Encopresis: How Can I Help My Child?
Encopresis is an involuntary leaking of poop due to chronic constipation. Know how you can help your child deal with this treatable disorder.
What is encopresis?
Encopresis is a disorder characterized by the involuntary leaking of poop due to chronic constipation. This disorder is usually observed in children 4 years old and above.
In encopresis, the wall and the nerves of the bowel are stretched when poop is held on for a longer time. This also makes the poop bigger and harder. Since the nerves have been stretched, the sensation or the urge to poop is lost.
When the bowel gets overloaded, poop can trickle down. This can happen after consuming food, exercising, and even when relaxing. However, overloading can still happen even without obvious constipation. If children are often constipated and do not regularly poop, the backlog continues.
Sometimes, soiling is caused by emotional and behavioral problems. Families and children need professional help to address these issues. Although encopresis can be embarrassing for your child and can be frustrating for parents like you, its treatment is often successful when coupled with positive reinforcement and patience.
Signs and Symptoms
The following are signs and symptoms of encopresis:
- Constipation with hard, dry poop
- Leaking of poop or liquid poop on underwear (can be mistaken for diarrhea)
- Passing large poop that can clog the toilet
- Abdominal pain
- Lack of appetite
- Trouble with bedwetting or daytime wetting
- Avoiding bowel movements
- Fewer bowel movements than normal
- Recurrent bladder infections in girls
Encopresis is usually caused by constipation, especially when children avoid having bowel movements. Some of the reasons why children hold their poop include:
- Painful bowel movements (during or after pooping)
- Dietary changes (e.g., not getting enough fluids or fiber)
- Hot weather
- Having to use bathrooms with less privacy
- Do not want to use restrooms away from home
- Ignoring the urge to poop, especially during playtime and other fun activities
The lower colon fills up and stretches out of its normal shape when children hold in their poop. When children hold in more poop, the colon tends to stretch more, making poop larger and harder.
If children have chronic constipation, their colon becomes floppy and so stretched that the muscles that help evacuate their poop no longer work properly. Large and hard poop can get stuck in the colon and only liquid can leak around the impacted stool. Oftentimes, children may not feel the leaking poop because their nerves have become less sensitive due to so much stretching.
Trouble with soiling can also occur in children with behavioral or emotional problems. Although rare, children may also have serious inborn health problems that cause encopresis. Consult your healthcare provider to know more about these serious causes.
Boys are more prone to developing encopresis. The following are also risk factors that may increase a child’s chances of soiling:
- The use of cough suppressants and other types of medications that can lead to constipation
- Autism spectrum disorder
- Attention-deficit/hyperactivity disorder (ADHD)
The first step for the treatment of encopresis is clearing the colon of the impacted stool. The earlier the treatment begins, the better. After colon clearing, treatment focuses on encouraging children to have healthy, regular bowel movements. Additional treatment such as psychotherapy may also help in some cases.
To clear the colon and relieve constipation, the doctor will likely prescribe one or more of the following medications:
- Rectal suppositories
To check the progress of colon clearing, the doctor may also recommend close monitoring of your child’s bowel movements.
After colon clearing, the doctor will recommend that you encourage your child to regularly have bowel movements by:
- Making sure that your child consumes adequate fluids and foods rich in fiber.
- Training your child not to ignore the urge to poop and going to the toilet as soon as possible.
- Gradually discontinuing the use of laxatives once your child’s bowel habits return to normal.
When it comes to behavior modification or bowel retraining, a mental health professional can help by discussing techniques on how to regularly have bowel movements. If your child’s encopresis is somewhat related to emotional problems, doctors may recommend psychotherapy with a mental health professional. If your child is depressed and feels guilt, shame, and low self-esteem due to encopresis, psychotherapy may help.
Other ways to help your child
Encopresis is not a lack of self-control nor a major behavioral issue, so humiliating or punishing a child with encopresis will only make it worse. To get through this treatable problem, talk to your child’s doctor. The doctor might also refer your child to a pediatric gastroenterologist.
Avoid using herbal products and other dietary supplements, including laxatives and enemas without first consulting your child’s doctor.
After encopresis treatment, it is very important to encourage your child to develop healthy bowel habits. The following tips can help your child:
- Eat fiber-rich foods: Encourage your child to consume a well-balanced diet along with incorporating whole grains, fresh fruits and vegetables, and other fiber-rich foods. These foods can help the stools become soft and easy to expel.
- Be well-hydrated: Being well-hydrated can soften the stool and keeps it from hardening. Let your child drink enough water and other fluids to avoid constipation that leads to encopresis.
- Limit the consumption of cow’s milk: Follow the recommendation of your child’s doctor when it comes to limiting cow’s milk consumption. Drinking cow’s milk has been linked to constipation. You can ask your child’s doctor on how much dairy and other dairy products you should give your child every day.
- Have a toilet training schedule: Let your child sit on the toilet for approximately 5-10 minutes at the same time daily. Your child can have toilet time after eating meals since the bowels tend to become more active after eating. Don’t forget to praise your child’s effort for following a schedule and sitting on the toilet.
- Use a footstool: Toilet posture can affect bowel movements. Using a footstool every bowel movement can make pooping easier.
- Be positive and encouraging: Use positive reinforcement and be patient with your child as he or she overcomes encopresis. Avoid blaming, giving punishments, or criticisms if your child has an accident, and offer support and unconditional love instead.
- Stick with the program: Developing normal and healthy bowel habits may take time. However, if you help your child stick with the program, relapses can be reduced.
Encopresis. (n.d.). Stanford Children's Health. https://www.stanfordchildrens.org/en/topic/default?id=encopresis-90-P01992
About Encopresis. (2018). Med.virginia.edu. https://med.virginia.edu/pediatrics/about/clinical-and-patient-services/patient-tutorials/chronic-constipation-encopresis/about-encopresis/
Encopresis (n.d.). Boston Children's Hospital. (2018). http://www.childrenshospital.org/conditions-and-treatments/conditions/e/encopresis
Encopresis: MedlinePlus Medical Encyclopedia. (2016). https://medlineplus.gov/ency/article/001570.htm
Soiling (Encopresis) (for Parents). (2018). https://kidshealth.org/en/parents/encopresis.html