Encopresis is not diagnosed until a child has reached a chronological age of at least 4 years (or for children with developmental delays, a mental age of at least 4 years). Inadequate, inconsistent toilet training and psychosocial stress (e.g., entering school, the birth of a sib- ling) may be predisposing factors. Two types of course have been described: a "primary” type, in which the individual has never established fecal continence, and a ”secondary" type, in which the disturbance develops after a period of established fecal continence. En- copresis can persist, with intermittent exacerbations, for years.
Genetic and physiological. Painful defecation can lead to constipation and a cycle of with- holding behaviors that make encopresis more likely. Use of some medications (e.g., anti- convulsants, cough suppressants) may increase constipation and make encopresis more likely.
In addition to physical examination, gastrointestinal imaging (e.g., abdominal radiograph) may be informative to assess retained stool and gas in the colon. Additional tests, such as barium enema and anorectal manography, may be used to help exclude other medical conditions, such as Hirschsprung’s disease.
A diagnosis of encopresis in the presence of another medical condition is appropriate only if the mechanism involves constipation that cannot be explained by other medical condi- tions. Fecal incontinence related to other medical conditions (e.g., chronic diarrhea, spina bifida, anal stenosis) would not warrant a DSM-S diagnosis of encopresis.
Urinary tract infections can be comorbid with encopresis and are more common in females.
This category applies to presentations in which symptoms characteristic of an elimination disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the elimination disorders diagnostic class. The other specified elimination disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific elimination disorder. This is done by recording “other specified elimination disorder" followed by the specific reason (e.g., “Iow-frequency enuresis").
Coding note: Code 788.39 (N39.498) for other specified elimination disorder with urinary symptoms; 787.60 (R15.9) for other specified elimination disorder with fecal symptoms.
This category applies to presentations in which symptoms characteristic of an elimination disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the elimination disorders diagnostic class. The unspecified elimination dis- order category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific elimination disorder, and includes presentations in which there is insufficient information to make a more specific diagnosis (e.g., in emer- gency room settings).
Coding note: Code 788.30 (R32) for unspecified elimination disorder with urinary symp— toms; 787.60 (R15.9) for unspecified elimination disorder with fecal symptoms.