1 The essence of the problem

Fecal incontinence can be explained by the congenital pathology of the organs, various lesions of the brain and spinal cord. However, it is often found in practically healthy children. This is the so-called functional encopresis.

Some parts of the cerebral hemispheres are involved in the defecation process, to which impulses are transmitted from the filled rectum to the conductionpathways of the spinal cord. These impulses are formed in the nerve endings of the periphyric nervous system. The very act of defecation is carried out with the help of tension of the abdominal muscles and musculature of the lower parts of the intestine. Accumulated fecal masses press on the walls of the rectum and on the nerve endings located in it. This causes electrical impulses that go to the cortex of the brain. And then, through the spinal canal, they are transmitted to the external sphincter and the terminal muscles. Thus, there is a strong-willed suppression of the urge to empty the intestine.

This mechanism begins to form in early childhood. This conditioned reflex is formed under the influence of the surrounding situation and depends on the characteristics of the child's psyche. The body gradually gets used to respond to certain signals, whether it be the time of day, certain sounds or the kind of toilet room.

However, in some cases, for various reasons, this process in the child begins to degenerate. Of course, this is very frustrating for both the child and the parents. Some moms and dads believe that the kid just does not want to control himself, others generally think that he does it consciously and punishes the crumbs. This behavior only aggravates the problem and leads to an untimely visit to the doctor. Violation of the links of the neural chain, which ensure the functioning of the formed conditioned reflex arc, leads to the incontinence of stool.

2 Causes of pathology

Distinguish between true and false encopresis. In the first case, the perception of the urge to defecate and the control exercised by the central nervous system over the arbitrary opening of the anal sphincters are disturbed. The most common cause of true encopresis is considered to be the transfer of the strongest negative emotions by the child. It can be:

• inadequate behavior of parents towards their baby;
• pressure, often experienced by a child in school or kindergarten;
• a constant sense of fear;
• strong experiences for any reason.

Often in a family these children have an unhealthy psychological situation, parents quarrel or divorce, too little time is spent on raising a child. True encopresis in most cases is accompanied in children by an astheno-neurotic syndrome. In addition, the development of pathology can provoke:

• anemia of the mother and the resulting fetal hypoxia;
• toxicosis;
• threat of miscarriage;
• injury at birth;
• cord embryos at birth and( again) asphyxia;
• birth by caesarean section.

Constipation in children is the main cause of the occurrence of false( paradoxical) incontinence of feces. Often the reason for such encopresis is the frequent restraint by the child of the urge to defecate, which occurs in different situations. For example, the kid wanted to use the toilet on the street, and he did not hurry to go home. A frequent cause of suppression is the inconvenience experienced by the child during defecation. It can be both physical( an uncomfortable pot or toilet bowl) and psychological( a crowded public toilet in a school or kindergarten).

From the physiological causes of true encopresis can be called the pain experienced by the child in the process of bowel evacuation. This is possible with a crack on the skin or mucous sphincter, various inflammatory processes of the rectum and anal opening, such as cryptite or papillitis. In all these cases there is a deliberate suppression of the urge to defecate, which leads to the accumulation of stool in the intestine, stretching the walls of the rectum. If such a situation occurs frequently, the receptors located in the walls of the organ lose their sensitivity. This reduces the feeling of urge and weakens the control of the process by the brain. Eruption of feces occurs spontaneously. In such cases, they speak of psychogenic encopresis.

Intestinal infections transferred by a child in infancy can also lead to degenerative changes in the nerve receptors of the rectum. As a result of the disease, the threshold of sensitivity of the nerve endings in the sphincter decreases, therefore, when the rectum is full, it opens before calling for an act of defecation.

Stool incontinence in single cases can occur with regular, conscious bowel movement during increased physical exertion or with exorbitant mental stress. Sometimes calibrations occur for no apparent reason.

Symptoms and the development of the disease depend on the causes that provoked its occurrence, the degree of changes that occurred in the autonomic and central nervous system. If the child does not receive timely help, controlled defecation is less and less, psychological problems are aggravated, physiological changes become persistent.

3 What should be the treatment?

In children, the treatment of encopresis involves a whole range of measures whose composition is determined by the cause that caused the disease. First of all, favorable psychological factors are created. A calm, friendly atmosphere, absence of conflicts in the family will help to eliminate the traumatic psychological factor. A child needs to be convinced that he can get rid of this problem. We must try to organize a comfortable regime of the day. Psychological work should also be conducted with parents.

It is necessary to start treatment with procedures for cleansing the colon from accumulated stool. Clefts with warm saline are done twice a day in the morning and evening at the same time. To restore the reflex put training enemas.

For normalization of the reflex to defecation, it is recommended to conduct training procedures( that is, it is suggested to keep the injected fluid for a short time).It is also recommended to do special physical exercises aimed at increasing the tone of the sphincter.

The diet is more important. It should include laxatives and it is easy to assimilate. The basis of nutrition should be fruit and vegetable salads with vegetable oil: beet, carrot, cabbage. Sour-milk products are very useful. It is necessary to exclude fixing and indigestible food from the ration: pasta, rice dishes, semolina porridge. Dried fruits raisins, dried apricots, prunes not only help to remove stool from the body, but also replenish it with the necessary vitamins and microelements.

In the complex treatment of encopresis should include drugs that normalize the metabolic processes of the cerebral cortex, which restore the intestinal microflora. If necessary, cholagogue and hepatoprotective agents are prescribed. To neutralize toxins recommended activated carbon, Lactofiltrum, etc.

One of the main methods of treatment of encopresis is endorectal electrostimulation. This method consists in restoring the normal reaction of nerve endings by stimulating them with low-voltage electrical discharges. From the recipes of traditional medicine, you can use sedatives. Success in treatment will be provided by patience, perseverance and competent psychological approach to the child.