ENCOPRESIS |
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DESCRIPTIONEncopresis means 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. The bowels, particularly the colon and rectum, are involved. Encopresis can affect children over age 2-1/2.
Appropriate health care includes:
Home care.
Physician's monitoring of general condition and medications, if home care fails.
Psychotherapy or counseling (sometimes).
SIGNS & SYMPTOMS
Bowel movements in underwear.
CAUSES
Physical or emotional crisis in your child's life, such as the birth of a sibling or a 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 child's behavior may persist as a habit.
RISK FACTORS
Stress.
Recent illness that brought the child increased attention.
PREVENTING COMPLICATIONS OR RECURRENCE
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.
BASIC INFORMATION
MEDICAL TESTS
Your own observation of symptoms.
Medical history and physical exam by a doctor, if necessary.
POSSIBLE COMPLICATIONSNone expected. The symptoms frequently trigger more emotional difficulties than the initial cause.
PROBABLE OUTCOME
Usually curable, unless there is a serious underlying physical problem.
TREATMENT
HOME CARE
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 your 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 your 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 your 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 your 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
Don't use:
Laxatives and stool softeners. These will probably cause diarrhea in addition to the original problem.
Enemas and suppositories. These may make the child resistant and uncooperative.
See Medications section for information regarding medicines your doctor may prescribe.
ACTIVITY
No restrictions.
DIET & FLUIDS
No special diet.
OK TO GO TO SCHOOL?Yes. It is important to encourage normal childhood activities.
CALL YOUR DOCTOR IF
Your child has encopresis, and it persists longer than 2 months despite your efforts.
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