Encopresis, sometimes called fecal incontinence or soiling, is the repeated passing of stool into clothing. Typically it happens when impacted stool collects in the colon and rectum: the colon becomes too full and liquid stool leaks around the retained stool, staining underwear. Eventually, stool retention can cause swelling of the bowels and loss of control over bowel movements. Encopresis usually occurs after age 4, when the child has already learned to use a toilet. In most cases, soiling is a symptom of chronic constipation. Less frequently it occurs without constipation and may be the result of emotional issues. Encopresis can be frustrating for parents — and embarrassing for the child. However, with patience and positive reinforcement, treatment for encopresis is usually successful.
Causes
Most encopresis cases are due to constipation. The stool is hard, dry, and difficult to pass when a person is constipated. Many kids hold their BMs to avoid the pain they feel when they go to the bathroom, which sets the stage for having a poop accident. So to understand encopresis, it's important to understand constipation. There's a wide range of normal when it comes to having a BM. "Normal" pooping might range from one or two BMs per day to only three or four per week. A child who passes a soft, medium-sized BM without any problems every 3 days is not constipated. But a child who passes a hard BM (small or large) every other day is.
Symptoms
Pediatric gastroenterologists indicate that symptoms of constipation generally involve six characteristics of abnormal stooling present in infants and toddlers for at least one month and children 4 to 18 years of age for two months. A minimum of two criteria must be present to fulfill the definition of constipation. These stooling patterns/problems include the following:
- Two or fewer bowel movements per week
- One episode of stool incontinence after mastering toilet-training skills
- A history of excessive stool retention which may be accompanied by characteristic retentive posturing in older children
- A history of passage of painful or hard bowel movements
- Palpation of a large mass of stool in the rectum during digital rectal exam
Treatment
- Avoid constipation - Help your child avoid constipation by providing a balanced diet that's high in fiber and encouraging your child to drink enough water.
- Learn about effective toilet training techniques - Educate yourself on effective toilet training techniques. Avoid starting too early or being too forceful in your methods. Wait until your child is ready, and then use positive reinforcement and encouragement to help make progress. Ask your doctor about resources on toilet training.
- Get early treatment for encopresis - Early treatment, including guidance from your child's doctor or mental health professional, can help prevent the social and emotional impact of encopresis. Regular follow-up visits with your doctor can help identify ongoing or recurring problems so that adjustments in treatment can be made as needed.
Diet and exercise are extremely important in keeping stools soft and BMs regular. Also, make sure your child gets plenty of fiber-rich foods such as fresh fruits, dried fruits like prunes and raisins, dried beans, vegetables, and high-fiber bread and cereal. Whatever you do, don't blame or yell — it will only make your child feel bad and it won't help manage the condition. With lots of love, support, and reassurance that he or she isn't the only one in the world with this problem, your child can overcome encopresis in no time.
