he answer is C. Most children with encopresis (instances of uncontrolled defecation) have a history of constipation, and constipation itself leads to fecal incontinence. Constipation is usually a result of stool withholding, leading to large, painful-to-pass bowel movements. These large stools stretch the rectal walls, which reduces a child’s ability to feel the urge to defecate and will then increase fecal accidents. While there are other causes of encopresis, determining if a child is constipated will most likely give the answer. The treatment involves clearing the bowel, adding fiber and fluid to the diet, and educating about and encourage good toilet habits. Elimination disorders include enuresis (uncontrolled urination) and encopresis and are common in children, and fair game for board exams. Psychosocial factors like B and D have been recently found to be linked to elimination disorders, but further research is necessary. A) family history may be useful, but first it is more important to rule out common causes.

Publication reference : Shepard, J et al. Evidence-Based Psychosocial Treatments for Pediatric Elimination Disorders. Journal of Clinical Child & Adolescent Psychology 2016
Reference URL: http://www.tandfonline.com/doi/citedby/10.1080/15374416.2016.1247356?scroll=top&needAccess=true