Evaluation of a standard protocol for retentive encopresis: A replication

Replicated the efficacy of a short-term, combined medical and behavioral inter-vention protocol for retentive encopresis. Fifty-nine children who had failed standard medical management for retentive encopresis and their parents partici-pated in six 1-hour group treatment sessions. Treatment protocol combined the medical management strategies of enema clean out, increasing dietary fiber, and daily toilet sitting with the child behavior management strategies of differential attention, contingency management, and contracting. For the overall sample, the number of soiling incidents decreased 85%, the weekly frequency of indepen-dent bowel movements increased 15%, the weekly frequency of parent-prompted bowel movements increased 9%, and daily dietary fiber intake increased 121% pre- to posttreatment. The majority of the sample (86%) stopped soiling by the end of treatment and did not require further treatment. Results are discussed in terms of the comparability with previous findings and the utility of combined medical and psychological treatments for children with encopresis who have failed standard medical approaches. KEY WORDS: encopresis; constipation; group behavior therapy; children. Encopresis and constipation are common problems in childhood and are esti-mated to account for 3 % of all general pediatric visits and 25 % of all pediatric gastroenterology visits (Sonnenberg & Koch, 1989). Encopresis is defined as the voluntary or involuntary passage of fecal material into underwear or other inap