title: Early constipation and toilet training in children with encopresis.
abstract: OBJECTIVE
  To evaluate the frequency of predisposing factors for encopresis before and during toilet training, comparing children with primary and secondary encopresis.
  
  
  METHODS
  In this retrospective study, questionnaires from the initial evaluation at an encopresis clinic at a tertiary care pediatric hospital were reviewed for the presence or absence of factors in the first 2 years of life, for toilet training practices, and for disruptive events during the training process. Children younger than 48 months or those with organic defecation disorders were excluded.
  
  
  RESULTS
  In 411 children with encopresis, the reported frequency of predisposing factors included constipation in 35%, and previous treatment for constipation in 24%. Toilet training was initiated before age 2 years in 26% and after age 3 years in 14%. Interruption of toilet training and punishment were seen more in primary encopresis than in secondary encopresis (50% versus 23%; P < 0.05) and (52% versus 26%; P < 0.05) respectively. Constipation (30% versus 18%; P < 0.05) and abdominal pain (23% versus 9%; P <0.0:5) during toilet training were more common in primary encopresis as was fear of the toilet (47% versus 10%; P < 0.05).
  
  
  CONCLUSIONS
  In children with encopresis, early difficult defecation, previous treatment for constipation, and early initiation of toilet training were less common than expected. Children with primary encopresis did not have an increased incidence of early constipation or invasive treatments compared with those with secondary encopresis. However, children with primary encopresis did have more difficult and disruptive toilet training experiences.
authors.affiliation: Combined Program in Gastroenterology and Nutrition, and Division of General Pediatrics, Children's Hospital, Boston, Massachusetts 02115, USA. Laurie.Fishman@tch.harvard.edu
authors.forename: Laurie
authors.initials: L
authors.lastname: Fishman
authors.forename: Leonard
authors.initials: L
authors.lastname: Rappaport
authors.forename: Dominique
authors.initials: D
authors.lastname: Cousineau
authors.forename: Samuel
authors.initials: S
authors.lastname: Nurko
mesh_terms: D000293:Adolescent; D001900:Boston; D015984:Causality; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000150:complications*; D004688:Encopresis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D014039:Toilet Training