If you’re a parent of a child with encopresis, you don’t have to imagine the psychological impact of encopresis on you and your child. You can’t send your child to school without dreading the possibility of your child passing stool in class or on the playground. You find excuses for your child not to go to friends’ houses for sleepovers. You dread answering the phone when your child is away from home, expecting it to be a call about your son or daughter having “an accident.” You see the frustration, anguish, and shame on your child’s face, as the harder they try to control their bowel movements the more they fail.
To make the situation worse, encopresis is a condition nobody likes to disclose or discuss, so families often become increasingly isolated. If you do venture to discuss your situation, you become the cause — other parents unfamiliar with encopresis will assume that you did something wrong when potty training your child. You’re likely to get plenty of unwelcome parenting advice on how to reward your child when he uses the potty and how to enforce consequences when he soils himself — as if soiling oneself isn’t consequence enough! Even some doctors fail to fully understand the problem or provide parents the valuable understanding, insight, and guidance they need to meet the challenge.
We’re here to help. Here we bring you up to speed on encopresis — symptoms, causes, and cures.
Symptoms of Encopresis
The most obvious symptom of encopresis is the soiling of oneself. Other symptoms, according to the Mayo Clinic, include the following:
- Leakage of stool or liquid stool on underwear, which can be mistaken for diarrhea
- Constipation with dry, hard stool
- Passage of large stool that clogs or almost clogs the toilet
- Avoidance of bowel movements
- Long periods of time between bowel movements
- Lack of appetite
- Abdominal pain
- Problems with daytime wetting or bedwetting (enuresis)
- Repeated bladder infections, typically in girls
As we point out in a previous post, “10 Tips for More Predictable Poops,” normal pooping involves going one to three times daily and having semi-soft stools that are light brown in appearance. There’s actually a Bristol Stool Chart presented in that post to help you determine whether the consistency of your child’s stool is in the normal range. If your child isn’t having a normal bowel movement at least once a day, or is experiencing one or more of the symptoms described above, consult your child’s doctor for advice.
What Causes Encopresis?
The primary cause of encopresis is chronic constipation, and the longer a child remains constipated, the worse the condition becomes. At a certain point, the stool can become so impacted in the bowels that it will not move, and the mass continues to grow, stretching (distending) the bowel muscles to the point at which they can no longer contract effectively to push the mass out. The bowels and rectum, which are already lacking in the nerve department lose any “feeling” they have, so the child doesn’t even sense when she “has to go number two.” Softer stool descending through the bowels flows around the existing mass and leaks out, through no fault of the child, soiling the child and her clothes. Yes, it’s disgusting, and your child knows it, but she can do nothing to control it.
But what caused the chronic constipation in the first place? Well, that depends. In some cases, a medical illness may cause or contribute to encopresis; hypothyroidism, Hirschsprung’s disease, diabetes, cystic fibrosis, spina bifida, and other illnesses have been linked to problems with colon function. In most cases, however, the cause of the chronic constipation is related to:
- Diet
- Sedentary lifestyle
- Medication
- Emotional/behavioral issues
- A combination of the four
Diet
It’s no secret that most kids these days eat more junk food than in generations past. Our hectic lifestyle leads us to eating more convenient, processed foods and less whole foods, and feeding these same processed foods to our children.
Like adults, children should be eating more as nature intended — primarily a whole foods diet consisting mostly of vegetables, nuts, and fruits; some whole grains; and protein from quality sources. A focus on whole foods naturally reduces consumption of sugary foods and drinks (and diet products), simple carbohydrates, and processed foods, such as chips, cupcakes, mac & cheese, and fruit rollups.
It’s all about establishing a consistently healthy, well-balanced diet. A diet that is overly restrictive can cause nutritional imbalances, but even too much of a good thing, such as cow’s milk and cheese, can contribute to constipation.
Sedentary Lifestyle
Many children lead active lives, but too many are overly sedentary, spending more time on their smart phones, watching TV, and playing video games than they do riding their bikes, jumping rope, exploring the great outdoors, and engaging in physical activities with friends. Healthy bodies require movement to keep muscles toned and blood flowing and to ensure proper digestion. If kids with encopresis simply matched every hour of sitting with a half hour of physical activity, they would be well on their way to avoiding constipation and achieving optimal health.
Medications
When you start researching encopresis, you find a lot of information about lack of fiber in the diet, dehydration, and behavioral issues, but you see very little in the literature about medications contributing to the problem. And the few medications cited may not be the biggest culprits. Several articles call attention to over-the-counter cold medications, antacids, anticonvulsants, chemotherapy, and narcotic pain medications as contributing to constipation, but none of the research we encountered pointed out what may be the biggest contributor of all — antibiotics.
