RE: encopresis and hx of prolonged traumatic stress

["Ondersma, Steven" <sondersm@xxxxxxxxxxxxx>]

All,

It's worth noting that there are subtypes of encropresis.  Two further
points are relevant:  (1) the most common subtype by far is retentive
encopresis, and (2) this subtype is best treated, without exception, via
behavioral and medical approaches.  Retentive encopresis is the result
of chronic constipation causing fecal impaction with "overflow
incontinence;" in short, a large amount of stool becomes impacted in the
colon, which becomes flacid and less able to function normally.
Unformed stool proximal to the impaction then involuntarily leaks around
the impaction without warning.  Occasionally the entire impaction can
suddenly be eliminated, also involuntarily.

Treatment involves some combination of removal of the impaction and
maintenance of regular bowel habits, usually with the aid of fiber
and/or mineral oil or other mild laxative agents.  Increases in liquid
intake and establishment of regular toilet sittings are also used. 

My point, I guess, is to provide a reminder that when you hear hoofbeats
(encopresis), think first of horses (the above) not zebras (abuse).
Sure, encopresis and abuse can go together, but so can depression and
abuse, anxiety and abuse, etc. etc. Non-intrusive screening for a range
of problems is just good practice generally, whether you're a primary
care physician or a psychologist doing an ADHD evaluation.  

Steve Ondersma

_______________________________________________________________________
Steven J. Ondersma, PhD, LP, Assistant Professor
Departments of Psychiatry & Behavioral Neurosciences and Obstetrics &
Gynecology
Wayne State University School of Medicine
2761 E. Jefferson Ave.
Detroit, MI  48207
Phone:  (313) 577-6680
Fax:  (313) 993-1372
sondersm@med.wayne.edu


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