Involuntary emptying. Fecal incontinence - causes, diagnosis, treatment

Fecal incontinence is a medical condition characterized by a disorder in which a person is unable to control bowel movements. Bowel cleansing occurs spontaneously. The patient loses calm and becomes psychologically unbalanced.

Fecal incontinence has a special medical term - encopresis. The disease is usually associated with the development of organic pathology. All factors are significant and require elimination and urgent consultation with a doctor.

Fecal incontinence in adults is an unpleasant and dangerous phenomenon. A person loses the ability to control internal processes; bowel cleansing is not controlled by the brain.

Feces can be of different consistencies - solid and liquid. The emptying process itself does not change. Fecal incontinence in women is diagnosed less frequently than in the stronger half of humanity. Statistics give figures - one and a half times less. But this does not allow women to be calm and confident that they are not afraid of such a pathology. The disease is nearby, waits for favorable conditions and manifests itself, disrupting the usual way of life.

There is an opinion that the pathological disorder is characteristic of old age. Fecal incontinence in the elderly is an optional sign of age; doctors have proven that this opinion is wrong. Statistics provide figures that explain the emergence of such opinions. Half of the patients are people over 45 years of age. Age is only one of the reasons that leads to illness.

To understand why fecal incontinence occurs, you need to understand the process of managing bowel movements. Who controls at what level of physiology this is laid down. Several systems control the output of feces. Their coordination leads to the normal functioning of the body.

The rectum contains a large number of nerve endings that are responsible for the functioning of muscle structures. The same cells are located in the anus. The muscles hold the feces and push them out.
The rectum is located inside the intestine so as to hold feces and send it in the right direction. Feces, once in the rectum, already acquire their final state. It is dense, compressed into voluminous ribbons. The anus closes its exit without control.
The compressed state of bowel movement is maintained until it is released, when the person is ready for the act of defecation and understands that it has occurred. In a normal state, a person can restrain the process until he can go to the toilet. The delay time can be hours.

If the process is disrupted, this condition is not controlled, feces are released instantly. The muscles of the pelvis and anal area do not support intestinal tone.

The sphincter plays an important role in the process. More precisely, the pressure in his area. Normally, it varies from 50 to 120 mmHg. For men, the norm is higher. The anal organ in a healthy state should be in good shape; a decrease in its functionality leads to worsening bowel movements. Its activity is controlled by the autonomic nervous system. It will not be possible to consciously influence the sphincter. Stimulation of fecal output occurs at the level of irritation of receptors in the walls of the rectum.

Scientific explanation for passing stool:

simultaneous vibration of the peritoneal muscles and closure of the main opening (slit passage);
increased pressure on the sphincter;
delayed compression of intestinal segments;

All processes lead to advancement, pushing feces towards the anus. The process is slow and cannot be accelerated. The pelvic muscles enter a relaxed state, the muscles open the rectal outlet. The internal and external sphincter relaxes. When a person cannot get into the sanitary room, he strains the internal receptors, the anorectal opening remains closed and tight. The degree of tissue tension stops the urge to go to the toilet.

Causes of fecal incontinence

There are a number of factors that cause fecal incontinence in adults.

The most common reasons:

constipation;
loose stools;
weakness and damage to muscle mass;
nervous conditions;
decreased muscle tone relative to normal;
dysfunction of the pelvic organs;
hemorrhoids.

You can consider and analyze the causes of fecal incontinence in detail.

Constipation. Solid waste from food processing accumulates in the intestines. The tissue in the rectum stretches, which relieves pressure on the sphincter. When constipated, a person has a desire to soften stool. Liquid stool accumulates above solid feces. They leak out and damage the anal passage.
Diarrhea. Diarrhea changes the condition of the stool, this becomes a factor in the development of pathology. Treatment of fecal incontinence becomes the first and necessary action to eliminate symptoms.
Innervation problems. Impulses are subject to two types of disturbance. In the first option, the problem is based on nerve receptors, the second - on abnormalities in the functioning of the brain. This is often characteristic of the senile state, when the activity of brain processes decreases.
Scars on the walls of the rectum. Due to a decrease in the strength of the walls of the lining of the esophagus, enuresis and encopresis begin to appear. Unpleasant processes disrupt the condition of the adult organ, and scars form. Sometimes scars form after inflammation, surgery, or radiation.
Hemorrhoidal venous seals. The knots prevent the hole from closing, the muscles become weak and inactive. In older people, hemorrhoids change the entire bowel movement process.

It is based on certain principles:

adjustment of regime and diet;
medicines;
training the muscles of the intestinal systems;
stimulation of work using electrical equipment;
operational activities.

Each principle will be analyzed by a specialist. Treatment of encopresis is aimed at eliminating the problem - the cause that caused the disruption of the bowel movement.

Medicines

Among medications that help normalize the functioning of the digestive system, Imodium tablets are considered one of the most popular. In medical language they are called Loperamide.

Drug groups:

antacids;
laxatives;
therapeutic.

Other anti-diarrhea drugs intervene in the disease and produce additional healing effects:

Atropine, Belladonna. Anticholinergic drugs, they reduce the development of secretion and increase peristalsis. Motility of the intestinal walls returns to normal. Can be used at various stages.
Codeine. The drug relieves pain, as it is one of the derivatives of the opium group of drugs. More often it happens that it is included in the group of dangerous contraindications. Prescribed only on the recommendations of a doctor.
Lomotil. A medicine with this name reduces the movement of feces and creates conditions for its hardening.

The most common are activated carbon tablets. The substance is named after the active element of its composition. Coal absorbs liquid and expands feces in volume. In addition, the medicine removes toxic substances from the body.

Doctors are studying the causes and treatment. They will select special devices if medication formulations do not help.

The problem may arise when it is impossible to go to a medical facility. Then you have to turn to the advice of healers, healers from the people. At home, the disease has been eliminated for many centuries. Treatment of fecal incontinence was carried out in villages, where grandmothers selected medicinal herbs and created miraculous tinctures.

You can use folk remedies, but such an action should not be permanent. What reasons led to loose stools, what caused intestinal malfunctions? Answers to questions can be obtained after a full examination and diagnostic procedure.

Enemas. Chamomile decoctions are used to carry them out. Take 50 g of medicinal herb and place it in a liter of boiling water. Over low heat, wait for the chamomile components to completely dissolve. Then cool to room temperature and insert into the rectum. You need to hold the medicine inside for a very long time, you can help with the help of medical devices or hands.
Infusions for internal use. The base is calamus grass. It is steamed in boiling water, the proportions are 20 g of herb, 200 ml of liquid. You can’t make a lot of water compositions. A liter of healing infusion is sufficient for a course of 7 days. Drink 1 spoon after meals.
Rowan juice. The fruits of the tree help when eaten fresh and pressed into a drink. Dosage rate: one spoon no more than 3 times a day.
Honey products. Honey, 1 tablespoon per day, will be both a therapeutic and preventive method of eliminating the disease.