Parents know better. Many parents of children with encopresis report that their children were put on repeated trials of antibiotics to treat persistent ear infections and other infections prior to developing encopresis. Given the fact that antibiotics kill intestinal bacteria at the same time they kill the targeted infectious agents, and the fact that beneficial intestinal bacteria are an essential ingredient to healthy bowel function, we wonder what role antibiotics might play in triggering encopresis in children. We would like to see such a study conducted. If you know of such a study, please post a comment to share with our readers.
Emotional/Behavioral Issues
As we point out in a previous post, “Don’t Get Your Colon in a Knot: The Anxiety-Pooping Connection,” healthy bowel movements are often a case of mind over matter. The same is true for children. Thoughts and emotions may impact their ability to poop. Here are a few emotional/behavioral issues that may contribute to constipation:
- Stress in the family, at school, or among friends
- A change in bathroom routine, such as when a child starts or returns to school after a break
- The busy boy or girl syndrome, in which the child is too busy to take time to use the restroom
Constipation and encopresis can result in additional emotional and psychological fallout, especially if the child doesn’t understand the condition and is blamed or blames herself for it. This is a highly stigmatizing condition.
What Can Be Done to Cure Encopresis?
Fortunately, encopresis can be cured in most cases, but it’s not unusual for full recovery to take a year or longer, especially if the bowel has been distended for some time. Bowel tone and function must be restored through changes in diet and lifestyle and through medical intervention. The first step is to see a gastroenterologist who can order x-rays and other tests to rule out or treat any medical conditions that may be at the root of the problem. Both the American College of Gastroenterology and WebMD have online physician directories that can help you get started.
Regardless of the cause, the gastroenterologist is likely to recommend/prescribe:
- Increased fiber consumption
- Reduction or avoidance of constipating foods, such as cheese, or milk (if your child has an intolerance to milk)
- Increased water consumption
- A pre- and probiotic to restore intestinal flora (see our previous post “Restoring Intestinal Flora Leads to a Healthy Gut and Happy Poop“)
- Laxatives (perhaps heavy doses over an extended time) and enemas to keep the bowels clear
- Counseling to help with any stress that may have contributed to the encopresis or any emotional or behavior issues resulting from it
Remember: The earlier treatment is started, the better the prognosis. Don’t let embarrassment stand in the way of your getting help for your child. Consult your child’s pediatrician or head directly to the nearest gastroenterologist for help.
An Ounce of Prevention
Encopresis is one of many illnesses that snowballs into a bigger problem when left untreated, so staying on top of your child’s gastrointestinal health is key to both treatment and prevention. You may be able to avoid ever having to deal with the problem if you invest in the following preventive care:
- Breastfeed, if possible. Breastfed babies generally have more and looser stools, producing anywhere from 5 to 40 bowel movements per week compared to 5 to 28 among formula-fed babies.
- Stock up on healthy foods, and clear the shelves of junk food.
- Encourage an active lifestyle to combat our culture’s sedentary lifestyle.
- Find a doctor who respects the pros and cons of antibiotics and prescribes them only when necessary.
- After your child completes a trial of antibiotics, re-inoculate your child with healthy intestinal flora by having her take a quality probiotic along with prebiotics. Consult your child’s doctor for details.
- Monitor your child’s frequency and consistency of poops. Obviously, you want to give your child some privacy at some point, but teach your child what’s normal — one to three snaky poops daily.
- Normalize discussion of poop, so your child will not hesitate to let you know when she’s having trouble. Healthy pooping is a key factor in your child’s health; don’t be squeamish. If your family trends on the more humorous side of life, consider reading “Pinching a Loaf and Other Poophemisms” for ideas on how to make the subject matter even more accessible.
- Transition your family from sitting to poop to squatting to poop. This more natural way of pooping enables everyone in the family to poop without pushing, it’s more fun, and it just may save you a ton of money on toilet paper!
To all those parents and their children out there who struggled with or are currently struggling with encopresis, we feel for you. Please post a comment to share your journey with other parents out there who may need support, encouragement, and information. Let us know how you approached this condition — what helped and what didn’t. Help shorten the journey from illness to wellness for others!
– – – – – – – –
Disclaimer: This blog post on Encopresis provides general information and discussion about medical issues and health-related subject matter. The words and other content provided in this post, and in any linked materials, are not intended and should not be construed as medical advice. If you or any other person has a medical concern, consult with an appropriately licensed physician or other health care professional immediately and do not rely on the information presented in this post. Never disregard professional medical advice or delay in seeking it because of something you have read in this blog post or in any linked materials. If you think you may have a medical emergency, call your doctor or 911 immediately.
