What is Encopresis?
Encopresis is defined as the voluntary or involuntary passage of stools (feces) in inappropriate places causing soiling of clothes by a child aged four or over. It is also know as overflow incontinence, bowel incontinence, soiling, fecal soiling and fecal incontinence.
Encopresis is fairly common in children and toddlers; 1-3% of children over the age of four are known to have encopresis and encopresis is more common in boys than it is in girls.....
The information presented here are general guidelines and are meant to provide you the parent with some knowledge and information, so that you can have a more informed conversation with your physician or your child's pediatrician.
Types of Encopresis.
There are two types of Encopresis:
- Retentive Encopresis
- About 80-95% of all cases are retentive encopresis and have a physiological or medical reason for soiling.
- Non Retentive Encopresis
- The other 5-20% of the cases seem to have an emotional or non physical reason for soiling.
Causes of Retentive Encopresis
Retentive Encopresis frequently results from chronic constipation, which over time results in fecal impaction and in leakage of soft or liquid stool accumulated around the impacted stool .... Causes of NONRetentive Encopresis
There maybe several reasons or causes for Nonretentive Encopresis.
While 99% of the cases of non retentive encopresis do not have an organic / medical basis, however the 1% of the cases do.....
Treatment for Retentive Encopresis
The optimal treatment regiment fro encopresis involves both a a medical and a behavioral approach. If a pediatrician makes a diagnosis of retentive encopresis, the physician my recommend laxatives, stool softeners and or an enema to remove the fecal impaction. The goal is prevent constipation and encourage good bowel habits. A stool softener is often prescribed. Children should eat a high fiber diet with lots of whole grains, fruits and vegetables. Large amount of water and regular exercise can help with softer stools and decrease the discomfort associated with bowel movements.
Parents should be supportive and should refrain from criticism or discouragement. Children can be taught to not feel ashamed of the toileting behaviors and psychotherapy can help decrease the sense of shame, guilt and or loss of self esteem that children may feel. For the really tough cases, pediatric gastroenterologists use a behavioral method involving biofeedback and video presentations to retrain children who contract, rather than relax their external sphincter muscles during an attempt to make a bowel movement. This method teaches the child the to strain while keeping his anal canal open.
Treatment for NONRetentive Encopresis
In the absence of fecal impaction or chronic constipation, the pediatrician may have to engage an pediatric psychiatrist or a behavioral counselors to determine the underlying cause of the nonretentive encopresis. Once the cause is determined, the psychiatrist, psychologist or behavioral counselors can decide on the specific treatment options.
For the 1% of nonretentive cases that are organically or medically based, the pediatrician would have to engange the appropriate specialist in those area for treatement options.
For the child that may not be developmentally ready for potty training (see child readiness section), the best option is to allow the child to mature physiologically, as well as cognitively, emotionally and socially. The child can also be taught the necessary motor and verbal skills required to for potty training.
For children with disruptive behaviors and childhood noncompliance across mutliple settings (e.g. dressing, bath time, bed time, eating etc.); the larger context of the child's behaviors have to be addressed before attempting toilet training. A child has to be cooperative and compliant to adult instructions for successfully potty training and bowel movement training. A pediatrick behaviral psychologist would be best for determining the treatement options.
Many children with nonretentive encopresis have a history of painful defecation, toilet phobia or toilet refusal behavior. What drives these children is fear. So the treatment for these children to address their fear.
Start by keeping a diary or a journal or chart of your child eliminations - both urination and bowel movements . Do this for 1-2 weeks. Log the time when he urinates or has a bowel movement and where he eliminated i.e did he do in the toilet, in his bed, in his underpants etc. If your child is day care during the day, ask the teacher to look for patterns in your child's toileting behavior. Positive toilet sits are one strategy to help children overcome their negative association of the bathroom. The goal of positive toilet sits is to have the child associate the bathroom and the toilet with a positive and enjoyable experience. The startegy is schedule 3-5 sits per day at the family's convenience. Initially, the sites are very short (i.e. 30 seconds) and then gradually increase the sits to a maximum of 5 minutes. The child can remain in his underpant or diapers and there should be not expecatation of producing a bowel movement. The child is encouraged to sit on the toilet, while comfortably resting his feet on a step stool and enjoys relaxing one on one activity with a parent such as reading or singing or talking.
If the child is extremely resistant to approaching the bathroom or the toilet, then the parents should employ the gradual shaping method. The parents start by modeling the appropriate toileting behavior for the child and after a few days of this, the parents should start playing games or reading books with the child near the bathroom. The parent and child should gradually progress to where the child is sitting on the potty chair or the toilet for longer periods of time.
While the parents are working on positive toilet sits and positive association, it is critical to ensure that the child is having relatively frequent, soft and well formed bowel movements beofre engaging in any intervention for soiling.
Dietary changes, use of supplements such as flavored fiber drinks, bran sprinkles, prunes, prune juice etc may be needed to increase the number of bowel movements.
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