Psychosomatic approach of encopresis in children.

Encopresis most often results from functional constipation and a behaviour disorder characterised by retention of faeces. Rarely it is a passive or ac tive expulsion of normal faeces. If indicates a failure in the education of sphincter control, often with a preferential development of autoerotic ver sus relational investments. A depressive component is frequent. We propose a bidisciplinary approach with a somatic and psychological evaluation of th e encopretic child from the first visit The physical examination assesses c onstipation and stercoral stasis. Associated psychopathological symptoms or a pathogenic psychosocial situation must he sought. The therapeutic means must be directed towards the different etiologic features. Explanations of the physiopathology of the symptom and discussion with the child and the pa rents on the origin of the dysfunction must be accomplished first A medical treatment of the constipation is generally indicated. Psychotherapy is ini tiated according to the background and associated psychopathological sympto ms. (C) 1999 Editions scientifiques et medicales Elsevier SAS.