Changes in bowel movements occur during pregnancy. Women hope that everything will end after childbirth. More often, the disease continues to occur and intensify. The problem becomes not so much physiological as psychological.

Fecal incontinence after childbirth is due to the following reasons:

impaired innervation of the bladder muscles;
deviations in the functioning of the muscles of the pelvic organs;
pathologies of the urethra;
dysfunction of the bladder and urinary systems;
instability of pressure inside the bladder.

The pathology occurs along with another process - gas incontinence is observed. A large number of women consult doctors after childbirth with such symptoms. They are trying to understand the reasons why gas incontinence occurs after childbirth.

There is not just one reason for the phenomenon, it is a whole complex:

Trauma to the anus during labor.
The birth of a large fetus against the background of external and internal ruptures.

Some injuries occur during special medical methods of assisting a woman in labor - the use of surgical equipment.

Gas incontinence after childbirth may have other explanations:

violation of the anatomical structure of the organs responsible for defecation (fistulas, cracks, wounds);
organic damage (diseases of the spinal cord or brain);
birth trauma;
consequences of surgical interventions;
mental disorders (neuroses, depression).

There are also medical pathologies that, with fecal incontinence, often become noticeable after childbirth.

epilepsy;
dementia;
catatonic syndrome.

Your doctor will tell you what to do to eliminate unpleasant symptoms.

The methods were developed by specialists based on the experience of doctors in studying the causes of fecal incontinence.

Operations to introduce a special gel into the canal. This type of therapy is used to strengthen the walls of the anus. The method does not promise a complete cure; relapse may occur.
Fixation of internal organs. Operations are rarely used. Surgeons secure the fluid emission channel, cervix, and bladder. After the intervention, a long recovery period will be required.
Loop method. One of the most frequently performed methods of surgical intervention. To eliminate urinary and fecal incontinence, a support is created from a loop of special medical material.

Treatment after injury to the sphincter region or damage to the pelvic muscle tissue consists of the method of modern technologies - sphincteroplasty. The surgeon stitches torn, stretched muscles. Another way is an artificial organ, which can be controlled by the person himself. The surgical cuff is inflated and deflated. Fecal incontinence after surgery can be hidden by simple measures: clean, changeable clothes, taking medications that reduce the smell of stool accompanied by gases.

Fecal incontinence in the older generation

Treatment for encopresis depends on the age of the patient. Fecal incontinence in the elderly is a common problem.

The main manifestation is observed after a stroke. The patient suffers from pelvic organ disorders.

Because of this, the functioning of internal systems begins to deteriorate:

constipation;
urinary retention;
incomplete exit of feces and urine from the intestines;
gas incontinence;
pain during bowel movements and urine output;
false desire to visit the toilet;
impotence.

Almost every person knows what diarrhea is. Under certain conditions, a single deterioration becomes a frequent illness. Knowing the causes and factors of its development will help you avoid pathology and maintain your usual lifestyle.

Fecal incontinence is a condition that invariably has a severe impact on a person’s life, both in social and moral aspects. In long-term care facilities, the prevalence of fecal incontinence among residents is up to 45%. The prevalence of fecal incontinence is similar among men and women, at 7.7 and 8.9%, respectively. This indicator increases in older age groups. Thus, among people 70 years and older it reaches 15.3%. For social reasons, many patients do not seek medical help, which most likely leads to an underestimation of the prevalence of this disorder.

Of primary care patients, 36% report episodes of fecal incontinence, but only 2.7% have a documented diagnosis. Healthcare system costs for patients with fecal incontinence are 55% higher than for other patients. In monetary terms, this translates into an amount equal to US$11 billion per year. In most patients, proper treatment achieves significant success. Early diagnosis helps prevent complications that adversely affect the quality of life of patients.

Causes of fecal incontinence

Gynecological trauma (childbirth, hysterectomy)
Severe diarrhea
Coprostasis
Congenital anorectal anomalies
Anorectal diseases
Neurological diseases

The passage of feces provides a mechanism with a complex interaction of anatomical structures and elements that provide sensitivity at the level of the anorectal zone and the pelvic floor muscles. The anal sphincter consists of three parts: the internal anal sphincter, the external anal sphincter and the puborectalis muscle. The internal anal sphincter is a smooth muscle element and provides 70-80% of the pressure in the anal canal at rest. This anatomical formation is under the influence of involuntary nervous tonic impulses, which ensures the closure of the anus during the rest period. Due to the voluntary contraction of the striated muscles, the external anal sphincter serves as additional retention of feces. The puborectalis muscle forms a supportive cuff surrounding the rectum, which further strengthens existing physiological barriers. It remains in a contracted state during the rest period and maintains an anorectal angle of 90°. During defecation, this angle becomes obtuse, thereby creating conditions for the passage of feces. The angle is sharpened by voluntary contraction of the muscle. This helps retain the contents of the rectum. Fecal masses gradually filling the rectum lead to stretching of the organ, a reflex decrease in anorectal resting pressure and the formation of a portion of feces with the participation of the sensitive anoderm. If the urge to defecate appears at an inconvenient time for a person, the activity of the smooth muscles of the rectum, controlled by the sympathetic nervous system, occurs with simultaneous voluntary contraction of the external anal sphincter and puborectal muscle. To shift defecation over time, sufficient compliance of the rectum is required, as the contents move back into the expandable rectum, endowed with a reservoir function, until a more suitable moment for defecation.

Fecal incontinence occurs when the mechanisms that maintain fecal retention are disrupted. This situation of fecal incontinence can occur due to loose stools, weakness of the striated pelvic floor muscles or internal anal sphincter, sensory disturbances, changes in colonic transit time, increased stool volume, and/or decreased cognitive function. Fecal incontinence is divided into the following subcategories: passive incontinence, urge incontinence, and fecal leakage.

