Understanding Encopresis (Fecal Soiling)

November 21, 2009

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Understanding Encopresis (Fecal Soiling)

by Robert Needlman, M.D., F.A.A.P.
reviewed by Robert Needlman, M.D., F.A.A.P.

When children who are toilet trained have bowel movements in their clothing, parents and children often find it terribly difficult to handle. There is so much shame associated with being "a baby" or being "dirty," and parents often believe (falsely) that the problem is a symptom of deep psychological disturbance and therefore their fault (it isn't).

Usually the problem has been going on for a long time before the parents, in desperation, bring it to the doctor's attention. Often both parents and child feel helpless. It's even hard to talk about this problem. None of the words for the solid waste we all produce feels comfortable: "stool" sounds like something to sit on; "feces" sounds like something an animal makes; and "BM" sounds babyish, not to mention "poop," "boo-boo," and "number two."

Call it what you will--I prefer BM because it's short--when a school-age child can't put his BMs in the right place (that is, the toilet), it's a major behavioral and physical challenge. The medical term for this problem is encopresis, or fecal soiling. There are two main varieties: primary encopresis, in which the child has never achieved bowel control; and secondary encopresis, where the child had established control for at least six months but then lost it. Typically, the BM that is passed is large, hard, and painful. But it also can be a runny liquid that comes out without being noticed. What the BMs usually aren't is normal in size and consistency.

The details of encopresis
Here, in a nutshell, are the key facts about encopresis. Other articles in this section go into more detail about how it comes about and how it can be treated.

In most cases, encopresis starts out as constipation. So it's crucial to understand constipation if you want encopresis to get better.

Most of the time, the psychological problems of children with encopresis are the result of their physical problem, not its cause. (There are a very few children with psychological disorders who deposit normal BMs in inappropriate places. In these cases, there are always other symptoms that point to the mental health problem.)

Treatment for encopresis involves two processes: teaching the child to understand what is happening inside his body (and also, to understand that he is not to blame), and treating the underlying constipation

Treating constipation requires changes in the child's diet (increasing fiber, for example) and behavior (learning new toilet-sitting techniques). It also usually requires cleaning out the colon with laxatives and often prolonged laxative use to keep the stools very soft and regular, while the colon recovers its strength. One word of caution: This should never be done without a doctor's supervision.

Most important, for treatment to be effective, the child has to be willing to work hard to take control over his bowel function. He has to believe that he can succeed. And he has to stick to it. With help from parents--who understand that this is, fundamentally, the child's problem to fix--and an experienced doctor, encopresis can be overcome. In follow-up studies, about 50 to 75 percent of children report normal or near-normal bowel function.

As with other chronic medical problems, encopresis can bring a hidden benefit: When children learn to take control of their bodies, they gain the self-confidence and maturity that comes from facing a problem head on and working to find a solution.


RELATED INFORMATION

			Anticonstipation Diet
			Encopresis

Created May 25, 2001
Reviewed August 15, 2004

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