ENCOPRESIS IN CHILDHOOD: ETIOLOGY, CLINICAL FORMS AND TREATMENT (LECTURE

Abstract

Encopresis is a functional fecal incontinence, its involuntary discharge in the absence of abnormalities in the structure of the intestine and anal sphincter. The diagnosis is established from the age of 4. Encopresis is often a monosymptomatic disorder, persistent and resistant to treatment. There are two main types of fecal incontinence - retentive (associated with constipation) and non retentive (functional). Encopresis occurs in 1-3% of children aged 5 years. There are the following forms of encopresis: neurotic, neurosis like, protest demonstrative, primary. In the etiology of encopresis, the constitutional hereditary factor, the residual organic, dysontogenetic, psychotraumatic, environmental, family and somatic factors are important. The theoretical provisions of functional encopresis are based on the evolutionary dynamic concept of mental dysontogenesis of V.V. Kovalev (1985), according to which encopresis is a productive dysontogenetic syndrome of a regressive nature, and the clinical ethological approach of Yu.S. Shevchenko (2018), according to which encopresis is an ethological prototype of non specific labeling behavior. The diagnostic criteria are reflected in the classification of functional gastrointestinal disorders “Roman Criteria IV”, the classification “Mental and behavioral disorders ICD-10” and “Diagnostic and Statistical Manual, 5th edition” of the American Psychiatric Association (Dsm-5). Treatment of encopresis, depending on the etiology, includes: 1) adequate training of the child in the skills of using the toilet; 2) correction of ways of influencing the child; 3) identification and correction of concomitant problems in the microsocial environment of the child.