Classification of functional fecal incontinence

Functional fecal incontinence	Diagnostic criteria: Repeated episodes of uncontrolled stool passing in a person at least 4 years of age with age-appropriate development and one or more of the following: disruption of the functioning of muscles with intact innervation and no damage; minor structural changes in the sphincter and/or disruption of innervation; normal or disorganized bowel movements (stool retention or diarrhea); psychological factors. Excluding all of the following reasons: impaired innervation at the level of the brain or spinal cord, sacral roots or damage at different levels as a manifestation of peripheral or autonomic neuropathy; pathology of the anal sphincter caused by multisystem damage; morphological or neurogenic disorders considered as the main or primary cause of NK
Subcategories	Mechanism
Passive incontinence	Loss of sensitivity in the rectosigmoid region and/or impaired neuroreflex activity at the level of the rectoanal segment. Weakness or rupture of the internal sphincter
Incontinence with urge to stool	Disruption of the external sphincter. Change in rectal capacity
Fecal leakage	Incomplete bowel movement and/or impaired rectal sensation. Sphincter function preserved

Risk factors for fecal incontinence

Elderly age
Female
Pregnancy
Traumatization during childbirth
Perianal surgical trauma
Neurological deficits
Inflammation
Haemorrhoids
Pelvic organ prolapse
Congenital malformations of the anorectal area
Obesity
Condition after bariatric surgery
Limited mobility
Urinary incontinence
Smoking
Chronic obstructive pulmonary disease

Many factors contribute to the development of fecal incontinence. These include loose stool consistency, female gender, old age, and multiple births. The greatest importance is given to diarrhea. Urgency to stool is the main risk factor. With age, the likelihood of fecal incontinence increases, mainly due to weakening of the pelvic floor muscles and decreased anal tone at rest. Childbirth is often accompanied by damage to the sphincters as a result of trauma. Fecal incontinence and surgical delivery or traumatic birth through the birth canal are certainly interrelated, but there is no evidence in the literature of the advantage of cesarean section over non-traumatic natural birth in terms of preserving the pelvic floor and ensuring normal fecal continence.

Obesity is one of the risk factors for NC. Bariatric surgery is considered an effective treatment for advanced obesity, but after surgery, patients often experience fecal incontinence due to changes in stool consistency.

In relatively young women, fecal incontinence is clearly associated with functional bowel disorders, including IBS. The causes of fecal incontinence are numerous, and they sometimes overlap. Sphincter damage may go unnoticed for many years until age-related or hormonal changes, such as muscle atrophy and atrophy of other tissues, disrupt established compensation.

Clinical examination of fecal incontinence

Patients are often embarrassed to admit incontinence and complain only of diarrhea.

In identifying the causes of fecal incontinence and making the correct diagnosis, one cannot do without a detailed history and a targeted rectal examination. The medical history must necessarily reflect an analysis of the drug therapy being carried out at the time of treatment, as well as the characteristics of the patient’s diet: both can affect the consistency and frequency of stool. It is very useful for the patient to keep a diary recording everything related to the stool. These include the number of episodes of urinary incontinence, the nature of incontinence (gas, loose or hard stools), the volume of involuntary passage, the ability to feel the passage of stool, the presence or absence of urgency, straining and sensations associated with constipation.

A comprehensive physical examination includes examining the perineum for excess moisture, irritation, fecal matter, anal asymmetry, fissures, and excessive sphincter relaxation. It is necessary to check the anal reflex (contraction of the external sphincter to a prick in the perineal area) and make sure that the sensitivity of the perineal area is not impaired; note prolapse of the pelvic floor, bulging or prolapse of the rectum when straining, the presence of prolapsed and thrombosed hemorrhoids. Rectal examination is crucial to identify anatomical features. Very severe cutting pain indicates acute damage to the mucous membrane, for example, an acute or chronic fissure, ulceration or inflammatory process. A decrease or sharp increase in anal tone at rest and during straining indicates a pathology of the pelvic floor. During a neurological examination, attention should be paid to the preservation of cognitive functions, muscle strength and gait.

Instrumental studies of fecal incontinence

Endoanal ultrasound is used to assess the integrity of the anal sphincters, and anorectal manometry and electrophysiology may also be used if available.

There is no specific list of studies that should be carried out. The attending physician will have to weigh the negative aspects and benefits of the study, the cost, the overall burden on the patient with the ability to prescribe empirical treatment. The patient's ability to tolerate the procedure, the presence of concomitant diseases, and the level of diagnostic value of what is planned to be done should be taken into account. Diagnostic studies should be aimed at identifying the following conditions:

possible damage to the sphincters;
overflow incontinence;
pelvic floor dysfunction;
accelerated passage through the colon;
significant discrepancy between anamnestic data and the results of a physical examination;
exclusion of other possible causes of NK.

The standard test to check the integrity of the sphincters is endoanal sonography. It shows very high resolution when examining the internal sphincter, but with respect to the external sphincter the results are more modest. MRI of the anal sphincter provides greater spatial resolution and is therefore superior to the ultrasound method, both for the internal and external sphincters.

Anorectal manometry allows one to obtain a quantitative assessment of the function of both sphincters, rectal sensitivity and wall compliance. With fecal incontinence, pressure at rest and during contraction is usually reduced, which allows us to judge the weakness of the internal and external sphincters. In the case where the results obtained are normal, one can think about other mechanisms underlying NK, including loose stools, the appearance of conditions for fecal leakage and sensory disturbances. The rectal balloon test is designed to determine rectal sensitivity and elasticity of the organ walls by assessing sensory-motor responses to an increase in the volume of air or water pumped into the balloon. In patients with fecal incontinence, sensitivity may be normal, weakened or enhanced.

Carrying out a test with expulsion of a balloon from the rectum involves the test subject pushing out a balloon filled with water while sitting on a toilet seat. Expulsion within 60 seconds is considered normal. This test is usually used in a screening examination of patients suffering from chronic constipation to identify pelvic floor dyssynergia.

Standard defecography allows for dynamic visualization of the pelvic floor and detection of rectal prolapse and rectocele. Barium paste is injected into the rectosigmoid colon and then dynamic x-ray anatomy is recorded - the motor activity of the pelvic floor - of the patient at rest and during coughing, contraction of the anal sphincter and straining. The defecography method, however, is not standardized, so each institution performs it differently, and the study is not available everywhere. The only reliable method for visualizing the entire anatomy of the pelvic floor, as well as the anal sphincter area, without exposure to radiation is dynamic pelvic MRI.

Anal electromyography allows us to identify sphincter denervation, myopathic changes, neurogenic disorders and other pathological processes of mixed origin. The integrity of the connections between the endings of the pudendal nerve and the anal sphincter is checked by recording the terminal motor latency of the pudendal nerve. This helps determine whether sphincter weakness is due to damage to the pudendal nerve, a disruption in the integrity of the sphincter, or both. Due to the lack of sufficient experience and lack of information that could prove the high significance of this method for clinical practice, the American Gastroenterological Association opposes the routine determination of terminal motor latency of the pudendal nerve during the examination of patients with NK.

