for 6 months. Group (B): include 30 patients diagnosed with functional encopresis receiving medical treatment only for 6 months.

Results: There were clinically significant differences between the studied groups regarding behavior problem outcome at the end of treatment according to Revised Behavior Problem Checklist outcome p values were (0.001). There were no clinically significant differences between the two studied groups regarding depression outcome at the base line and at the end of treatment according to The Children's Depression inventory. There were no clinically significant differences between the studied groups regarding quality-of-life outcome at the base line and at the end of treatment according to WHO quality of life scale domains p value 0.001. Regarding comorbidity with other psychiatric disorders, the most comorbid disorder in group (A) is ADHD which represented 53.3% followed by enuresis 50% while the most comorbid disorder in group (B) is enuresis 43% followed by ADHD 40%. Additionally, there was negative correlation between total behavior score and social class of the patients of group (A) with statistically significant difference p value = 0.001 i.e., the higher the social class, the lower the total behavior scores.

Conclusions: Encoporesis is associated with many behaviors problem, depressive symptom and has low quality of life. Encoporesis is associated mainly with ADHD, enuresis and anxiety disorder. Quality of life in children with encoporesis is improved after administration of treatment specially in group A (receiving medical and behavior treatment).