ENCOPRESIS

Constipation is defined by two or more of the following events for 2 months:

• fewer than three bowel movements per week,
• more than one episode of encopresis per week,
• impaction of the rectum with stool,
• passage of stool so large that it obstructs the toilet,
• retentive posturing and fecal withholding, and
• pain with defecation.

Encopresis is the repeated passage of stool into inappropriate places (such as in the underpants) by child who is chronologically or developmentally older than 4 years. It occurs each month for at least 3 months and is not attributable to the physiologic effects of a substance or another medical condition except to the mechanism involving constipation.

Behavioral scientists often divide encopresis into (1) retentive encopresis, (2) continuous encopresis, and (3) discontinuous encopresis.

It is critical to note that more than 90% of the cases of encopresis result from constipation. Thus, in the evaluation of a child with encopresis, one must rule out underlying pathology associated with constipation while at the same time addressing functional and behavioral issues.

Conditions associated with constipation include metabolic disorders such as hypothyroidism, neurologic disorders such as cerebral palsy or tethered cord, and anatomical abnormalities of the anus. In addition, children who have been continent can also develop encopresis as a response to stress or child maltreatment.

PREVELANCE:  The prevalence of encopresis is somewhat difficult to precisely ascertain as it is a subject often kept secret by the family and the child. However, some authors report that 1 %-3% of children ages 4-11 years of age suffer from encopresis. The highest prevalence is between 5 and 6 years of age.

DIAGNOSIS: A complete history and meticulous physical examination must be performed, including a rectal examination, particularly looking for abnormalities around the anus and spine. An abdominal radiograph can be helpful in determining the degree of constipation, the appearance of the bowel, and whether there is obstruction.

MANAGEMENT: Assuming no gastrointestinal abnormalities, initial intervention starts with treatment of constipation. Subsequently education, support, and guidance around evacuation are essential, including behavioral strategies such as having the child sit on the toilet after meals to stimulate the gastrocolic reflex. It is most important to avoid punishing the child and making him or her feel guilty and ashamed. Helping the child to clean himself and his clothing in a nonjudgmental, nonpunitive manner is far more productive approach than criticism and reproach. At the same time, if there is an underlying psychiatric disorder such as depression, the child should be treated for the mental health problem along with the treatment of the constipation. When medical management of constipation is indicated, oral medication or an enema for "bowel cleanout" followed by oral medications should be used. Such treatment can be monitored by abdominal radiographs to be sure that the colon is clean. A bowel regimen needs to be established with the goal of the child achieving continence and defecating in the toilet bowl on a regular basis. The child should be encouraged to have a daily bowel movement, and the use of fiber, some laxatives, and even mineral oil can be helpful.

HOMOEOPATHIC TREATMENT:

Lycopodium: This helps where the baby is irritable with constipation. Lots of burping and farting. They seem never to get filled instead of having a poor appetite. So they tend to eat a lot and get hungry even at night time. Babies also become fussy and clingy in general from the discomfort, and their stomach will be as hard as a rock.

Calc-Carbonica: This homeopathic remedy is useful if your baby acts indifferent despite being constipated, and the bowel just seems inactive. Most times, you notice sweats round the back of your baby’s head, and they look chubby and contented. They are scared of the dark and prone to have nightmares with high fevers. They may be sensitive to milk protein or lactose and have trouble digesting milk. Constipation may also follow teething or not.

Nux-Vomica: This is the best homeopathic remedy for constipated babies that looks impatient or determined. Your baby is independent and not clingy but tends to get frustrated with developmental hurdles than other babies. You can also give your baby this remedy if you’ve given them any conventional medicine that seems to upset their system- may be a laxative to produce a bowel movement. Your baby tries to push but nothing comes out after all efforts.

 Silica: You can give silica when your baby’s stool is hard, small, and dark, and it takes a lot of effort to push them out. The stool comes partway out and then go back in again. Babies tend to undergo lots of unsatisfactory trips to the loo, with lots of pushing. Sometimes, small tears in the anus (fissures). This comes with pain and babies become reluctant to poo. The result is an aggravated situation. This homeopathic remedy is also suitable if constipation coincides with teething that is slow and difficult. It’s also effective if your baby has reduced appetite (can be aggravated by breast milk) or there are not gaining any significant weight.

Opium: Stubborn constipations were brought on by ailment from fright for the mother (frightening delivery). This works to treat constipation caused by prolonged and difficult delivery. It can also be as a result of fright or fear during the pregnancy for the mother. Other factors include paralysis of the peristaltic movement, the inaction of the intestines. Your baby has no desire, no urge to stool, so the feces becomes solid and impacted in the bowels. And when passed, they are often hard, dry, and little, black balls. In worst cases, gas may build up in the upper part of the intestines.

Bryonia: This homeopathic remedy for constipation in babies for cases where your baby gets a feeling of dryness in the rectum- stools sit around for a long time. Large dry stools that are difficult to push out, with tearing and sticking pains. The baby feels out of sorts or grouchy and may become tensed easily. They become thirsty for large volumes of water. They want to be out when home, and when they’re home, they want to go out.