Sometimes stool analysis and determination of intestinal transit time help to understand the reasons underlying diarrhea or constipation. To identify pathological conditions that aggravate the situation with fecal incontinence (inflammatory bowel disease, celiac disease, microscopic colitis), an endoscopic examination is performed. It is always necessary to understand the cause, as this determines treatment tactics and ultimately improves clinical results.

Treatment of fecal incontinence

Often very difficult. Diarrhea is controlled with loperamide, diphenoxylate, or codeine phosphate. Exercises for the pelvic floor muscles, and in the presence of defects of the anal sphincter, improvement can be achieved after sphincter restoration operations.

Initial treatment approaches for all types of fecal incontinence are the same. They involve changes in habits aimed at achieving stool consistency, eliminating defecation disorders and ensuring access to the toilet.

Lifestyle change

Medicines and diet changes

Older people usually take numerous medications. It is known that one of the most common side effects of medications is diarrhea. First of all, you should review what the person is being treated with that can trigger NK, including over-the-counter herbs and vitamins. It is also necessary to determine whether there are components in the patient’s diet that aggravate the symptoms. This includes, in particular, sweeteners, excess fructose, fructans and galactans, and caffeine. A diet rich in dietary fiber may improve stool consistency and reduce the incidence of urticaria.

Container type absorbents and accessories

Not many materials have been developed to absorb feces. Patients tell how they get out of the situation with the help of tampons, pads and diapers - everything that was originally invented to absorb urine and menstrual flow. The use of pads in cases of fecal incontinence is associated with the spread of odor and skin irritation. Anal tampons come in different styles and sizes and are designed to block the leakage of stool before it even happens. They are poorly tolerated, which limits their usefulness.

Toilet accessibility and “gut training”

Fecal incontinence is often a problem for people with limited mobility, especially the elderly and psychiatric patients. Possible measures: visiting the toilet on a schedule; making changes to the interior of the house to make visiting the toilet more convenient, including moving the patient’s sleeping place closer to the toilet; location of the toilet seat directly next to the bed; Place special accessories in such a way that they are always at hand. Physiotherapy and exercise therapy can improve a person's motor function and, due to greater mobility, make it easier for him to access the toilet, but, apparently, the number of episodes of fecal incontinence does not change from this, at least it should be noted that the results of studies on this topic are contradictory .

Differentiated pharmacotherapy depending on the type of fecal incontinence

Fecal incontinence due to diarrhea

At the first stage, the main efforts should be directed to changing the consistency of the stool, since formed stool is much easier to control than liquid stool. Adding dietary fiber to your diet usually helps. Pharmacotherapy aimed at slowing bowel movement or stool binding is usually reserved for patients with refractory symptoms that do not respond to milder measures.

Antidiarrheals for fecal incontinence

Conservative therapy for NK	Possible side effects
Dietary fiber in the form of dietary supplements	Increased gas discharge, bloating, abdominal pain, anorexia. Able to alter drug absorption and reduce the need for insulin
Loperamide	Paralytic ileus, rashes, weakness, cramps, constipation, nausea and vomiting. May increase the tone of the anal sphincter at rest. Cautious use in active inflammatory processes in the colon, as well as in infectious diarrhea
Diphenoxylate-atropine	Toxic megacolon, central nervous system effects. The anticholinergic effect of atropine may occur. Cautious use in active inflammatory processes in the colon, as well as in infectious diarrhea
Colesevelam hydrochloride	Constipation, nausea, nasopharyngitis, pancreatitis. Use cautiously if there is a history of colonic obstructive obstruction. May alter drug absorption
Cholestyramine	Increased gas formation and discharge of gases, nausea, dyspepsia, abdominal pain, anorexia, sour taste in the mouth, headache, rashes, hematuria, feeling of fatigue, bleeding gums, weight loss. May alter drug absorption
Colestipol	Gastrointestinal bleeding, abdominal pain, bloating, increased passage of gas, dyspepsia, liver dysfunction, skeletal muscle pain, rashes, headache, anorexia, dry skin. May alter drug absorption
Clonidine	Recoil syndrome in the form of arterial hypertension, dry mouth, sedation, manifestations from the central nervous system, constipation, headache, rash, nausea, anorexia. If there is no effect, the drug should be discontinued slowly
Laudanum	Sedation, nausea, dry mouth, anorexia, urinary retention, weakness, hot flashes, itching, headache, rash, central nervous system reaction in the form of depression, arterial hypotension, bradycardia, respiratory depression, development of addiction, euphoria
Alosetron	Constipation, severe ischemic colitis. The drug must be discontinued if there is no effect at a dose of 1 mg 2 times a day for 4 weeks

Patients with IBS-D deserve special attention, since their use of dietary fiber can increase abdominal pain and bloating, which makes them refuse this measure. If there is no improvement, they switch to pharmacotherapy that is more effective for this group of patients, including loperamide, TCAs, probiotics and alosetron.

Fecal incontinence due to constipation

Chronic constipation can lead to distension of the rectum as a result of a persistent tendency towards overcrowding and suppression of sensitivity. Both create conditions for overflow incontinence. This type of incontinence is especially common among older people. In case of overflow incontinence, it is advisable to increase the amount of dietary fiber in the diet as an initial measure, and only then, if necessary, can laxatives be prescribed.

Fecal leakage

Leakage is not the same as NDT. In this case, they mean the passage of a small amount of liquid or soft feces after normal bowel movements. The patient may talk about wetting in the perianal area, changes in the frequency of bowel movements, or symptoms more characteristic of dysfunction of the anal sphincters, which, upon an objective examination of the anorectal area, is not always regarded by the doctor as a violation of physiological functions. Leakage is more common in men with preserved anal sphincter function. It can be explained by hemorrhoids, poor hygiene, anal fistula, rectal prolapse, hypo- or hypersensitivity of the rectum. In patients suffering from leakage, proper diagnosis and treatment of the specific pathology can completely eliminate symptoms. If manifestations still remain, it is recommended to empty the rectal ampulla using an enema or suppositories every day, regardless of the urge to defecate. For enemas, it is better to use plain water, since repeated administration of sodium phosphate or glycerin can damage the mucous membrane and lead to rectal bleeding. The desired time for a regular procedure is the first 30 minutes after eating in order to enhance the normal reflexes characteristic of the colon after eating.

Rectally injectable blocking agents

Several means have been proposed to block the anal sphincter with the formation of an obstacle to the involuntary passage of feces. Among them are silicone, carbon-coated beads and, the newest, dextranomer in hyaluronic acid [(Solesta) Solesta]. A 2010 Cochrane systematic review found that, due to the small number of trials conducted, no clear conclusion could be reached regarding the effectiveness of injectables. Nevertheless, this approach remains the subject of close attention as it is promising and promises the emergence of new drugs that are truly capable of eliminating NK. Side effects include pain, bleeding and, rarely, abscess formation.

