[Classification of enuresis/encopresis according to DSM-5]. / Klassifikation der Enuresis/ Enkopresis im DSM-5.

Elimination disorders are common in childhood and adolescence. Enuresis is traditionally defined as wetting from the age of 5 years and encopresis as soiling from 4 years onwards - after all organic causes have been excluded. In the past decades, many subtypes of elimination disorders have been identified with different symptoms, etiologies, and specific treatment options. Unfortunately, the DSM-5 criteria did not integrate these new approaches. In contrast, classification systems of the International Children's Incontinence Society (ICCS) for enuresis and urinary incontinence as well as the ROME-III criteria for fecal incontinence offer new and relevant suggestions for both clinical and research purposes.

Encopresis: long-term clinical outcome of 67 cases.

In this study we attempted to investigate the outcome of encopresis and to determine factors affecting prognosis. The sample consisted of 52 boys (77.6%) and 15 girls (22.4%) diagnosed as encopresis according to DSM IV diagnostic criteria. These patients were evaluated six years after their initial examination in the Department of Child Psychiatry. Clinical and demographical data were compared between initial and follow-up interviews and between patients with complete recovery and others. Fifty-six patients (83.6%) recovered completely and 11 (16.4%) continued to be encopretic after six years. Good school performance (p<0.005), high levels of parental education (p<0.005) and absence of constipation (p<0.05) were associated with favorable outcome. In addition, secondary encopretics who were diagnosed within a year from onset of the symptom recovered significantly earlier (p<0.001). Encopresis is a chronic disorder and complete recovery rates tend to increase with time. Families and primary health care providers should be informed about the treatment possibilities of encopresis for early intervention.

Functional fecal retention with encopresis in childhood.

OBJECTIVES: The most common cause of encopresis in children is functional fecal retention (FFR). An international working team suggested that FFR be defined by the following criteria: a history of >12 weeks of passage of <2 large-diameter bowel movements (BMs) per week, retentive posturing, and accompanying symptoms, such as fecal soiling. These criteria are usually referred to as the ROME II criteria. The aims of this study were to evaluate how well the ROME II criteria identify children with encopresis; to compare these patients to those identified as having FFR by historical symptoms or physical examination; to determine whether 1-year treatment outcome varied depending on which definition for FFR was used; and to suggest improvements to the ROME II criteria, if necessary. METHODS: Data were reviewed from the history and physical examination of 213 children with encopresis. One-year outcomes identified were failure, successful treatment, or full recovery. RESULTS: Only 88 (41%) of the patients with encopresis fit the ROME II criteria for FFR, whereas 181 (85%) had symptoms of FFR by history or physical examination. Thirty-two (15%) patients did not fit criteria for FFR, but only 6 (3%) appeared to have nonretentive fecal soiling. Rates of successful treatment (50%) and recovery (39%) were not significantly different in the two groups. CONCLUSIONS: The ROME II criteria for FFR are too restrictive and do not identify many children with encopresis who have symptoms of FFR. The author suggests that the ROME II criteria for FFR could be improved by including the following additional items: a history of BMs that obstruct the toilet, a history of chronic abdominal pain relieved by enemas or laxatives, and the presence of an abdominal fecal mass or rectal fecal mass.

Conduct disorder, enuresis and specific developmental delays in two types of encopresis: a case-note study of 63 boys.

Encopresis, defined as the passage of stool in an unacceptable place, may occur either as a failure to establish toilet training (primary encopresis), or as a subsequent breakdown in that training (secondary encopresis). A case-note study of sixty-three encopretic boys was undertaken to test the hypothesis that primary and secondary encopresis differed in their associated psychopathology. Boys with primary encopresis were more likely to have developmental delays (p<0.001) and enuresis (p<0.05) than boys with secondary encopresis. Those with secondary encopresis had excesses of psychosocial adversity (p <0.001) and conduct disorder (p <0.05) compared to those with primary encopresis. These results suggest that future research should clearly distinguish these two subtypes when investigating the associated psychopathology of encopresis in boys; research is needed to establish if these associations hold for girls also.

[Enuresis and encopresis: their relationship]. / Enuresis y encopresis: relaciones.

The incidence and types of enuresis in 113 encopretic children were studied. The sex ratio was 5.17 males to every 1 female. Half of the patients were enuretics (50.44%). Of these, 78.9% were primary and secondary enuretics. No primary encopretic manifested secondary enuresis. The ratio of primary to secondary enuresis (3.75:1) in children with encopresis was much lower than in the population of enuretics. Of the enuretic encopretics, 40.34% had mixed or diurnal bladder incontinence. The results emphasize the role of peripheral dysfunctions and constipation-encopresis in the etiology of some enuresis. The therapeutic implications of these findings are also discussed.

Children with encopresis: A descriptive analysis.

During an 18-month period, 102 children with encopresis were seen in a general pediatric outpatient clinic. Through interviews and questionnaires, extensive historical information was obtained. Children were compared with respect to demographic characteristics, bowel-function histories, early training and management, and present manifestations of bowel dysfunction. A wide variety of historical backgrounds and manifestations was observed. It was found that many of the traditional generalizations about encopresis could not be substantiated. It is suggested that a very individualized approach to this problem be adopted and that children with encopresis be investigated carefully to uncover early developmental problems, critical life events, and the precise physiology and dynamics of present bowel dysfunction.