Encopresis is a problem that children can develop due to chronic constipation. With constipation, children have fewer bowel movements than normal, and the bowel movements they do have can be hard, dry and difficult to pass. Once a child becomes constipated, a vicious cycle can develop.
The child may avoid using the bathroom to avoid discomfort. Stool can become impacted and unable to move forward. The rectum and intestine become enlarged due to the hard, impacted (backed up) stool. Eventually, the rectum and intestine have problems sensing the presence of stool, and the anal sphincter (the muscle at the end of the digestive tract that helps hold stool in) loses its strength. Liquid stool can start to leak around the hard, dry, impacted stool, soiling a child's clothing.
For unknown reasons, boys develop encopresis six times more than girls do. Any child with chronic constipation may develop encopresis. Some of the situations that lead to constipation include:
- Eating a high-fat, high-sugar, "junk-food" diet
- Drinking mainly soft drinks and sugared drinks
- Lack of exercise
- Reluctance to use public bathrooms
- Stress in the family, with friends or at school
- Being too busy playing to take time to use the bathroom
- Change in bathroom routine, such as when a child is adapting to fewer bathroom breaks in a structured situation, like school
Encopresis can cause both physical and emotional problems. Impacted stool in the intestine can cause abdominal pain, as well as loss of appetite. Some children develop bladder infections. Other health problems may cause chronic constipation, including diabetes, hypothyroidism, Hirschsprung disease and inflammatory bowel disease.
What Are the Symptoms of Encopresis?
The following are the most common symptoms of encopresis. However, each child may experience symptoms differently. Symptoms may include:
- Loose, watery stools
- Involuntary stooling, or needing to have a bowel movement with little or no warning, which may soil underwear when a child cannot get to the bathroom in time
- Scratching or rubbing of the anal area due to irritation by watery stools
- Withdrawal from friends, school, and/or family
How Is Encopresis Diagnosed?
A physician or healthcare provider will examine your child, and obtain a medical history. Imaging tests may also be done to evaluate the intestine and rule out other health problems.
These tests may include:
- Abdominal X-ray - a diagnostic 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. Barium, a fluid that shows up well on x-ray, is given as an enema, and then the intestine is viewed with an x-ray.
What Is the Treatment for Encopresis?
Specific treatment for encopresis will be determined by your child's physician based on the following:
- The extent of the problem
- Your child's age, overall health, and medical history
- The opinion of the physicians involved in the child's care
- Your opinion or preference
Treatment for encopresis may include:
- Removing the impacted stool.
- Keeping bowel movements soft so the stool will pass easily.
- Retraining the intestine and rectum to gain control over bowel movements.
- An enema may be prescribed by your child's physician to help remove the impacted stool. An enema is a liquid that is placed in your child's rectum and helps loosen the hard, dry stool. (DO NOT give your child an enema without the approval of a physician or healthcare provider.) Your child's physician will often prescribe medications to help keep your child's bowel movements soft for several months. This will help prevent stool impaction from occurring again. Please do not give your child stool softeners without the approval of a physician.
- Diet changes. 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 (check the nutritional labels on food packages for foods that have more fiber).
- Offer your child fruit juice instead of soft drinks.
- 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.
- Increase exercise. Exercise aids digestion by helping the normal movements the intestines make to push food forward as it is digested.
- Proper bowel habits.
- Have your child sit on the toilet at least twice a day for at least 10 minutes, preferably shortly after a meal. Giving stickers or other small rewards, and making posters that chart your child's progress can help motivate and encourage them.
If these methods do not help, or if your physician notices other problems, they may recommend laxatives, stool softeners or an enema. These products should only be used with the recommendation of your child's physician. Do not use them without consulting your child's physician first.
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 their self-esteem as bowel control improves.
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