Non-pharmacological treatment options

Biofeedback method

The biofeedback method is one of the forms of psychotherapy based on the principle of reinforcement, in which information about a physiological process, which in a normal situation is transmitted at a subconscious level, is visually demonstrated to the patient so that he can influence the process, but already controlling it with his own by will. The essence of what is happening is to monitor the work of the striated muscles of the pelvic floor, so that the patient, taking this into account, voluntarily coordinates the performance of special exercises for strength training. Simultaneously with the development of strength, the ability to separate sensitive signals can be trained. According to the opinion of the majority of specialists dealing with this problem, this method of treatment is suitable for patients with mild to moderate manifestations of the disease, who meet the physiological criteria for dysfunction of the anal sphincters, who are ready for cooperation in work, are well motivated, and are able to put up with a certain severity of the feeling of rectal distension, retaining the ability to voluntarily compress the external sphincter.

Sacral nerve stimulation

Initially invented for the rehabilitation of patients with paraplegia, stimulation of the sacral nerves, instead of its main purpose, as it turned out later, promotes defecation. Later, promising results were obtained with NK. The first reports on this subject indicated the success of this technique in a large percentage of cases, which made sacral nerve stimulation a popular intervention and prompted the rapid development of the method.

Currently, publications have begun to appear on the results of long-term follow-up of patients, but they are much less optimistic and describe a smaller percentage of success. Among elderly patients, the number of postoperative complications reaches 30%. Complications include pain at the implant site, inflammation in the subcutaneous pocket, electrical sensation, and rarely battery displacement or failure, requiring repeat surgery.

Surgery

Surgical treatment is indicated when the cause of fecal incontinence is anatomical changes. Most often, sphincteroplasty is used to restore the sphincter by stitching the defect together with an overlap. After surgery, the edges of the wound often diverge, which significantly prolongs the healing time. Up to 60% of patients report improvement, but the long-term results of lap sphincteroplasty are poor. For patients with an extensive anatomical defect of the sphincter, for whom simple sphincteroplasty is unacceptable, graciloplasty and transposition of the gluteus maximus muscle have been developed. When performing graciloplasty, the gracilis muscle is mobilized, the distal tendon is split in half, and the muscle is enclosed around the anal canal. With dynamic graciloplasty, electrodes are applied to the muscle and connected to a neurostimulator, which is sutured into the abdominal wall, its lower part. Complications include inflammation, problems with stool passage, leg pain, intestinal damage, perineal pain and the formation of anal strictures.

If other options for surgical treatment have been exhausted, the option remains with implantation of an artificial anus. The artificial sphincter is passed around the natural sphincter through the perianal tunnel. The device remains inflated until it is time to defecate. During defecation, the artificial sphincter is deactivated (deflated). In general, a positive effect from the intervention is observed in approximately 47-53% of patients, that is, in those who tolerate the artificial sphincter well. The majority require surgical revision, and in 33% of cases, removal. Complications include inflammatory processes, destruction of the device or its malfunction, chronic pain syndrome and obstruction during the passage of feces. Colostomy or permanent stoma for fecal incontinence is considered an option for patients who have failed or where all other methods have been completely insufficient.

Key aspects of patient management

Fecal incontinence is actually a disabling disorder that dramatically reduces a person's quality of life.
For the development of diagnostic and therapeutic tactics, the collection of anamnesis with a detailed elucidation of how the pathology of defecation was formed, and an anorectal examination are crucial.
Treatment of all types of fecal incontinence begins with analysis and lifestyle correction. The goal is to outline measures aimed at improving stool consistency, coordinating bowel dysfunction, and ensuring toilet accessibility.
Intrarectal occlusive agents and sacral nerve stimulation have been shown to reduce the number of incontinence episodes.
Surgical interventions should be reserved for those rare cases that do not respond to conservative treatment methods, in particular for patients with obvious anatomical defects.

In a physiological state, a person can control the process of evacuation of feces from the large intestine. He senses the urge to have a bowel movement and can regulate the timing of this process. Without conscious control, the sphincter opens any time there is excess pressure in the rectal cavity.

The normal act of defecation occurs when the exit sphincter relaxes and the muscles of the rectum tense. Thus, with jerky movements, feces are expelled and bowel movements occur.

Very often, when describing their symptoms, patients confuse encopresis (fecal incontinence) with diarrhea. It is necessary to understand the significant difference between these two concepts. With diarrhea, frequent bowel movements occur with unformed stool of a liquid consistency. With true diarrhea, bowel movements occur more than 3 times in 24 hours and the total volume of the mass exceeds 300 ml. With diarrhea, the sick person has complete control over the bowel movement process. With fecal incontinence, a person is unable to control himself even for a few minutes and may not even feel the act of defecation.

Signs and symptoms of fecal incontinence

Usually, the first signs of fecal incontinence are carefully hidden and passed off as temporary difficulties with bowel function. Unfortunately, it is this initial stage of the disease that can give hope for complete healing if treatment is started in a timely manner. In advanced cases, encopresis is quite difficult to correct, especially for children and the elderly.

Often the first symptoms of encopresis are masked by flatulence and intestinal disturbances. Feces can pass freely when intestinal gases pass. As the disease progresses, the volume of feces increases and gradually reaches a complete uncontrolled process of bowel movement. This is usually accompanied by associated symptoms of fecal incontinence such as:

loose stools;
constant ;
the formation of large amounts of intestinal gas and flatulence;
constant unpleasant odor from the anal area;
voluntary passage of intestinal gases.

All these symptoms are a consequence of fecal incontinence. Other signs and symptoms may be related to the cause of encopresis.

Socialization and psychological problems in persons suffering from encopresis

Fecal incontinence always becomes a personal drama and psychological problem for those who suffer from it to one degree or another. This leads to constant contamination of underwear and the appearance of a persistent unpleasant odor of feces. In old age, with the development of dementia (senile dementia), involuntary acts of defecation are not perceived by a person. He is not fully responsible for his actions, and is unable to take care of his personal hygiene. This becomes an acute problem for family members living nearby. In old age, this phenomenon may be associated with diseases of the intestines and external genitalia.

In childhood, fecal incontinence in a child under 4 years of age cannot be considered a manifestation of encopresis. But at the same time, it is important to monitor the baby’s regular bowel movements and accustom him to timely bowel movements in the right places. Young children often avoid this procedure for a long time, restraining the evacuation of feces. As a result of this, excessive overstretching of the rectum occurs, which can subsequently cause the development of encopresis. In the future, the child’s fecal incontinence may be associated with psychological factors, which will be quite difficult to eliminate without the professional help of a psychologist.

