Encopresis

In the medical literature, encopresis is defined as the " the repeated passage of feces into inappropriate place (in clothing or on the floor) whether involuntary or intentional. For our purposes we limit the discussion to the involuntary elimination of stool into the underwear. This type of encopresis differs from fecal staining, which commonly results when a child does not wipe himself well enough after defecating.

Most cases of encopresis are associated with constipation accompanied by what we call overflow incontinence. It can result from a vicious cycle:

1- Children who are constipated may experience pain at defecation and start holding their stool. The more they withhold their stool, the more constipated they become.

2- When children are fecally impacted, the stool in the colon ca become dry and hard as a rock, and the colon becomes large and distended. This distention stretches the linings of the colon so that the muscles and nerves of the colon get stretched out, so that the child may have difficult expelling contained stool (because of weak bowel muscles), lose the sensation of the urge to defecate (perhaps related to poor bowel nerve function) or both.

3- Newly formed stool, which is watery, cannot push its way through the hard, dry stool and consequently the liquid seeps around it and out.

4- The underwear becomes stained with stool that is usually soft and unformed. Thus, parents may mistakenly conclude that their child is not constipated, and do not initiate treatment.

Parents often complain that they do not understand how their child could not smell or feel the stool coming out. The answer is that in addition to the reduced sensation of the stretched bowel, children are so used to the smell of bowel movements that they become desensitized to it.

In order to treat encopresis, first the hard stool must be removed, usually with an enema. The initial clean out is essential. At the same time, the child must begin a regular stool program, including a high fiber diet, fluids a stool softener and stimulant, and sufficient exercise. In time, the colon likely will return to its normal size, and normal sensation will resume as defecation becomes regular.

Treating encopresis can take several months, it must be done aggressively and conscientiously to prevent recurring constipation and impaction. Children who are resistant to regular toileting-sitting program can be motivated with small rewards.

We recommend that some children older than the age five or six be responsible for scrubbing out their own soiled underwear before placing them in the laundry. (a parent should demonstrate how to do it the first time) Again, stress to your child that this is not intended as punishment. It is meant to give the child a sense of independence and responsibility, and to increase the child's motivation to defecate in the toilet.