Manifestations
Constipation. The principal symptoms of constipation are absence of stool, abdominal pain and cramping without distention, and palpable, movable fecal masses with large amounts of stool in an enlarged rectum. The child may also experience diarrheal overflow, normal or decreased bowel sounds, malaise, anorexia, headache, nausea, vomiting, and anal fissures.
Encopresis. Children with encopresis have evidence of soiled clothing and fecal odor without apparent awareness. Anal irritation leads to scratching or rubbing of the anal area. Social withdrawal and avoidance of extended contact with others (e.g., overnight stays, camp) are common. Urinary incontinence and urinary tract infections may also be present.
Diagnostic Evaluation
Abdominal radiographs may demonstrate an enlarged rectum with large amounts of stool and gas. The definitive diagnostic procedure is a rectal examination. This is rarely performed because of its emotional Impact on the child and the possibility of pain from and fissures. A thorough history is usually sufficient of the diagnostic.