Causes of fecal incontinence

All causes of fecal incontinence in children and adults can be divided into several fairly broad groups:

intestinal dysfunction;
pathology of the anus;
obstetrics and gynecology;
neurology.

Let's try to deal with each group separately.

Changes in the nature of stool

In most cases, fecal incontinence is closely associated with diarrhea and chronic constipation. They are two of the most common causes of fecal incontinence. With frequent, profuse, loose stools with severe tenesmus, a person is unable to endure it for long. This is observed in severe forms of enteritis. Spontaneous bowel movements can occur during vomiting or a strong gag reflex. During constipation, excessive stretching of the muscular wall of the large intestine occurs, which ultimately leads to spontaneous bowel movements.

Rectal pathologies

A number of anorectal diseases ultimately lead to partial or complete encopresis. The leader among such diseases is, in which pain in the anus mutes the sensations from the passage of feces. Similar symptoms can occur with Crohn's disease and rectal prolapse. In the vast majority of cases, such fecal incontinence can be regulated by force of will on the part of the sick person. The situation is more complicated with irritable rectal syndrome, in which any delay in defecation is accompanied by severe pain.

Obstetric reasons

Damage to the pelvic floor muscles and associated nerves during or after childbirth can affect the degree of bowel control. Typically, these phenomena are temporary and completely disappear on their own after the female body recovers.

Neurological causes

Neurological causes of fecal incontinence include both damage to the roots of the nerve endings responsible for the control function and disturbances in the activity of the central nervous system.

Some of these reasons may be expressed in diseases such as:

diabetic neuropathy – damage to nerve endings due to long-term uncompensated diabetes mellitus;
dementia;
multiple sclerosis;
any damage to the spinal cord, especially in the lower part of the spinal cord (coccyx);
anorectal surgery, such as for excision of hemorrhoids.

Treatment of fecal incontinence in children and adults

For successful treatment of ectopresis in children and adults, timely elimination of the causes of this unpleasant phenomenon is necessary. Only treatment of the underlying disease, which formed the basis for the development of fecal incontinence, can help to completely get rid of it.

Each disease has symptoms, based on which and on the basis of laboratory tests it is possible to establish an accurate diagnosis. The degree of regression or severity of symptoms can be used to judge the effectiveness of treatment methods and predict recovery. Urinary and fecal incontinence are considered one of the most unpleasant symptoms that sharply worsen the patient’s quality of life and jeopardize the social perception of others.

In the vast majority of cases, fecal incontinence is not an independent disease, but only a manifestation of an existing pathology. In this case, the doctor needs to find out the cause of the disease and select the optimal treatment in order to save the patient from moral and physical suffering as soon as possible. This symptom, of course, does not threaten the patient’s life, but it creates a lot of problems both for himself and for the people around him.

In medicine, fecal incontinence is called encopresis or incontinence. It occurs when the patient, for some reason, ceases to control the act of defecation, and quite often there is parallel incontinence of urine and feces. This is due to the fact that both processes are regulated by nerve centers that are similar in nature. However, according to statistics, fecal incontinence is 15 times more common than uncontrolled urination and often affects men.

There may be several reasons for the appearance of these symptoms: the absence of mechanisms that contribute to the appearance of the defecation reflex, the delayed formation of this reflex, or its loss due to provoking factors. That is, fecal incontinence can be either primary, that is, congenital, or secondary, resulting from damage to the brain or spinal cord, mental state disorders, pathologies of the excretory system, or trauma.

Most often, doctors are faced with fecal incontinence of psychogenic origin, that is, this symptom is caused by hysterical and neurotic psychoses, pathocharacterological disorders such as dementia or mental illnesses - schizophrenia and epilepsy. Much less often, incontinence occurs due to diseases of the digestive tract (anal injuries, rectal prolapse) or other diseases (decreased tone of the perineal muscles, severe forms, tumors of the anus and birth injuries of the pelvis).

Diagnosing fecal incontinence is not at all difficult, because specific patient complaints allow a diagnosis to be made in 100% of cases, but to determine the causes of the symptom, doctors take tests and conduct studies that allow them to prescribe the necessary therapy.

Treatment of fecal incontinence with parallel urinary incontinence largely depends on identifying the causes of the disease, the age and condition of the patient. Quite often, doctors recommend surgical intervention for such patients, which falls into the category of plastic surgery and has been used in practice for quite a long time. This solution to the problem is resorted to when the cause of incontinence is a sphincter defect.

However, in cases where the sphincter muscles are not damaged and incontinence is not associated with mechanical disorders, it is much more difficult to cope with the disease. Most often, doctors resort to non-surgical methods: drug and non-drug therapy. Treatment with drugs is aimed at eliminating the underlying disease, as well as increasing the tone of the anal sphincter muscles. Among non-drug methods, biofeedback, psychotherapeutic methods, acupuncture and dietary measures have become widespread. Take care of your health!

Parents of children 4-10 years old sometimes encounter the phenomenon of fecal incontinence (encopresis). Leakage of feces into underwear after a child has mastered the skill of using the toilet is observed in 1.5% of children, often accompanied by enuresis (urinary incontinence). Disorders of the rectal sphincter are more often detected in boys, which still has no explanation.

Some children suffer from fecal incontinence even after they have mastered the potty.

What should be considered normal and what should be considered pathology?

Involuntary defecation is typical for newborn babies, whose body is not yet able to control the functioning of the digestive organs. However, by the age of 3, the cycle of conditioned reflexes is established, children are already able to recognize body signals and sit on the potty on time.

The urge to go to the toilet arises as a result of a complex of reactions. Feces accumulate in the rectum and put pressure on the sphincter. With a strong impact, the impulse travels to the brain, from where the command is returned through the spinal canal to empty the intestines or retain feces (based on the situation). Their conscious evacuation involves the muscles of the peritoneum, rectum and nervous system.

Encopresis occurs in children aged 4-6 years when a malfunction occurs in one of the sections of the physiological chain. Sometimes it is secondary (the child has learned to go to the toilet as expected, but under the influence of certain reasons, stool smearing occurs).

There are known cases of incontinence in adolescents, young adults and the older generation. Each of them requires its own approach and correction.

Age characteristics

Depending on age and dietary habits, the frequency of bowel movements in children varies. What is accepted as normal in some cases, in others indicates a problem:

Up to 6 months, it is considered normal for an infant to stool up to 6 times a day. More frequent urges indicate diarrhea; there is no talk of incontinence - the baby does not control the sphincter.

Up to 6 months, the child has no control over the bowel movement at all.

