IS ENCOPRESIS ALWAYS THE RESULT OF CONSTIPATION

Encopresis is often the result of chronic constipation in the majority of paediatric patients. In clinical practice, however, encopresis is also seen without constipation and it is unknown whether these two cli nical variants are based on similar or different pathophysiological me chanisms, requiring different therapeutic approaches. We analysed clin ical symptoms, colonic transit time (CTT), orocaecal transit time (OCT T), anorectal manometric profiles, and behavioural scores. Patients we re divided into two groups, one consisted of 111 children with paediat ric constipation, and another group of 50 children with encopresis and /or soiling without constipation. Significant clinical differences in children with encopresis/soiling existed compared with children with p aediatric constipation regarding: bowel movements per week, the number of daytime soiling episodes, the presence of night time soiling, the presence and number of encopresis episodes, normal stools, pain during defecation, abdominal pain, and good appetite. Total and segmental CT T were significantly prolonged in paediatric constipation compared wit h encopresis/soiling, 62.4 (3.6-384) and 40.2 (10.8-104.4) hours, resp ectively. No significant differences were found in OCTT. Among the two groups, all manometric parameters were comparable, except for a signi ficantly higher threshold of sensation in children with paediatric con stipation. The defecation dynamics were abnormal in 59% and 46% in pae diatric constipation and encopresis/soiling, respectively, and were si gnificantly different from controls. Using the child behaviour checkli st no significant differences were found when comparing children with paediatric constipation and encopresis/soiling, while both patient gro ups differed significantly fi om controls. In conclusion, our findings support the concept of the existence of encopresis as a distinct enti ty in children with defecation disorders. Identification of such child ren is based on clinical symptoms, that is, normal defecation frequenc y, absence of abdominal or rectal palpable mass, in combination with n ormal marker studies and normal anal manometric threshold of sensation . Thus, encopresis is not always the result of constipation and can be the only clinical presentation of a defecation disorder.