In children 4 years old and older, encopresis can be an embarrassing problem where stool leaks into the child’s underwear. Impacted stool in the rectum cannot pass easily, and the child may not want to go to the bathroom because it is painful. The hard stool continues to build up and dulls the normal urge to go to the bathroom. Softer stool cannot be held back, and it leaks around the blockage resulting in the soiling.
Encopresis is a fairly common problem. An estimated one to three percent of children are affected by encopresis, and it happens more in boys than girls. The majority of all cases have chronic constipation and fecal impaction. Less frequently, it may be the result of developmental or emotional issues.
There may be several reasons for a child having long-term (chronic) constipation. Factors that can contribute to constipation include:
- A diet low in fiber
- Not drinking enough fluids
- Eating an excess of dairy products
- Lack of exercise
- Fear or reluctance to use unfamiliar bathrooms, such as public restroom
- Not taking time to use the bathroom.
Emotional stress may also trigger encopresis. A child may experience stress from premature toilet training, or an important life change like a divorce of a parent or the birth of a sibling. In some cases, the child simply refuses to use the bathroom. A child can also develop self-esteem problems, become depressed, do poorly in school and refuse to socialize with other children.
A child with encopresis may have the following symptoms:
- Loss of appetite
- Abdominal pain
- Loose, watery stools (bowel movements)
- Scratching or rubbing the anal area due to irritation from watery stools
- Decreased interest in physical activity
- Withdrawal from friends and family
- Secretive behavior associated with bowel movements.
Encopresis can be very embarrassing for your child. The soiling is not something your child can control. You can help by being patient and understanding with your child as you follow the treatment steps.
The first step in treating encopresis is to remove the impaction. There are several methods for clearing the colon and removing the impacted stool. The doctor may recommend one or more of the following:
- Stool softeners
- Colon lubricants, such as mineral oil
- Rectal suppositories
- More oral fluids.
Once the colon is clear, the next step is to keep the bowel movements soft and easy to pass, and should include changing the child’s diet and encouraging regular trips to the bathroom. The doctor may also recommend stool softeners. The goal is for your child’s bowel to begin working normally. Reaching this goal can take as long as six months to a year, but both you and your child will benefit greatly from your patience and effort.
Exercise is essential for regular bowel movements. Physical activity helps decrease the time it takes for food to move through the large intestines, thus limiting the amount of water absorbed from the stool into your body. This helps to stimulate the natural contraction of intestinal muscles. Intestinal muscles that contract efficiently help move stool out quickly. Remind your child to sit on the toilet after meals for 10 minutes to encourage bowel movements.
It is important for your child to get plenty of fiber rich foods such as fresh fruits, dried fruits like prunes and raisins, dried beans, vegetables, and high fiber cereals. Fiber is present in all plants including fruits, vegetables, grains and legumes. Foods high in soluble fiber include whole wheat, oat bran, oatmeal, beans, peas, rice bran, barley, citrus fruits, strawberries and apples.
It is important that your child drinks plenty of fluids each day, including water and 100% fruit juices like pear, peach, and prune to help draw water into the colon. Limit the amount of greasy foods, refined starches (simplified or processed grains), dairy products, and bananas which can make the symptoms worse.
Below are some creative ways to incorporate fiber into your child’s diet:
- Bake cookies or muffins using whole wheat flour instead of regular flour. Add raisins, apples or prunes to the mix.
- Add bran to baking items such as cookies, muffins, meatloaf, meatballs, burgers or cereal.
- Serve apples topped with peanut butter.
- Serve bran waffles topped with fruit.
- Add lentils to soup.
- Make bean burritos with whole grain soft taco shells.
- Top a high fiber cereal with fruit.
- Add shredded carrots or pureed zucchini to spaghetti sauce or soup.
- Add fiber supplements such as Metamucil or Benefiber (0.5 gm/kg/day, max. 20 gm/day)
Changing your child’s bowel habits can be a big job and it can take time. Consider meeting with one of our dieticians to help your child develop a healthy diet to help treat encopresis. Call (865) 546-3998 to schedule an appointment.
Successful treatment of encopresis depends on the support the child receives. Positive reinforcement helps to encourage the child throughout treatment. If your child feels shame, guilt, depression, or low self-esteem related to encopresis, psychotherapy can be helpful. A psychologist can help your child deal with these feelings, and may also give you techniques for teaching your child not to withhold stool.
A psychologist can help both the child and the family. Please consider having your child meet with one our psychologists. Call (865) 546-3998 to schedule an appointment.