Encopresis, soiling or leakage of stool, occurs mainly in those who are chronically constipated. It occurs in 2 out of 100 children.
Causes of Encopresis
Encopresis typically occurs in those with chronic constipation. Constipation can often occur from withholding of stool or bowel movement. The withholding leads to poor emptying of stool in the rectum and stretching out of the lower part of the intestines. The old, hard stool gets stuck in the rectum while newer, softer, watery stool leaks around the old stool and causes soiling. The stretched intestines have poor muscle and nerve tone and they don’t push out the stool well, which leads to more retained stool. Because the muscles and nerves are stretched, they don’t send the proper signals to let the child know the right time to have a bowel movement or even when they have soiled.
Children with behavioral or emotional issues can often have encopresis. Rarely, more significant medical problems can cause encopresis.
How Encopresis Presents
Typically, encopresis occurs around school aged children. They hold in poop for many days then pass large and hard stool. The stool can clog the toilet because it is so large. But sometimes they will also have very watery stool. This is the newer stool leaking around the old, harder stool.
Sometimes children refuse to poop in the toilet. They might hide their soiled clothes or underwear. Others will not even notice the feeling or smell of the leaking stool. Many children with encopresis will also have urine accidents. Read about the relationship between the poop and pee here.
Working with a Medical Provider to Treat Encopresis
A physical exam and history can usually be enough to diagnose encopresis. Getting a Xray of the abdomen (KUB) can help to evaluate the amount of stool and can be used to see progress.
Treatment involves a close relationship between the medical provider, caregiver and patient. There is often a lot of back and forth with figuring out which medications or supplements work for the child.
The goal is to keep the lower colon as empty as possible to allow the intestines to heal and shrink back to a normal size.
- Treatment with laxatives and stool softeners are often used.
- Suppositories or enemas can also be used to help clear out the poop in the lower colon.
- Timed sitting after meals to allow for full emptying with a foot stool is helpful.
- Additionally, pelvic floor physical therapy can be helpful.
Lastly, consistency, time and patience are needed in all involved with the process. It can sometimes take years to fully resolve encopresis. Regressions are common. But routine and hard will result in success.
Using Diet, Supplements, and other Behavioral Modifications to Treat Encopresis
Plenty of water drinking is important to treat constipation and encopresis. At least ½ of a child’s body weight (lbs) in ounces of water daily is recommended.
- Fruits and vegetables. Limit bananas.
- Whole grains, less white breads, pasta, crackers, and rice
- Avoiding too much dairy
- Avoid a “beige” diet. More naturally colorful foods – you should be eating a “rainbow” of foods.
- Limiting processed foods. Aim for foods in their original shape. If it comes in a package, it probably is not good for you.
Too much fiber without enough water can make constipation worse.
Probiotics, flax seed, chia seeds can be helpful for constipation
Magnesium and Vitamin C supplements can also help with constipation.
Sitting after meals for at least 10-15 minutes can help with a routine of passing adequate volumes of poop at the right time. The body has a natural reflex that allows for passage of stool after meals. Scheduling time for that and getting the body used to the sensation takes time. Using a kazoo or bubbles while sitting on the toilet can help with engaging the abdomen to push correctly to pass a bowel movement. Use a foot stool high enough to bring the knees above the hips.
Rewarding your child for the hard work and good days. No shaming or punishing for the soiling. It is not their fault.
Let the school and teachers know about the treatment plan and that the soiling can sometimes get worse before it gets better. It is okay for them to take a change of clothes to school. Have the clothing be like what they wore that day. Leave it with the nurse so they can change without making it obvious to others. Pre-school children can still use disposable underwear until the soiling improves.