Occupational therapy intervention and psychosocial considerations in the care of youth with secondary encopresis

Occupational therapy practitioners (OTPs) work with children and youth diagnosed with encopresis to support participation in meaningful occupations in their everyday lives. According to the Occupational Therapy Practice Framework: Domain & Process, 4th ed. (American Occupational Therapy Association, 2020), OTPs have a distinct role in facilitating performance patterns such as habits, routines, roles, and rituals that are impacted due to chronic conditions. Encopresis is a disorder characterized by the involuntary leaking of feces caused by chronic constipation that affects an estimated 1.5% to 7.5% of children ages 6 to 12 (Deleon et al., 2022). Primary type encopresis is present if the child has not established continence, and typically resolves with time. In contrast, secondary encopresis (SE) occurs when the child has been toilet trained and has demonstrated soiling behaviors (Çoban et al., 2021). When a child is constipated, large amounts of feces develop, causing stretching of the rectum, which can result in dull nerve endings. As a result, a child can have challenges knowing when they need to go to the bathroom. Once a child can no longer hold the stool, leaking may occur, causing them to soil themselves. Research has shown that encopresis can also be caused by the intestines’ inability to move, weak pelvic floor muscles, or stressful events (Rajindrajith et al., 2022).