Encopresis

Encopresis is involuntary fecal incontinence usually caused by underlying constipation. This happens when stool collects in the colon and is unable to be passed. Eventually, the colon stretches and becomes distended. When this happens liquid stool passes around the hard stool and leaks out the rectum.  Encopresis can affect any age group but is most common in school age children. The treatment goal for encopresis is for the colon to shrink back to its normal size and contract as designed to release stool. This process can take several months to one year. It can be frustrating for parents and embarrassing for the child.  However, it  is important to stick with treatment because without treatment, this condition can lead to complications requiring surgery later in life.

Diagnosis

Encopresis is diagnosed based on verbal history of symptoms. Sometimes a x-ray called a KUB or a rectal exam is done to assess how much stool is in the colon. Symptoms include soiling clothes, stool withholding behavior, and constipation. Stool withholding behavior is common in children who do not like to use the bathroom at school or forget to use the bathroom due to distractions such as playing with toys or friends.  Children who have bowel movements daily may be constipated and not know it. This is usually the case if they do not allow enough time in the bathroom to expel the entire amount of stool in the colon.

Treatment

  1. Sit on the toilet for 5-10 minutes after each meal. Use a stool underneath feet to create a 90° angle at the hips and knees. This will allow the left side colon to relax so stool can easily pass out.
  2. Take a fiber supplement daily. Recommend Benefiber® or Metamucil®.
  3. Take daily probiotic—VSL #3 or Culturelle for Kids
  4. Eat a healthy diet. Increase dietary fiber intake by eating more fruits, vegetables, and whole grains. Decrease dairy intake.
  5. Use Miralax daily as needed and adjust dose to achieve 1-2 soft bowel movements per day.
  6. Alternate stool softeners and stimulants as needed to clean out and prevent impaction.

Miralax and Milk of Magnesia work by drawing water to the bowel to soften and moisten the stool

Ducolax and Ex-Lax stimulate the colon to contract, alerting you to have a bowel movement

 

Written by Madden Wilson, RDN, LDN, CNSC.