Encopresis is the repeated passing of feces into places other than the toilet, such as in underwear or on the floor. This behavior may or may not be done on purpose.
What Causes Encopresis?
The most common cause of encopresis is chronic (long-term) constipation, the inability to release stools from the bowel. This may occur for several reasons, including stress, not drinking enough water (which makes the stools hard and difficult to pass) and pain caused by a sore in or near the anus (the opening of the rectum in the fold between the buttocks, where waste is expelled).
When a child is constipated, a large mass of feces develops, which stretches the rectum. This stretching dulls the nerve endings in the rectum, and the child may not feel the need to go to the bathroom or know that waste is coming out. The mass of feces also can become impacted -- too large or too hard to pass without pain. Eventually, the muscles that keep stool in the rectum can no longer hold it back. Although the large, hard mass of feces cannot pass, loose or liquid stool may leak around the impacted mass and onto the child's clothing.
Factors that may contribute to constipation include:
- A diet low in fiber
- Lack of exercise
- Fear or reluctance to use unfamiliar bathrooms, such as public restrooms
- Not taking the time to use the bathroom
- Changes in bathroom routines; for example, when going to school and there are scheduled bathroom breaks
Another possible cause of encopresis is a physical problem related to the intestine's ability to move stool. The child also may develop encopresis because of fear or frustration related to toilet training. Stressful events in the child's life, such as a family illness or the arrival of a new sibling, may contribute to the disorder. In some cases, the child simply refuses to use the toilet.
What Are the Symptoms of Encopresis?
In addition to the behavior of releasing waste in improper places, a child with encopresis may have other symptoms, including:
- 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.
Treatments?
Involuntary encopresis is treated by addressing the cause of the constipation and establishing soft, pain-free stools. This can include:
- increasing the amount of liquids a child drinks
- adding high-fiber foods to the diet
- short-term use of laxatives or stool softeners
- emptying the large intestine by using an enema
- establishing regular bowel habits
Once the constipation is resolved, involuntary encopresis normally stops.
Treatment of voluntary encopresis depends on the cause. When voluntary encopresis results from a power struggle between child and adult, it is treated with behavior modification. In addition to taking the steps listed above to ensure a soft, pain-free stool, the adult should make toileting a pleasant, pressure-free activity. Some experts suggest transferring the initiative for toileting to the child instead of constantly asking him/her to use the toilet. Others recommend toileting at scheduled times, but without pressure to perform. In either case, success should be praised and failure treated in a matter-of-fact manner. If opposition to using the toilet continues, the family may be referred to a child psychiatrist or a pediatric psychologist.
With older children who smear or hide feces, voluntary encopresis is usually a symptom of another more serious disorder. When children are successfully treated for the underlying disorder with psychiatric interventions, behavior modification, and education, the encopresis is often resolved.
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