Encopresis, also known as fecal incontinence or soiling, is a medical condition where a child, typically over the age of four and already toilet-trained, involuntarily passes stool into their clothing. This often occurs as an accident, and it is important to understand that it is not a behavioral choice or an act of defiance. Encopresis can be a distressing experience for both the child and their family, but effective treatments are available to help children regain bowel control and improve their overall well-being.
Understanding the Underlying Causes
Encopresis is primarily linked to chronic constipation in most cases. When a child experiences constipation, their stool becomes dry and hard, making bowel movements painful and difficult to pass. This discomfort can lead a child to intentionally withhold stool, which only worsens the problem by allowing more stool to accumulate in the colon and rectum.
Over time, the continuous accumulation of hardened stool stretches the rectum and large intestine, causing them to become enlarged. This stretching desensitizes the nerves in the rectum, reducing the child’s ability to feel the urge to have a bowel movement. As a result, softer or liquid stool from higher up in the intestine may leak around the impacted mass and soil the child’s clothing unnoticed. A proper medical diagnosis is necessary to confirm chronic constipation as the cause and to rule out other rare underlying medical conditions.
Clearing the Bowel
The initial step in treating encopresis is to clear the impacted stool from the bowel, a process known as disimpaction. This step is crucial because it removes the blockage that prevents regular bowel movements and allows the stretched rectum to begin returning to its normal size and sensitivity. Disimpaction should always be performed under the guidance of a medical professional.
Oral laxatives, such as polyethylene glycol (PEG), are commonly used for disimpaction due to their effectiveness and safety. These laxatives work by drawing water into the intestines, softening the stool and making it easier to pass. For severe impaction, enemas or suppositories may be administered rectally to help clear the lower bowel. Rarely, if constipation is very severe, a child might require hospitalization for a thorough bowel cleanout.
Establishing Healthy Habits
After initial bowel clearing, the focus shifts to long-term management strategies to prevent re-impaction and promote regular, soft bowel movements. This phase involves consistent routines, dietary adjustments, and continued use of maintenance medications. The goal is to retrain the bowel to recognize and respond to the natural urge to defecate.
A consistent daily routine includes scheduled toilet sitting for 5-10 minutes, 15-30 minutes after meals. This timing takes advantage of the gastrocolic reflex, a natural intestinal contraction after eating, to stimulate a bowel movement. Proper posture on the toilet, with feet supported, also helps facilitate easier stool passage. Maintenance laxatives, such as mineral oil or PEG, are often prescribed to keep stools consistently soft and prevent them from hardening again.
Dietary recommendations include increased fiber intake through fruits, vegetables, and whole grains. Adequate fluid consumption is equally important, as it helps prevent stools from becoming dry and hard. These dietary changes, along with sufficient hydration, contribute to the formation of soft, easy-to-pass stools. Positive reinforcement strategies, such as sticker charts or small rewards for successful toilet sittings or clean days, can encourage a child’s compliance and motivation throughout this lengthy treatment process.
Supporting Emotional Well-being
Encopresis can have a significant emotional and psychological impact on both the child and their family. Children may experience shame, embarrassment, anxiety, and low self-esteem due to involuntary soiling. Parents and caregivers should avoid expressing anger, blame, or punishment, as this can worsen the child’s emotional distress and hinder progress.
Creating a supportive and understanding environment is important for the child’s emotional recovery. Open communication about the condition, emphasizing that it is a medical problem and not the child’s fault, can help reduce feelings of guilt. For children with prolonged encopresis or significant emotional challenges, professional psychological support, such as counseling or therapy, may be beneficial. This support helps children cope with anxiety, address behavioral issues, and develop healthier self-perceptions.