From six months to one year, the child’s muscles become stronger, and the intestines empty their bowels 2 times a day. Children do not understand the importance of hygiene and may continue to dirty their laundry.
The sphincter muscles of a 1.5-4 year old child have already become stronger, he is able to control the process of defecation and ask to go to the potty on time. The exception is stress and psychological trauma, as a result of which the baby forgets about it.
Between the ages of 4 and 8, fecal incontinence in children is far from normal. It indicates psychological or physical disorders. It is important to undergo an examination, identify and eliminate the cause.

Causes of encopresis

Experts identify two causes of encopresis in children: psychological and physiological. For some people it does not go away as they get older (major disorder). Others develop an indirect disorder due to circumstances that caused severe stress (entry to school, parental divorce, deterioration of social and living conditions, etc.). The causes of indirect violations are:

excessive demands on the baby;
forced potty training;
fear of the potty or toilet;
lack of affection in the family;
inability to express emotions;
inability to visit the toilet on time (in the garden, school, other place);
reluctance to attend kindergarten or school;
unfavorable home situation, other factors.

Forced potty training leads to psychological trauma and sometimes encopresis

What often precedes encopresis?

The onset of encopresis is often preceded by constipation. The baby may be embarrassed to go to the toilet in an unusual environment (long trip, hike, strangers in the house) or the process of defecation causes him pain. He often suppresses the urge, which eventually causes a reflex. As feces accumulate, they become denser and stretch the walls of the rectum. Reflexes are suppressed, and at an unexpected moment spontaneous excretion of feces occurs.

Stagnation of feces in the intestines can lead to poisoning of the body - “false diarrhea”. In the second case, active fermentation begins in the upper parts of the intestine, and a liquid with a fetid odor descends to the sphincter, washing the compacted feces, and leaks out. Sometimes encopresis is a consequence of “bear disease” (irritable bowel syndrome), which arises as a result of unresolved problems and fears.

The opinion of psychologists about encopresis

While communicating with a child, a good psychologist can quickly identify the cause of the problem. Usually, these are difficult relationships with peers, quarrels and family troubles, because of which the child is in constant tension. It has been noted that encopresis most often affects boys and girls whose parents do not pay them due attention, are addicted to alcohol, and use harsh parenting methods.

A qualified psychologist will help you identify the cause of your child’s problem.

The problem does not bypass hyperactive children, prosperous families, where parents strive to create better conditions for their children (we recommend reading:). It is not always possible to select effective therapy and cure the causes of fecal incontinence in a short time. Much depends on the elders’ perception of this problem and their willingness to meet the child’s problems halfway.

Symptoms

Encopresis in children usually develops slowly, and parents do not always sound the alarm in time. An important “bell” is the remains of feces on your underwear; it cannot be ignored. If the situation repeats, you should observe the child, his behavior and well-being.

Typically, children suffering from neurotic encopresis experience irritability, poor appetite and mood. You should show your baby to a doctor if fecal residue appears regularly on the underwear.

The main symptoms of true encopresis

Depending on the causes of encopresis (physiological or psychological disturbance of bowel movement), symptoms also vary. True encopresis (main disorder) is usually accompanied by:

anointing;
enuresis (we recommend reading:);
behavior outside the generally accepted norms;
half-open sphincter (examined by a doctor);
a stench that cannot be hidden from the environment.

It is difficult not to notice the disease, as the child’s things and body begin to smell bad

Symptoms of false encopresis

False encopresis in children (indirect violation) is confirmed by the following symptoms:

alternating constipation and foul-smelling diarrhea;
cracks and redness near the anus;
child's isolation;
hard abdomen when examined by a doctor (palpation);
pain in the navel area;
chronic accumulation of feces in the large intestine.

Fecal incontinence in a child is often accompanied by a tense family situation. Parents should not isolate the child from other family members, ignore the problem, scold him for dirty things, or allow him to be ridiculed. This will lead to a deterioration in academic performance, an internal protest of the child, who will ignore school and home responsibilities, become withdrawn and gloomy.

The problem of fecal incontinence in children should not be left to chance, believing that it can be “outgrown”, you should not. The child grows up and needs to adapt to society. Timely medical assistance will allow you to find out what means can be used to treat incontinence and how to cope with stool.

A doctor will help you cope with true and false encopresis

Diagnostic methods

First of all, the doctor differentiates between true and false encopresis. All causes leading to constipation are examined, worms are excluded, and additional tests are prescribed (blood, feces, urine, ultrasound of the abdominal cavity, colonoscopy) to identify congenital pathologies. When a delicate problem cannot be solved for a long time, a biopsy of the rectal wall and motility analysis are performed.

Treatment options

If a child is suspected of having fecal incontinence, they should initially contact a pediatrician. The doctor may order tests, prescribe laxatives (for example, Duphalac) and enemas, which will cleanse the intestines and return the rectum to its original size (see also:). After examination and initial prescriptions, the pediatrician refers the child for consultation with a neurologist and gastroenterologist.

If the problem affects a schoolchild, it is important to find a doctor who specializes in the treatment of encopresis and is ready to work with the child and his relatives. Treatment will be based on the following components:

prevention of stool retention;
establishing a regular bowel movement regime;
restoration of control over bowel function;
reduction of the tense psychological atmosphere in the family caused by encopresis.

If a problem affects a student, it is very important to eliminate not only the cause, but also the psychological consequences

Working with a psychologist

The first stage of treatment necessarily includes consultations with a psychologist, during which a specialist will figure out why encopresis occurred. He will help the child overcome the fear of the disease, reduce nervous tension, and work separately with the parents. Sometimes the help of a good specialist is enough to overcome the problem. By listening to the advice of a psychologist and creating a friendly, trusting atmosphere in the family, parents will help their child cope with a delicate problem.

Diet

Proper nutrition will help avoid the accumulation of feces in the intestines. The emphasis is on easily digestible foods rich in fiber. A child's diet requires cabbage, low-fat soups, salads with sour cream from beets and carrots, dried fruits (prunes, dried apricots), fermented milk products, fruits and berries.

It is advisable to limit the consumption of honey, lard, fatty foods, and baked goods. As encopresis progresses, dysbiosis develops, so doctors often prescribe medications to restore the intestinal microflora. Among them are the drugs “Linex” (Sandoz d.d, Lek), “Hilak Forte” (Ratiopharm) and others.

In the process of establishing the functioning of the gastrointestinal tract, a review of the child’s diet may be necessary.

