ENCOPRESIS

General Information

DEFINITION--Lack of bowel control in a child who has previously been toilet-trained and does not have diarrhea or constipation. A child cannot be expected to have complete bowel control until at least 2-1/2 years of age.

BODY PARTS INVOLVED--Bowels.

SEX OR AGE MOST AFFECTED--Both sexes of children over age 2-1/2.

SIGNS & SYMPTOMS

• Bowel movements in underwear.
• Mass in left lower abdomen (sometimes).

CAUSES

• Physical or emotional crisis in the child's life, such as birth of a sibling or recent illness with diarrhea.
• Resistance to using the toilet because of too much pressure to do so.
• If the problem is long-term, the original cause may be forgotten and the behavior may persist as a habit.
• Less frequently, might be due to impairment in the child's nervous system.
• Painful bowel movements.
• Resistance to using toilet facilities at school, on camping trips, or outdoor toilets.
• Dietary problems that cause constipation.

RISK INCREASES WITH

• Stress.
• Recent illness that brought the child increased attention.
• Child abuse.

HOW TO PREVENT

• Don't lavish attention on a child for being ill.
• Avoid undue emphasis on toilet-training. Approach it calmly with realistic expectations. Don't shame or blame the child for accidents.
• Be sensitive to stressful situations your child faces. Talk together about the child's feelings.
• Protect your child against physical and sexual abuse.
• Maintain good diet and nutrition for your child.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor, if necessary.

APPROPRIATE HEALTH CARE

• Home care.
• Doctor's treatment, if home care fails.
• Psychotherapy or counseling (sometimes).

POSSIBLE COMPLICATIONS

• Anal fissure.
• Skin rash in rectal area.
• Stool impaction.

PROBABLE OUTCOME--Usually curable, unless there is a serious underlying physical problem.

How To Treat

GENERAL MEASURES--

• Let your child decide when it is time to go to the bathroom. Don't remind him or make him sit on the toilet against his will. This fosters a negative attitude.
• Praise your child for having bowel movements in the toilet--he deserves positive reinforcement for success. Other family members may also praise the child.
• Provide a prearranged reward if the child stays clean all day. The favorite reward of many children is 30 minutes of free time with either parent, doing whatever the child chooses. Incentives build motivation to succeed.
• Respond gently to accidents. When the child is soiled, he should clean himself and change into clean underwear. For younger children (under age 5), the parent will probably have to do this.
• Don't blame, criticize, restrict or punish the child for accidents. This may cause him to give up, as well as lead to secondary emotional problems.
• Don't allow siblings or others to tease the child.
• Never put the child back in diapers.
• Ask for the school's cooperation. The child needs quick access to the bathroom at school, especially if he is shy or new at school. Remind him that there should be nothing embarrassing about leaving the classroom to go to the bathroom.

MEDICATION--

• Stool softeners and bulk producers may be helpful.
• Enemas or suppositories may be necessary if there is an impaction. Ask your doctor before giving any to your child.

ACTIVITY--No restrictions.

DIET--

• Avoid excessive milk, bananas, apples and gelatin.
• Increase fiber in the child's diet.

Call Your Doctor If

Your child has encopresis and it persists longer than 2 months, despite your efforts.