Fecal Soiling (Encopresis): Pathophysiology and Clinical Approach

Pathophysiology and Diagnosis

In constipation-related encopresis, chronic constipation leads to rectal distension, impacted stool in the rectum causes stretching of the internal anal sphincter, and watery stool from higher in the bowel may leak around the impaction (overflow), with decreased rectal sensation over time contributing to the problem, as noted by the Annals of Oncology 1
Digital rectal examination may reveal a full rectum or fecal impaction, as reported by the Annals of Oncology 1
Observation of the perianal area for evidence of fecal soiling is an important diagnostic step, according to Gastroenterology 2

Initial disimpaction if fecal impaction is present (digital fragmentation and extraction of stool) is a recommended treatment approach for constipation-related encopresis, as stated by the Annals of Oncology 1
Maintenance bowel regimen to prevent recurrence, including the use of osmotic laxatives (polyethylene glycol, lactulose) or stimulant laxatives (senna, bisacodyl), is a treatment approach for constipation-related encopresis, as noted by the Annals of Oncology 1
Suppositories and enemas may be used when digital rectal examination identifies a full rectum, as reported by the Annals of Oncology 1