Encopresis

What is encopresis?

Encopresis is a problem that children age four or older can develop due to chronic (long-term) 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. The child may avoid using the bathroom to avoid discomfort. Stool can become impacted (packed into the rectum and large intestine) and unable to move forward. The rectum and intestine become enlarged due to the hard, impacted 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.

Which children develop encopresis?

Any child with chronic constipation may develop encopresis. Some of the situations that lead to constipation include the following:

• Eating a high-fat, high-sugar, "junk-food" diet
• Drinking mainly soft drinks and sugared drinks, and not drinking enough water and fruit juices
• 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 starts a new school year and bathroom breaks are less frequent than they were over the summer

For unknown reasons, boys develop encopresis six times more than girls. Family stress can be linked to constipation, there does not seem to be any association between developing encopresis and how many children are in a family, a child's birth order (for example, first, middle, or last), a child's age, or the family's income.

Why is encopresis of concern?

Encopresis can cause both physical and emotional problems.

Impacted (backed up) stool in the intestine can cause abdominal pain, as well as loss of appetite. Some children may develop bladder infections.

Other health problems may cause chronic constipation, including diabetes, hypothyroidism, Hirschsprung's Disease, and inflammatory bowel disease.

Children with encopresis can certainly feel emotionally upset by the "accidents" they have when they soil their clothes. They usually do not have control of this leakage of stool. Their self-esteem and interactions with other people can be affected. Children are often ashamed or embarrassed. They may avoid going to school, playing with friends, or spending the night away from home. Parents may feel guilt, shame, anger, or distaste by the problem.

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
• Hiding their underwear

Symptoms of encopresis may resemble other conditions or medical problems. Please consult your child's doctor for a diagnosis.

How is encopresis diagnosed?

A doctor or other health care 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 obstruction (blockage), strictures (narrow areas), and other abnormalities. A fluid that shows up well on X-ray, called barium, is given as an enema, and then the intestine is looked at with an X-ray.

What is the treatment for encopresis?

Specific treatment for encopresis will be determined by your child's doctor based on the following:

• The extent of the problem
• Your child's age, overall health, and medical history
• The opinion of the health care providers involved in the child's care
• Your opinion or preference

Treatment for encopresis may include:

• Removing the impacted stoolk
• 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 doctor 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 doctor or other health care provider.)

Your child's doctor 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 doctor.

Dietary 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)

What are good fiber sources?

Here are other dietary ideas:

• 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 2 years of age and older, 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.

Other suggestions:

• Increase exercise. Increasing the amount of exercise your child gets can also help with constipation. Exercise aids digestion by helping the normal movements the intestines make to push food forward as it is digested. People who do not move around much are often constipated. Encourage your child to go outside and play rather than watch TV or engage in other indoor activities.
• 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. Make this time pleasant; do not scold or criticize the child if they are unable to have a bowel movement. Giving stickers or other small rewards, and making posters that chart your child's progress can help motivate and encourage him/her.
  
  If these methods do not help, or if your doctor notices other problems, he or she may recommend laxatives, stool softeners, or an enema. These products should ONLY be used with the recommendation of your child's doctor. DO NOT use them without consulting your child's doctor first.
  
  Until the intestine and rectum regain their muscle tone, children may still have "accidents" and soil their underwear on occasion. Preschool 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 his or her self-esteem as bowel control improves.

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Online Resources of Digestive & Liver Disorders