Encopresis. It’s a problem I wouldn’t wish on any family. The Mayo Clinic defines encopresis as the following:
“Encopresis, also called stool holding or soiling, occurs when your child resists having bowel movements, causing impacted stool to collect in the colon and rectum. When your child’s colon is full of impacted stool, liquid stool can leak around the impacted stool and out of the anus, staining your child’s underwear.”
Basically, if your child poops in his/her pants after the age of 4 on a somewhat regular basis, your child has encopresis. In most cases, the child has become so impacted that he/she has completely lost nerve sensitivity and no longer feels the urge to go. This is what happened to our son. Initially, we didn’t realize that my son had encopresis. In fact, I didn’t know the condition existed. Our son didn’t have the classic symptoms of encopresis or chronic constipation. He would have bowel movements every day, but when he had to go, he had to go right that instant. Somewhat frequently, he would simply poop in his pants. My sister told me that some mothers in her mom’s group had children with similar problems, and that they had been constipated. As a result, I took my son to the doctor, and they performed an x-ray. The x-ray revealed that my son was so constipated that his colon had stretched to an abnormally large size. As a result, he simply couldn’t feel the need to go.
I was shocked. Our son ate purely whole grains, lots of fruits and vegetables, bran cereal and oatmeal; yet, he had become completely constipated, so constipated that a prescribed dosage of laxatives from our pediatrician didn’t even get rid of the entire stool collected in his colon.
Like most parents when something goes fundamentally wrong during the parenting journey, I blamed myself and wondered whether I had done something to instigate the encopresis. I had heard that children could develop problems if you punished them for accidents or pressured them during potty training, so I never punished my son during the potty training process. Instead, I used sticker charts, rewards and apps as incentives (the potty training app being the most effective). As it turns out, I don’t think the problem necessarily had anything to do with my parenting. My son simply became too engaged in his play to stop what he was doing and go to the bathroom. While I didn’t know it at the time, difficulty in shifting attention from one thing to another or hyper-focus is one of the symptoms of ADHD. While not all kids with ADHD have encopresis, a German study showed that children with ADHD were 4 times more likely to have daytime wetting accidents. Another study showed that kids with ADHD were almost twice as likely to have encopresis than the general population.
Regardless of why or how the condition starts, it is important to treat it as soon as possible so that the colon can regain its shape and elasticity. Our treatment involved visits to a gastroenterologist, a complete colon cleansing for a weekend similar to prepping for a colonoscopy, daily dosages of miralax and fiber gummies, discussions with my son’s therapist, and my own realizations about my son’s behavior. I also have a friend whose daughter had encopresis, and she helped me a lot. Reading message boards about encopresis online was more discouraging than helpful. While we are not out of the woods yet, my son has had marked improvement since we discovered the problem. Aside from the medicine, here are the things that have helped my son:
- Regular sitting on the toilet 20 to 40 minutes after a meal. I usually schedule these sitting times after breakfast, after school snack, and after dinner. In the morning, I make my son sit on the toilet for at least 10 to 15 minutes.
- Having your child place his/her feet on a foot stool. Apparently, legs dangling off the toilet are not conducive for having a bowel movement. As a result, we keep a set of stairs (the kind a child uses to get into a bed) in our bathroom.
- Bringing toys, markers with paper, legos or anything that will distract your child into the bathroom. I noticed that my son was having accidents when he was drawing or relaxed. As a result, I started storing some paper and markers in the bathroom.
- Using an incentive chart. The incentive charts have not been as helpful with my son’s encopresis as they have been with other behavioral issues. However, I give him a quarter to put in his piggy bank every time he goes to the bathroom by himself.
- Taking a daily probiotic. I’m not sure if the probiotic has helped, but I figure it couldn’t hurt.
Like I said, my son isn’t cured from his encopresis, but he has far fewer accidents than before (one accident every two weeks as opposed to an accident every day). If your child has this problem, I wish you the best of luck. Dealing with encopresis takes a lot of patience, a lot of soap, a good washing machine, and compassion for a little body and mind that are not cooperating with each other.