Encopresis (not being able to control bowel movements properly) means a child passes stool into his underpants or some other inappropriate place instead of the toilet. In most children with encopresis, the problem is caused by chronic constipation (too long a time between bowel movements). When the intestine (bowel) needs to be emptied, a large chunk of stool collects in the lower bowel (rectum). This causes the bowel wall to become stretched out. This feeling of the bowel being stretched is what normally makes us realize we have to go to the bathroom.
However, if the bowel wall is stretched for a long time between bowel movements and loses its normal muscle tone and feeling, then it becomes harder and harder to pass the enlarging chunk of stool, creating an unhealthy cycle. As newer stool is produced in the intestines, some of it leaks around the large chunk of hard stool, passes out of the rectum, and soils the child's underpants with a foul-smelling liquid or paste. In almost all children with encopresis due to constipation, fecal (stool) soiling is not done on purpose. In fact, some children do not even realize that the stool has leaked out. The first embarrassing clue to the problem may come when someone notices that the child "smells bad."
Common causes of chronic constipation include:
- Problems related to toilet training. Some young children try hard not to have bowel movements as a way of being in control of the toilet-training process. This is most common when parents have started the toileting process too early or if they push their child too hard to be toilet trained. It can also happen when toilet training overlaps with another stress in the family, such as the arrival of a new baby.
- Diet. If a child's diet has too little fiber (fruits, vegetables, whole grains) or too much of certain types of food that tend to cause constipation (whole milk, cheese, bananas, white rice, white bread), he may become constipated.
- Not enough liquids by mouth. Children need to drink enough liquid to keep their stools soft. Aim for four to six glasses of liquid each day and more in hot weather.
- Not enough exercise. Exercise helps to get the intestines (bowels) moving, so that stool passes through more easily and quickly. Some children who spend too much time sitting (watching television or playing on the computer) become constipated.
- Being afraid to go to the bathroom. If a child is afraid to use a toilet away from home (for example, at school, summer camp or a friend's house), he may become constipated.
- Ignoring the feeling (urge) to have a bowel movement. Some children ignore the urge to go to the bathroom because they are too busy (for example, playing a game or watching television) or may be afraid at school to ask for permission to leave class to use the restroom.
In addition to soiled underpants, children with encopresis may have very large bowel movements (sometimes large enough to clog the toilet), streaks of blood on the outside of the bowel movement (stool), spots of blood on the toilet tissue after wiping, belly pain, or bed-wetting.
Encopresis can be difficult to treat and should be discussed with your child's doctor. Do not give your child suppositories or enemas unless recommended by your doctor. In general, treatment involves clearing the bowel of the large amount of hard stool, preventing the return of constipation and teaching normal bowel habits. Treatment may involve medications in addition to changes in diet and toileting behavior.
To help prevent encopresis caused by chronic constipation, you can:
- Increase the amount fiber in the diet. Your child's doctor can help to guide you.
- Increase the amount of liquids he drinks.
- Be careful not to give too many constipating foods. Children older than the age of 2 should drink low-fat or nonfat milk (which is usually less constipating than whole milk) and generally do not need more than 16 ounces of milk per day.
- Increase the amount of exercise each day. Limit the time your child spends watching television or using the computer; encourage your child to be physically active.
- Encourage your child to use the toilet whenever he feels the urge to have a bowel movement. Change your daily routine if necessary to make time for this important activity. For example, if your child usually feels like going to the bathroom 20 to 30 minutes after breakfast, but doesn't because there isn't time before leaving the house for school, set an alarm clock to wake up earlier.
Most children with encopresis either outgrow the problem or respond to medication and motivational therapy. However, occasional accidents may still happen. Parents should never punish a child for soiling his pants. Try not to show disgust or disappointment as you change your child's soiled clothing. It is important that you always remain calm and casual, and support your child through this challenging time.