Traditional medicine in solving the problem of encopresis

When treating fecal incontinence, gentle traditional methods are usually used. They are aimed at eliminating psychological discomfort, reducing the child’s aggressiveness and anxiety. Among the safe and effective methods that are used after consultation with a gastroenterologist and pediatrician:

taken before meals 100 ml. fresh apple or apricot juice;
evening herbal baths with valerian root, calendula, chamomile, sage, pine extracts;
warm mint tea before bed to calm and prevent insomnia.

The Importance of Exercise

Physical activity helps fight constipation. In addition to walks and games in the fresh air, physical therapy is recommended for children with encopresis. Exercises to strengthen the muscles of the abdominal wall, anal sphincter and pelvic floor help combat physiological incontinence. Time is devoted to breathing exercises and gentle gymnastics. However, jumping, skipping, and power loads are excluded.

If the sphincter is not completely closed, special muscle training may be prescribed. A rubber tube (lubricated with Vaseline) 3 cm is inserted into the anal canal. The child, on command, compresses and unclenches the anal muscles for 1-15 minutes. Exercises are done daily for a month.

Walking in the fresh air improves the body's metabolism

Note to parents

There are 4 stages in the treatment of encopresis: conversations with the child and his parents (education, joint overcoming of misconceptions on this issue), facilitating the passage of stool, therapeutic support and diet, slow withdrawal of laxatives after bowel movements are established. Reconfiguring the intestines takes time and is sometimes accompanied by relapses, so at the last stage of treatment, the support of specialists is important.

Dr. Komarovsky notes a number of limitations in the drug treatment of encopresis in children under 7. Most drugs to combat constipation are designed for older people, and those that can be taken are not always effective. Often, only non-conservative treatment is recommended for children under 7 years of age (physical exercise, diet, relaxing baths, formation of a bowel movement reflex before bedtime).

Surgical intervention is used in children over 7 years of age if the muscles and nerve endings of the anus are atrophied (necessarily confirmed by medical research). In this case, other treatment methods should be tried. In other cases, success can be achieved by correcting bowel function and creating a positive atmosphere in the home.

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We also had such a period. My daughter’s incontinence arose on psychological grounds - a divorce from her father, moving to her stepfather in another city. We overcame it thanks to diet and the help of a psychologist. It is important not to let things take their course, do not be shy to talk to your child about a sensitive topic, and listen to the doctor’s recommendations.

At two and a half years old, my son developed encopresis. A psychiatrist, then a gastoenterologist, a neurologist, were in hospitals. At the age of 10 we went to Moscow for treatment. One consultation with a pediatrician, one with a gastroenterologist. The examination took place at home. Only one sphinctrometry test was performed in Moscow, the same doctor referred me for physiotherapy. After 10 procedures we completely forgot about this problem. In their city they were treated for 7 years, but in Moscow everything was resolved in two months.

1. Good afternoon, Anastasia. Based on your complaints, we can assume that your child has encopresis (fecal incontinence). This disease can be of physiological or psychological origin. If your physiology is abnormal, you should consult a surgeon, gastroenterologist or nutritionist. If doctors do not identify a physiological disorder, then you should contact a psychologist for an in-person consultation.

My daughter is 6 years old, in September she started staining her panties with feces and she worries about it, because this happens often during the day and at night, what is the correct way and what is needed to quickly solve this problem?

Ekaterina, good afternoon. This situation may arise due to problems in the gastrointestinal tract. A face-to-face consultation with a gastroenterologist and examination of the girl is recommended. Be healthy!

Hello, our child is 5 years old, we have a problem - urinary incontinence, now we have started to notice that there is also fecal incontinence, he does not feel like he wants to go to the toilet. Help me, what examinations to undergo, the neurologist and pediatrician don’t care, there’s no way to go for a fee, I give up.

If the child has not been fully potty trained, then the problem is primary; it is worth putting the child out more often and praising him every time he successfully goes to the toilet/potty. In cases where urinary and fecal incontinence have recently appeared, the situation is most likely associated with neurological disorders. You need to contact a good neurologist for examination and treatment.
1. If a child is afraid of the toilet, it means there was a situation that scared him. Perhaps this is the reason for not wanting to sit on the toilet. Try to praise your child when he does his job in the potty, encourage him, for example, with a toy. Children develop a sense of neatness at different ages, some later, some earlier.

Good evening, my son is 10 years old, at home I have never noticed fecal incontinence, but in the village my grandmother notices it very often, when they asked him why this was happening to him, he replied that he did not feel when he wanted to go to the toilet, the child is hearing impaired, We wear our devices to a regular school. Where should you go first? Reading the previous comments, I can assume that it’s a pediatrician?

The main cause of encopresis may be chronic constipation, but it may also be associated with a psychological aspect. Perhaps the change of environment and living in another place had such an impact on the child. We need the help of a pediatrician, pediatric surgeon, gastroenterologist.

Hello! My grandson (3.7 g) has stools 6-7 times a day. He has stool every 2-3 days. At 2 years old I had severe constipation. Now no, the stool is very thick for its age. My breath smells strong even though I brush my teeth. Sometimes it happens that he shrinks so as not to release the keku, and sometimes it seems that he does not feel that they are coming at all. While eating, he says that his tummy hurts and will lie down, after 1-2 minutes he jumps and runs again, he himself is very active. He has no other complaints.

The cause of encopresis in children in most cases is constipation. If you still have complaints of abdominal pain, then a consultation with a gastroenterologist is necessary.

Hello. A problem has arisen - a boy of almost 8 years old, his panties are not always stained with a round spot. Mostly during walks and at home, I never noticed it at school. I started asking when this happens, he said that I just want to fart and it turns out like this. How can I help him? We live in a small town and don’t have any psychiatrists.

You need to be examined by a gastroenterologist; often a similar problem occurs with diseases of the gastrointestinal tract, if the child has constipation. You need to normalize your diet, consume more fluid, and, if necessary, undergo a course of treatment prescribed by a specialist.
My 11 year old son has encopresis. It doesn't happen every day. We saw a psychologist, he says he is healthy. I do not know what to do. Please tell me where to start?
A 4-year-old child, a girl, secretes a small amount of mushy or liquid feces into her panties several times a day. Once a day, the intestines are emptied normally, although the masses seem large and dense. There is diarrhea, abdominal pain, and sometimes the stomach is distended. How to solve a problem. Is it constipation? Or maybe lactose intolerance. The child often eats ice cream, but never drinks milk and does not like dairy products. Breastfeeding was until 3 years.
My boy, 3 years 6 months old, fell ill with PNEUMONIA in January of this year; he was given antibiotics in tablets for 8 days and injected with antibiotics for 8 days. I gave Hilak Forte together. Two weeks later they found panties stained with feces, and now this happens every day, 2-3 times, the child still cannot explain why this happens. Feces with a very pungent strong odor. What to do?