Encopresis is a condition in which a child resists having bowel movements, causing impacted stool to collect in the colon and rectum and lead to leakage.
Sometimes called faecal incontinence or contamination, Encopresis are repetitive (usually unintentional) passing of stool in clothing. This usually occurs when the affected stool builds up in the colon and rectum: the colon becomes too full and the liquid stool leaks around the retained stools and stain clothing. Eventually, retention of stool can cause intestinal swelling and loss of control of bowel movements.
In the United States, it is estimated that 1% to 2% of children under the age of 10 are affected by Encopresis. There are more boys than girls who suffer from encopresis, about 80% of the affected children are boys.
In most children, Encopresis is associated with chronic constipation. Constipation occurs when bowel movements are not frequent enough. The stool is hard and dry too.
Symptoms of Encopresis
More than 80% of children with encopresis have experienced painful constipation or bowel movements in the past. In many cases, constipation or pain occurs many years before being referred to a doctor.
Most children with Encopresis say they are reluctant to defecate before smearing their underwear. Pollution usually occurs during the day when the child is awake and active. Many school-aged children soil late in the afternoon after returning from school. Soiling at night is unusual.
For most children with Encopresis, the clearest signs are:
- Soiled underwear
- Bad body odour (stool odour)
- Constipation with hard, dry stool
- Passage of large stool that clogs or almost clogs the toilet
- Avoidance of defecation
- Long periods of time between bowel movements
- Loss of appetite
- Repeated bladder infections, mostly in girls
- Blood streaks on the outside of the stool or on toilet paper that are used to wipe after defecation
- Abdominal or rectal pain
- Stool-stained clothes, hidden in the closet, under the bed or elsewhere
- Bedwetting, maybe because of pressure from a large stool in the rectum
In rare cases, the child may drop or smear stool on the floor, walls, or furniture if encopresis is caused by a serious mental health problem. Less common psychological causes may include:
- behavioral problems, such as conduct disorder
- familial, school, and other stressors
- anxiety over toileting.
Causes of Encopresis
In rare cases, encopresis is caused by anatomic abnormalities or diseases that the child is born with. In most cases, it is caused by long-term chronic constipation.
Constipation does not only imply infrequent bowel movements but also difficulty or pain when doing so.
Many people think of constipation as not defecating daily. However, everyone has his own schedule and many healthy people do not defecate every day. A child with constipation can defecate every third day or less.
For most children with Encopresis, the problem starts with the painful passing of a very large stool. This might have happened long before the encopresis started, and when asked, the child might not remember it. Over time, the child will hesitate to defecate and hold bowel movements to avoid pain. This becomes a habit that often lasts long after constipation or pain during bowel movements have been treated.
As more and more stool builds up at the colon, the large intestine stretches slowly (sometimes referred to as megacolon).
When the large intestine expands, the child loses the natural urge to defecate.
Eventually, partly formed stool from higher up in the intestine leaks around the large collection of harder, more formed stool at the bottom of the colon and then leaks out of the anus.
Often, only a small amount of stool leaks out early, which causes streaks on the child’s underpants. As a rule, parents assume that the child is not cleaning very well after defecating and do not show concern.
Over time, the child becomes increasingly unable to hold the stool in and more stool leaks, and eventually the child experiences defecation in her underpants. The child often does not realize that he has had a bowel movement.
Because stool usually does not pass through the large intestine, it often becomes very dark and sticky and can have a very unpleasant odor.
There are several causes of encopresis which include, Constipation, Medical and Emotional issues.
Most cases of encopresis are the result of chronic constipation. This chronic constipation that turns into encopresis can have many different causes and these include:
- Tension and fear because of problems during toilet training.
- Holding the stool for fear of using an unfamiliar toilet (especially when you are away from home) or because the stool is painful.
- High foods diet that tend to cause constipation such as Whole milk, Cheese, White rice, White bread.
- Not wanting to interrupt games or other activities.
- Eating low fiber diet (found in Fruits, Vegetables, Whole grains).
- Not drinking enough fluids.
- An inactive lifestyle with too little exercise (exercise stimulates the intestine to move)
- Not paying attention to the urge that it’s time to defecate: some children don’t go to the toilet if they want. The child might be too busy playing games, watching TV, or engaging in other interesting activities. At school, they may be afraid to ask permission to leave the classroom to use the toilet.
- Fissure: When a child with constipation finally experiences bowel movements, an unusually large stool can injure his anal skin. This can cause painful tears on the skin called fissures. Because of this painful fissure, the child may become more and more afraid of defecating for fear of pain.
