Diseases & Conditions

Encopresis

Encopresis occurs when your child resists having bowel movements, causing impacted stool to collect in the colon and rectum. When your child's colon is full of impacted stool, liquid stool can leak around the impacted stool and out of the anus, staining your child's underwear. Encopresis may also be called stool holding.

Encopresis usually occurs after age 4, when your child has already learned to use a toilet. In most cases, encopresis is a symptom of chronic constipation. Less frequently, it may be the result of developmental or emotional issues.

Encopresis can be frustrating for you — and embarrassing for your child. However, with patience and positive reinforcement, treatment for encopresis is usually successful.

Signs and symptoms of encopresis may include:

• Leakage of stool or liquid stool on your child's underwear. If the amount of leakage is large, you may misinterpret it as diarrhea.
• Constipation with dry, hard stool.
• Passage of large stool that clogs or almost clogs the toilet.
• Avoidance of bowel movements.
• Lack of appetite.
• Abdominal pain.

When to see a doctor
Call your doctor if your child is older than age 4, is toilet trained and is exhibiting one or more of the symptoms listed above.

Your child's doctor will ask about the symptoms. The doctor also may conduct a physical examination, including a digital rectal examination to check for impacted stool. During this exam, the doctor inserts a lubricated, gloved finger into your child's rectum while pressing on his or her abdomen with the other hand.

Your child's doctor also may recommend an abdominal X-ray to confirm the presence of impacted stool.

If the cause of encopresis is not a physical issue related to the colon, the doctor may recommend a psychological evaluation to help determine the cause.

A child who has encopresis may experience a range of emotions, including embarrassment, frustration, shame and anger. If your child is teased by friends or chastised by adults, he or she may feel depressed or have low self-esteem.

Early treatment, including spending time with a mental health professional, can help prevent the social and emotional impact of encopresis.

Treatment of encopresis focuses on clearing the colon of retained, impacted stool and encouraging healthy bowel movements. This includes training your child to go to the toilet as soon as reasonably able when the urge to defecate occurs.

There are several methods for clearing the colon and relieving constipation. Your child's doctor will likely recommend one or more of the following:

• Stool softeners, such as lactulose
• Colon lubricants, such as mineral oil
• Rectal suppositories
• Enemas
• More fluids

Your child's doctor may recommend abdominal X-rays to check the progress of the colon clearing.

Once the colon has been cleared, it's important to encourage your child to have regular bowel movements. In addition to recommending self-care measures such as a high-fiber diet, your child's doctor may recommend the use of stool softeners for six to 12 months.

Psychotherapy
If your child feels shame, guilt, depression or low self-esteem related to encopresis, psychotherapy can be helpful. A psychologist can help your child deal with these feelings and may also give you techniques for teaching your child not to hold stool. Ask your child's doctor for a recommendation.

Once your child has been treated for encopresis, it's important that you take steps to encourage softer stools and regular bowel movements. The following tips can help:

• Focus on fiber. Feed your child a diet that includes plenty of fruits, vegetables and foods high in fiber. Offer whole grains, which are brown — not white — in color.
• Push fluids. Encourage your child to drink plenty of water.
• Limit dairy products and fats. These can inhibit bowel movements.
• Set a schedule. Adopt regular mealtimes and bedtimes.
• Arrange bathroom time. Have your child spend three minutes alone on the toilet after one meal each day trying to have a bowel movement. This applies only to children who are toilet trained and are at least 4 years old.
• Stick with the program for several months. The relapse rate for encopresis is high.

As you help your child overcome encopresis, be patient and use positive reinforcement. Don't blame, criticize or punish your child if he or she has an accident. Instead, offer your unconditional love and support.