Trends in referral to a single encopresis clinic over 20 years.
OBJECTIVE
To compare the characteristics of children with encopresis referred to a single encopresis clinic over the course of 20 years, including symptoms, previous diagnostic and therapeutic interventions, and parental attitudes.


METHODS
A retrospective study was conducted of an encopresis clinic at a tertiary care pediatric hospital. Questionnaires at initial evaluation elicited information about bowel habits, soiling, previous evaluations, previous treatments, and parental attitudes.


RESULTS
In 503 children with encopresis, the average age of referral dropped from 115 months during the earliest 5 years to 77 months during the most recent 5 years. Children who had soiling for >3 years before referral decreased from 63% to 12%. The use of barium enema before referral decreased from 14% to 5%, as did psychological evaluation, from 25% to 14%. Previous therapy with enemas decreased from 45% to 27%. Mineral oil use remained at approximately 50%, and 20% of children had no previous treatment. Symptoms at referral and parental attitudes did not change across the years.


CONCLUSIONS
Children are now referred at an earlier age to our tertiary encopresis clinic. The number of invasive and psychological evaluations has decreased before referral. However, treatment by many primary care providers before the referral has not changed. These data may suggest that pediatricians have increased awareness of encopresis and greater appreciation of its primarily physical rather than psychological nature. Additional studies will be needed to determine how these factors affect outcome.
Combined Program in Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts 02115, USA. laurie.fishman@tch.harvard.edu
Laurie
L
Fishman
Leonard
L
Rappaport
Alison
A
Schonwald
Samuel
S
Nurko
D000328:Adult; D001290:Attitude; D002648:Child; D002675:Child, Preschool; D004688:Encopresis / Q000175:diagnosis* / Q000473:pathology / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010290:Parents; D012017:Referral and Consultation / Q000639:trends*; D012189:Retrospective Studies; D013995:Time; D014039:Toilet Training