Encopresis

1 What is Encopresis?

Encopresis is commonly known as stool holding, and it happens when the child resists the urge to defecate. It is a problem because it promotes stool impaction in the colon and rectum. If the colon becomes filled with impacted stool, liquid stool passes around it and leaks through the anus, causing characteristic soiling.

Note that a child is said to have encopresis when symptoms occur at 4 years old and above, the time when he or she becomes familiar with using the toilet. Most cases of encopresis are caused by chronic constipation. Some are caused by developmental or emotional problems.

There are two classifications of encopresis; primary and secondary. Primary encopresis happens to children that have never been successfully toilet trained. Secondary encopresis happens in toilet-trained children. Both conditions can be a source of embarrassment and stress to the child and parents.

Most children with encopresis respond well to positive reinforcement and plenty of patience on the side of the parents.

2 Symptoms

Your child may exhibit the following signs and symptoms of encopresis:

  • Leaks of stool or liquid stool in the child’s underwear. Sometimes, leaks can be large it can be mistaken as diarrhea
  • Passage of large hard stools that almost clog the toilet
  • Marked constipation, passing out hard dry stools
  • Noticeable avoidance of moving the bowels
  • Long periods of time between bowel movements, sometimes as long as a week
  • Pain in the abdomen
  • Lack of appetite
  • Having frequent urinary tract infections

You need to see a doctor if your child has one or more symptoms.

3 Causes

The main cause of encopresis is constipation. A child may experience discomfort passing out hard, dry stools, and so avoid going to the toilet.

The large intestines absorb water from the feces, and so the longer the stool stays there, the harder it becomes. Constipation worsens until the colon becomes packed with hard stools. The packed colon is unable to absorb much water from the feces, allowing passage of soft or liquid stools that leaks out the anus causing staining.

Certain child behaviors can worsen constipation, like withholding stool due to fear of using the toilet, not wanting to interrupt play or not drinking enough water or fluids. Some children experience constipation due to milk allergy or too much consumption of cow’s milk.

Another significant cause if encopresis is emotional issues. Stress in a child’s life can be caused by things like divorce, birth or death of a sibling.

4 Making a Diagnosis

To make a proper diagnosis of encopresis in your child, your pediatrician may refer you to another specialist, such as a pediatric gastroenterologist.

You must bring your child to the doctor if he/she experiences stool leaks. Depending on the child’s presentation, the doctor may refer you to a pediatric gastroenterologist, which specializes in digestive disorders in children, or to a mental health provider if the child exhibits emotional issues.

You can prepare in the meantime to help improve care to the child by doing the following:

  • Call the doctor and see if there is some kind of preparation needed before the appointment.
  • List your child’s symptoms and when did the symptoms start. Make sure to include a list of medicines, vitamins and supplements.
  • Note recent life changes or sources of stress in a child’s life, like moving to a new home, divorce of parents or addition of new sibling
  • Do note foods your child eats and drinks daily, including milk

Feel free to ask your doctor questions about the child’s condition. Here are some good questions to ask:

  • What could be the causes of the child’s condition?
  • What are the needed tests? Do some of them require certain preparations?
  • What are the available treatments?
  • What are the associated side effects of treatment?
  • What are the needed dietary changes that might help improve the child condition?
  • What are the physical activities that might benefit the child’s condition?
  • Can you share to me printed materials or access to websites to help me understand the condition better?

During the appointment, the doctor may ask you the following:

  • Toilet training status of the child
  • Toilet training status of the child’s siblings
  • If the child has passed out hard or dry stools lately
  • Medicines, vitamins or supplements that were taken
  • Behaviors of the child when using the toilet, like resisting going to the toilet or having pain during bowel movements
  • Presence of stains or fecal matter on child’s underwear
  • As a parent, how do you deal with the child when she or he stains his or her underwear?
  • Recent life changes in child’s life, such as divorce, moving to a new home, experiencing death or divorce in the family
  • If the child experiences embarrassment or is depressed due to staining

In the meantime, you can do diet changes that may help improve the condition. Increase child’s intake of fiber by giving fruits and vegetables, and giving plenty of fluids. Reduce dairy or milk because it worsens constipation.

5 Treatment

Treatment for encopresis involves removing retained stools in the intestines and then interventions to promote healthy bowel movements. Early intervention to encopresis gives better results. Also, the child is given training to go to the toilet when the urge to bowel movement occurs.

There are several methods to clear up the bowels and relieve constipation.

Your doctor might consider recommending one or two of the following treatments:

  • Increasing fluid intake
  • Rectal suppositories medications to move the bowels
  • Mineral oil for oral administration, which softens stool. Given only to children older than 6 years of old
  • Administration of stool softener medications like lactulose

The doctor may recommend x-rays imaging of the child’s abdomen every few days to monitor the progress of colon clearing.

Once imaging shows that the colon is cleared, you need to give your child encouragement and support to learn healthy regular bowel movements. You will be given teachings like increasing fiber and fluid intake. The doctor may also prescribe stool softeners for six months or more.

Some children have encopresis due to feelings of shame, guilt, low self-esteem or depression. If your child has those problems, the doctor may also refer you to a psychologist. Psychologists may provide talk therapy (psychotherapy) to the child to deal with these feelings.

In many cases, psychologists also provide valuable teachings to parents. Ask your psychologist for help in situations like teaching the children not to hold stool.

6 Prevention

You can prevent constipation and encopresis happening in the first place by giving the child high-fiber diet and plenty of fluids.

Most parents do not know to do proper toilet training to their child. They tend to start too early or being too forceful, which only cause the child to experience feelings of guilt, shame, and low self-esteem.

Young children must be able to do certain things first that indicate readiness for toilet training, which tends to happen after reaching 2 years of age.

The child must be able to do the following for toilet training:

  • Able to ask one-word questions
  • The child is able to pull pants down
  • The child is able to stop activities when feeling the urge to move the bowels

Use a potty when toilet training. The child’s feet must be on the ground when pushing the bowels, and may not feel secure when using the toilet.

7 Lifestyle and Coping

Lifestyle modifications are necessary for your child in order to cope with encopresis.

The relapse rate of encopresis is high. Though labeled for constipation, it is not recommended to give enemas or laxatives to your child without doctor’s supervision. This includes herbal or homeopathic laxatives and enemas.

You can avoid encopresis in the first place by preventing constipation.

Here are good methods to avoid constipation:

  • Include lots of fiber from fruits and vegetables. Many children have fussiness in vegetables. Most kids like baby corn, baby carrots, carrot juice, popcorn and baked potatoes. Give them baked goods like muffins, pancakes or cupcakes made from whole grain flour.
  • Encourage your kids to drink water often, especially when they strain when moving the bowels. Some kids prefer slightly cooled water. You can give them a tumbler during playtime.
  • For toilet-trained children, make the child sit on the toilet for 10 to 15 minutes after breakfast or supper. The bowels are more likely to move after eating. Give praise to your child for sitting as requested. It is not appropriate to give praise or rewards to the child for passing stool, or punish for not passing stool.
  • Limit dairy and fats, which can induce constipation. Dairy is healthy, so ask your doctor how much your child needs.
  • Provide the child a footstool when sitting on the toilet.

As a parent, you must have lots of patience and use positive reinforcement to help your child overcome encopresis.

8 Risks and Complications

Here are the risk factors for encopresis:

  • Encopresis is more common in boys than in girls
  • Children with untreated constipation
  • Inadequate fluid intake
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