Encopresis

Encopresis

Definition:

Encopresis occurs when your child resists having bowel movements, causing impacted stool to collect in the colon and rectum. When your child's colon is full of impacted stool, liquid stool can leak around the impacted stool and out of the anus, staining your child's underwear. Encopresis may also be called stool holding.

Encopresis usually occurs after age 4, when your child has already learned to use a toilet. In most cases, encopresis is a symptom of chronic constipation. Less frequently, it may be the result of developmental or emotional issues.

Encopresis can be frustrating for you — and embarrassing for your child. However, with patience and positive reinforcement, treatment for encopresis is usually successful.

Symptoms:

Signs and symptoms of encopresis may include:

• Leakage of stool or liquid stool on your child's underwear. If the amount of leakage is large, you may misinterpret it as diarrhea.
• Constipation with dry, hard stool.
• Passage of large stool that clogs or almost clogs the toilet.
• Avoidance of bowel movements.
• Long periods of time between bowel movements, possibly as long as a week.
• Lack of appetite.
• Abdominal pain.
• Repeated urinary tract infections.

When to see a doctor
Call your doctor if your child, who is older than age 4 and already toilet trained, begins exhibiting one or more of the symptoms listed above.

Causes:

There are several causes of encopresis. The most common are:

• Constipation. Most cases of encopresis are the result of chronic constipation. In constipation, the child's stool is hard, dry and may be painful to pass. As a result, the child avoids going to the toilet — making the problem worse. The longer the stool remains in the colon, the more difficult it is for the child to push stool out. The colon stretches, ultimately affecting the nerves that signal when it's time to go to the toilet. When the colon becomes too full, soft or liquid stool may leak out.
  
  Common causes of constipation include eating too little fiber, not drinking enough fluids or consuming an excess of dairy products. Sometimes, a child with a cow's milk intolerance may experience constipation, although milk intolerance causes diarrhea more often than constipation.
  
  
• Emotional issues. Emotional stress also may trigger encopresis. A child may experience stress from premature toilet training or an important life change — for instance, the divorce of a parent or the birth of a sibling.

Complications:

 A child who has encopresis may experience a range of emotions, including embarrassment, frustration, shame and anger. If your child is teased by friends or chastised by adults, he or she may feel depressed or have low self-esteem.

Early treatment, including spending time with a mental health professional, can help prevent the social and emotional impact of encopresis.

Treatments and drugs:

Generally, the earlier treatment begins for encopresis, the better. The first step in treatment focuses on clearing the colon of retained, impacted stool. After that, treatment includes encouraging healthy bowel movements. This includes training your child to go to the toilet as soon as reasonably able when the urge to defecate occurs.
There are several methods for clearing the colon and relieving constipation. Your child's doctor will likely recommend one or more of the following:

• Stool softeners, such as lactulose
• Colon lubricants, such as mineral oil
• Rectal suppositories
• Enemas
• More oral fluids

Your child's doctor may recommend abdominal X-rays to check the progress of the colon clearing.
Once the colon has been cleared, it's important to encourage your child to have regular bowel movements. In addition to recommending self-care measures such as a high-fiber diet, your child's doctor may recommend the use of stool softeners for six months or more.

Psychotherapy
If your child feels shame, guilt, depression or low self-esteem related to encopresis, psychotherapy can be helpful. A psychologist can help your child deal with these feelings and may also give you techniques for teaching your child not to hold stool. Ask your child's doctor for a recommendation.