Patient's question:
In the summer of 9, there was an episode of illness that lasted about a week, with almost one episode almost every day. Later, it returned to normal, but now it has flared up again, with almost one episode almost every day, defecating, and it has been going on 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 participate in 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: reluctance to use the toilet and retreating before finishing, refusal to use the toilet, anal fissures, congenital abnormalities such as inflammation of the spinal cord, anal atresia (post-surgical), and other related anomalies; Hirschsprung's disease (refer to Section 261 for gastrointestinal defects); thyroid dysfunction; malnutrition; cerebral palsy; mental health issues in children or family members.Treatment should first educate parents and children about the causes of encopresis or chronic constipation, completely eliminate the child's guilt from being unable to control bowel movements, and alleviate any negative emotional responses that arise. 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 bowel-moistening treatment should be implemented, followed by measures to maintain regular bowel movements. The initial bowel-moistening treatment is carried out according to the following regimen for 1 to 4 courses:
Day 1: Use an adult low-phosphate enema (≥7 years old: 2 doses).
Day 3: Docusate rectal suppository (10mg).
Day 3: Docusate tablets orally (5mg).
Abdominal X-rays can be taken to observe the adequacy of the enema. Maintenance treatment can include multiple different vitamins (twice daily), with light mineral oil (15–30ml) taken orally twice daily for 4–6 months (or longer if regular bowel movements persist). Mineral oil may interfere with vitamin absorption, so vitamin dosage should be increased. Neonates and frail children should discontinue mineral oil to prevent recurrent respiratory distress. A high-fiber or roughage diet is recommended, but children should not be forced to eat it. Let the child sit on the toilet for a maximum of twice daily, with each session lasting no more than 10 minutes, preferably after meals. For severe cases, if necessary after enemas, oral laxatives (e.g., senna leaf 5–10ml/day) should be taken for 2–3 weeks, followed by every other day for one month. Recurrences are common, and if detected early, oral laxatives may be taken for 1–2 weeks. Mineral oil should be gradually discontinued after normal bowel movements for 4–6 months. If this treatment is successful, further evaluation of diet and bowel habits is recommended.
Aftercare: Thank you for your statement. I hope my explanation has been helpful. Wishing you good health.