Encopresis: Understanding and Overcoming Stool Soiling

What is it Stool Soiling?

Stool soiling is a condition that occurs after most children have been potty trained and have control of their bowels, typically over the age of 4 years. Stool soiling is three to six times more common in boys than in girls and affects 1-2 percent of kids under the age of 10 years. (1)

If the soiling is not caused by a physical illness or disability, it is called encopresis. “Children with encopresis may have other problems, such as short attention span, low frustration tolerance, hyperactivity and poor coordination.” (2)

What Causes Stool Soiling?

“Most encopresis cases (90%) are due to functional constipation—that is, constipation that has no medical cause.” (1) This constipation is most likely the result of stool withholding — that is, your child isn’t fully emptying his/her rectum when he/she uses the toilet or not emptying at all.

There could be different reasons for this including fear of the pain that comes with having a bowel movement, not waiting long enough on the toilet to have a bowel movement.

Stressful changes in the child’s life, such as the birth of a sibling, separation/divorce of parents, family problems, or a move to a new home or school may also be factors.

So long as the poop isn’t completely cleaned out, what remains in the rectum becomes harder and it is harder to push the large, dry poop out. The large poop also stretches out the colon, weakening the muscles and affecting the nerves that tell a child when it’s time to go to the bathroom.

Eventually, the rectum and lower part of the colon become so full that the sphincter (the muscular valve that controls the passage of feces out of the anus) can no longer hold the poop in, resulting in partial BMs and the child soiling his or her pants.

Softer poop may also leak out around the large mass of feces and stain the child’s underwear. The child cannot prevent the soiling and is often completely unaware that it’s happening because the nerves that would tell him/her about the need for a bowel movement aren’t working properly. (1)

Call the doctor if your child shows any of the following symptoms:

• Poop or liquid stool in the underwear when your child isn’t ill

• Hard poop or pain when having a BM

• Toilet-stopping BM

• Abdominal pain

• Loss of appetite

source: kidshealth.org

What is the Treatment for Stool Soiling?

[M]any people mistakenly believe that encopresis is a lack of self-control or laziness issue and punish a child for it, but this will only increase the pooping difficulties, as well as increase the chances for low self-esteem.

“Up to 20% of kids with encopresis experience feelings of low self-esteem that require the intervention of a psychologist or counselor.” (1)

“Although most children with soiling do not have a physical condition, they should have a complete physical evaluation by a family physician or pediatrician.” (2)

Treatment is usually carried out in three phases described by kidshealth.org:

1. The first phase involves emptying the rectum and colon of hard, retained poop using mineral oil (stool softener) and/or laxatives or enemas depending on the child’s age and other factors. Never give laxatives or enemas to your child at home without first talking to your doctor.

2. The second phase involves the resetting of your child’s BM schedule once the large intestine is empty. This will usually include the help of stool softeners and daily scheduled potty time, usually after meals when the bowels are naturally stimulated. The goal of this is to give the bowels a chance to shrink back to normal size.

3. The third phase will involve a reduction in the use of stool softeners as bowel movements become more regular.

“Keep in mind that relapses are normal, so don’t get discouraged if your child occasionally becomes constipated again or soils his or her pants during treatment….” (1)

“Patience is the key to treating encopresis. It may take anywhere from several months to a year for the stretched-out colon to return to its normal size and for the nerve in the colon to become effective again.” (1)

Sources:

1) Encopresis (Soiling). KidsHealth.org. Web. Mar 25, 2013.
http://kidshealth.org/parent/general/sick/encopresis.html#

2) Facts for Families: Problems with Soiling and Bowel Control. American Academy of Child and Adolescent Psychiatry. Web. Mar 25, 2013.
http://aacap.org/page.ww?name=Problems+With+Soiling+and+Bowel+Control&section=Facts+for+Families

3) Fecal Soiling. Silberstein, Warren P. Mindspring.com. Web. Mar 25, 2013.
http://www.mindspring.com/~drwarren/encopres.htm

Reviewed March 25, 2013
by Michele Blacksberg RN
Edited by Jody Smith

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• Emotional Health
• Parenting
• Wellness