Encopresis

Template

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AssessmentChoose one

ExamChoose any

HistoryChoose any

Red flags presentChoose any

Red flags absentChoose any

TestingChoose any

Bowel planChoose one

Behavior planChoose any

Additional planChoose any

Follow-upChoose one

Follow-up reasonChoose anyJoins the line above

Counseling

Accidents happen because a stretched bowel cannot feel when stool is coming, not because a child is lazy or doing it on purpose. Improvement is gradual, and treatment usually continues for several months after the accidents stop. Recommended supportive care with an emphasis on soft daily stools, fruits, vegetables, and water, regular toilet sits, and praise without punishment. Return precautions given including belly pain or swelling, vomiting, blood in the stool, new leg weakness or trouble walking, wetting accidents, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

CounselingNot in the note with these choices

Some children have accidents without being constipated, often from stress or not taking time to use the toilet. A steady routine and calm encouragement help most. Recommended supportive care with an emphasis on regular toilet sits, praise for successes, and a calm response to accidents. Return precautions given including belly pain, hard stools, blood in the stool, new leg weakness, wetting accidents, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Encopresis
• Fecal soiling from overflow with stool retention
• Stool palpable on abdominal exam
• Reviewed stool pattern, withholding, toilet habits, diet, and stressors
• No leg weakness or abnormal reflexes, sacral dimple or spinal skin findings, abnormal anal position or tone, poor growth, or urinary symptoms or daytime wetting
• No testing needed given no red flags
• Clean-out with miralax, then daily miralax titrated to soft daily stools
• Scheduled toilet sits for 5 minutes after meals with feet supported, with praise and a reward chart
• Encouraged a calm, nonpunitive response to accidents
• Follow up in 1 month to adjust the bowel plan

Accidents happen because a stretched bowel cannot feel when stool is coming, not because a child is lazy or doing it on purpose. Improvement is gradual, and treatment usually continues for several months after the accidents stop. Recommended supportive care with an emphasis on soft daily stools, fruits, vegetables, and water, regular toilet sits, and praise without punishment. Return precautions given including belly pain or swelling, vomiting, blood in the stool, new leg weakness or trouble walking, wetting accidents, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Retentive vs nonretentive
Red flags; no routine labs
Disimpaction then maintenance
Maintenance months

Return precautions in the template

belly pain or swellingvomitingblood in the stoolnew leg weakness or trouble walkingwetting accidents

Sources

Pediatric Care Online Key Points: Encopresis

Few formal guidelines cover this topic, so the template also leans on expert opinion.

Template

Encopresis, follow-up

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MonthChoose anyFirst line

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AccidentsChoose one

StoolsChoose one

AdherenceChoose one

HistoryChoose any

Medication planChoose one

Clean-outChoose any

Bowel careChoose any

Additional planChoose any

Testing and referral statusChoose any

ReferralChoose one

Follow-upChoose one

Counseling paragraphChoose oneParagraph

Note when inserted as is

Encopresis, follow-up
November 2026: Doing well.
• Accidents improving
• Soft daily stools on the current plan
• Taking the bowel medicine daily and doing toilet sits as directed
• No medication change planned at this time
• Continue scheduled toilet sitting and positive reinforcement
• Follow up in 1 month

Accidents usually stop gradually over months as the bowel returns to its normal size, and they are not on purpose. Recommended supportive care with an emphasis on daily toilet sits after meals, a steady bowel medicine, praise for sitting, and a calm response to accidents. Return precautions given including belly pain that keeps getting worse, vomiting, blood in the stool, new trouble walking or wetting, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Accidents improving; none; unchanged; worse
Stool retention
Continue scheduled toilet sitting and positive reinforcement
Repeat cleanout; calm response; school note
GI; behavioral health

Return precautions in the template

belly pain that keeps getting worsevomitingblood in the stoolnew trouble walking or wetting

Sources

Pediatric Care Online Key Points: Encopresis