Patient's question:
In the summer of 9 years, there was an episode of illness that lasted about a week, with almost one episode per day. Later, it returned to normal, but now it has flared up again, with almost one episode per day of defecation, lasting for over ten days without improvement. I don't know the reason or how to treat it. In 2009, May...Doctor's answer:
Functional encopresis refers to the inability to control bowel movements that is not caused by obvious organic defects or diseases. The incidence rate in 3-year-old children is 17%, and in 4-year-old children, it is 1%. Common causes include a child's refusal to undergo potty training, but it can also be triggered by chronic constipation, leading to uncontrollable bowel movements. Constipation is defined as difficulty or inability to have regular bowel movements, with hard stools or the sensation of incomplete evacuation. Recurring causes include hesitancy to use the toilet, refusal to use the toilet, anal fissures, congenital anomalies such as inflammation of the spinal cord, anal atresia (post-surgical), and other related abnormalities; Hirschsprung's disease (refer to Section 261 for gastrointestinal defects); thyroid dysfunction; malnutrition; cerebral palsy; mental illness in children or family members.Treatment should first educate parents and children about the causes of encopresis or chronic constipation, eliminate the child's guilt over being unable to control bowel movements, and alleviate any negative emotional responses. Abdominal X-rays can reveal a large amount of feces in the abdomen. If the initial medical history and physical examination rule out specific diseases, a laxative treatment should be implemented, followed by measures to maintain regular bowel movements. The initial laxative treatment is administered in 1 to 4 courses as follows:
Day 1: Use an adult low-phosphate enema (≥7 years old: 2 doses).
Day 3: Docusate rectal suppository (10mg).
Day 3: Docusate oral tablet (5mg).
Abdominal X-rays can be taken to monitor the effectiveness of the enema. Maintenance treatment can include multiple different vitamins (twice daily), with oral light mineral oil (15–30ml) twice daily for 4–6 months (if regular bowel movements persist for a longer duration). Mineral oil may interfere with vitamin absorption, so the dosage of vitamins should be increased. Neonates and frail children should discontinue mineral oil to avoid recurrent breathing difficulties. A high-fiber or roughage diet is recommended, but children should not be forced to eat it. Children should sit on the toilet for no more than twice daily, with each session lasting no more than 10 minutes, preferably after meals. For severe cases, if necessary, oral laxatives (e.g., senna leaf 5–10ml/day) should be administered for 2–3 weeks after enema, followed by every other day for one month. Recurrences are common; if detected early, oral laxatives should be taken for 1–2 weeks. Mineral oil should be gradually discontinued after normal bowel movements for 4–6 months. If this treatment plan is successful, further evaluation of diet and bowel habits is recommended.
Aftercare: Thank you for your inquiry. I hope my explanation has been helpful. Wishing you good health.