Risk factors for overflow incontinence11/22/2023 ![]() ![]() In research studies, colonic transit time appears within normal limits however, it has been shown that there is some limitation of the relaxation on external sphincter during the defecation. ![]() The majority of them have a complete evacuation of bowel, not just staining of the underwear as in retentive incontinence. On the other hand, children with non-retentive encopresis pass stools into inappropriate places without evidence of stool retention. Nocturnal incontinence is considered an indicator of severe fecal impaction in the rectum. Incontinence of feces can occur during the day as well as at night time. Finally, stool withholding may be a learned avoidance behavior that is less intentional or even unconscious due to repeated painful bowel movements. A child may not want to have an interruption in an enjoyable activity to have a bowel movement. The child may be reluctant to use the toilet at school due to limited time, lack of privacy, or concern about restroom cleanliness, choosing instead to withhold stool until coming home. It may be due to a painful bowel movement that is caused by a stool that was larger or harder than normal, an anal fissure, or a perianal infection. Stool withholding may be an intentional behavior to avoid unpleasant sensations and associations with defecation. There are different reasons why a child may withhold stool or avoid defecation. The volume of fecal matter that leaks out is usually small and, most of the time, just stain the underwear. Finally, feces leak between the solid fecal mass and rectal wall and come out through the anal canal when the sphincter muscles are relaxed. Withholding of stool creates a vicious circle of accumulation of feces and hardening of the fecal mass in the rectosigmoid colon. In the absence of organic causes, encopresis is secondary to overflow, and therefore results from the presence of constipation. ![]()
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