- Hypothyroidism: Low thyroid hormone levels can cause your child’s digestive system to work slower than usual. This can cause constipation.
Medical problems involving the nerves in the spine or the bowel wall can cause encopresis.
Emotional stress can cause encopresis. A child can suffer stress through:
- Toilet training that is premature, difficult, or conflict intensive.
- Changes in the child’s life, e.g. Changes in diet, toilet training, elementary school or planning.
- Emotional stress factors such as divorce from parents or the birth of siblings.
Over time, a child with encopresis can also develop incoordination of the muscle that is used for defecating. In many children, the anal sphincter contracts rather than relaxes when they are trying to defecate. This impaired coordination of muscle function, which keeps the stool intact, is the key to diagnosis and is also known as an anismus or paradoxical contraction of the pelvic floor to defecation.
Encopresis is usually diagnosed based on reported symptoms, medical history, and physical examination. Physical examination may involve a rectal examination. Your Pediatrician will look for lots of dry, solid faeces.
Sometimes, an abdominal X-ray is used to determine the amount of stool, but often this is not necessary or recommended.
Psychological assessments can be used to find the main emotional causes of this problem.
Prevention of Encopresis
The best way to prevent encopresis is to prevent constipation which causes it. Make sure your child gets a varied diet with lots of fruits and vegetables as well as whole wheat bread and cereals. The child must drink water and other liquids frequently and be physically active daily. Also, make sure that your child has a regular daily schedule when he sits on the toilet. After eating is the best time for it.
Below are some of the best strategies that can help prevent encopresis and its complications.
- Increase the amount of fibre in your child’s diet by providing lots of fruit, vegetables, and whole grains.
- Make sure your child drinks plenty of water throughout the day.
- Let your child sit on the toilet for 10 to 15 minutes twice a day simultaneously. Your child must go to the bathroom 10 to 15 minutes after eating.
- Keep your child active. Exercise helps move the intestines (bowel movements) so that stool can pass more easily and quickly.
- Encourage and praise your child for every day that is successful, clean and environmentally friendly. Never punish, humiliate or blame.
- Talk to your doctor before giving a child an enema or rectal suppository. Also, avoid making use of laxatives every day unless it’s part of your child’s care plan.
Remember that accidents can also occur after your child is trained in the toilet. It is important to remain calm and carefree when changing your child’s dirty clothes. Try not to show disgust, frustration, or frustration for your child. This will help a lot in preventing encopresis.
Treatment of Encopresis
Your Pediatrician may suggest that you try to motivate your child. An example is the use of “token and prize system”. This usually involves using a color chart to track your child’s progress. Gold stars or stickers are given for every clean day. When the table is finished, your child wins a prize. Every child is different in what motivates them to change.
If your child has chronic constipation, the treatment consists of the following:
- Removing the Blockage: This can usually be done by taking medication or laxatives. Sometimes an enema or rectal suppository is needed.
- Lifestyle Changes: There are various lifestyle changes that can help your child overcome encopresis.
- A high-fiber diet increases bowel movements. Examples of high fiber foods are strawberries, bran cereal, beans, grapes, and broccoli.
- For children between 4 and 8 years old, drinking five glasses of water a day can help keep stool soft and make passage easier. Limiting the intake of caffeine can also help prevent dehydration.
- Daily exercise helps move material through the intestine. Encourage your child to exercise regularly. Limiting media time can increase your child’s activity level.
- Prevention of constipation: For a period of six months or more, the child may need to use a stool softener to make defecation easier and more comfortable. Examples of stool softeners are lactulose and mineral oil. It can take several weeks or even months for the intestine to regain its normal size and muscle tone.
- Teach the child normal bowel habits Children should sit on the toilet regularly for 10 to 15 minutes during the day, even after eating. This allows the intestinal muscles to respond normally to the urge to defecate.
If your child’s issue seems to be linked to a serious mental health problem, your doctor will most likely refer your child to a psychiatrist or other mental health professional.
- National Digestive Diseases Information Clearinghouse — http://www.niddk.nih.gov/health/digest/nddic.htm/
- American College of Gastroenterology (ACG) — http://www.acg.gi.org/
- Harvard Health Online — https://www.health.harvard.edu/a_to_z/encopresis-fecal-soiling-a-to-z
- WebMD — https://www.webmd.com/digestive-disorders/encopresis
- Mayo Clinic — https://www.mayoclinic.org/diseases-conditions/encopresis/symptoms-causes/syc-20354494