Encopresis is involuntary “fecal soiling” in adults and children who have usually already been toilet trained. Persons with encopresis often leak stool into their undergarments.
The estimated prevalence of encopresis in 4-year-olds is approximately 1-3%. The disorder is thought to be more common in males than females, by a factor of 6 to 1.
Encopresis is commonly caused by constipation, by reflexive withholding of stool, by various physiological, psychological, or neurological disorders, or from surgery (a somewhat rare occurrence).
To diagnose encopresis, a physician or health care provider will examine your child, and obtain a medical history. Testing is usually not required but might include:
- Abdominal x-ray – a test to evaluate the amount of stool in the large intestine.
- Barium enema – a test that checks the intestine for blockage, narrow areas and other abnormalities.
Treatment for encopresis will be determined by your child’s physician based on:
- Your child’s age, overall health, and medical history
- Extent of the condition
- Cause of the condition
- Expectations for the course of the constipation
Treatment includes:
- Cleaning the hard stool out of the lower intestine
- Keeping bowel movements soft so the stool will pass easily
- Retraining the intestine and rectum to gain control over bowel movements
Your child’s physician will often prescribe medications to help keep your child’s bowel movements soft. This will help prevent stool impaction from occurring again. Please do not give your child stool softeners without the approval of a physician.
Often, making changes in your child’s diet will help constipation. Consider the following suggestions. Increase the amount of fiber in your child’s diet by:
- Adding more fruits and vegetables
- Adding more whole grain cereals and breads
- Encourage your child to drink more fluids, especially water
- Limit fast foods and junk foods that are usually high in fats and sugars and offer more well-balanced meals and snacks
- Limit drinks with caffeine, such as cola drinks and tea
- Limit whole milk to 16 ounces a day for the child over 2 years of age, but do not eliminate milk altogether; Children need the calcium in milk to help their bones grow strong
Plan to serve your child’s meals on a regular schedule. Often, eating a meal will stimulate a bowel movement within 30 minutes to an hour. Serve breakfast early so your child does not have to rush off to school and miss the opportunity to have a bowel movement.
Increasing the amount of exercise your child gets can also help with constipation. Exercise aids digestion by helping the normal movements the intestines make to push food forward as it is digested. People who do not move around much are often constipated. Encourage your child to go outside and play rather than watch TV or engage in other indoor activities.
Have your child sit on the toilet at least twice a day for 5-10 minutes, preferably shortly after a meal. Make this time pleasant; do not scold or criticize the child if they are unable to have a bowel movement. Giving stickers or other small rewards and making posters that chart your child’s progress can help motivate and encourage him/her.
Until the intestine and rectum regain their muscle tone, children may still have “accidents” and soil their underwear on occasion. Pre-school children may be able to wear a disposable training pant until they regain bowel control.
Taking a change of underwear and/or pants to school can help minimize your child’s embarrassment and improve his/her self-esteem as bowel control improves. Talk to school teachers about your child’s need to be able to go to the bathroom at any time. Many children prefer privacy in bathrooms and will avoid going to the bathroom at school.