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Childhood encopresis: a neurodevelopmental-family approach to management.

CHILIDHOOD ENCOPRESIS, although not rare, is given little notice in the pediatric and surgical literature, where it is known as "functional megacolon" or "chronic obstipation with fecal soiling." The problem usually reaches the attention of a physician after the symptoms can -no longer be obscured and are presented as a mass in the abdomen (fecalith with megacolon, to be differentiated from aganglionic megacolon') or after an "accident" of fecal soiling has occurred away from home. With fear of exposure, the "potting couple"2 (mother and child) attempt to keep these symptoms concealed, with increasing anxiety and heightened parent-child conflict. Usually the child has been shamed and the parents fear their secret will become known outside the family to friends or to the pediatrician. Richmond3 has three classifications of megacolon: (1) psychogenic, (2) neurogenic (Hirschsprung's disease), and (3) anatomic. Richmond and Huschka3'4 subscribe to the belief that fecal soiling is psychogenic, the most popular view up to this time. Anthony reviewed the many facets that contribute to this behavior complex in his classic study in 1957*2. He discussed the psychodynamics, the different cultural patterns, the taboos of bowel training, and the differences of family style of bowel training. He also described the kinds of mothers, the socio-economic style of toilet training, the kinds of mother-child relationships,