Symptoms of Encopresis

In addition to leakage of liquid stool, children with encopresis may exhibit other symptoms, such as:

• Soiling their underwear
• Constipation
• Abdominal pain
• Loss of appetite
• Irritability

Treatment for Encopresis

Treatment for encopresis typically involves addressing the underlying constipation. This may include:

• Dietary changes to include more fiber and water
• Stool softeners or laxatives
• Toilet training and establishing a regular bathroom routine
• Behavioral therapy to address any anxieties or emotional issues related to bowel movements
• Regular follow-up with a healthcare provider to monitor progress

It is important to seek medical advice if your child is experiencing symptoms of encopresis. With the right treatment and support, most children can overcome this condition and regain control of their bowel movements.

Risk factors for developing encopresis

In addition to chronic constipation, there are other risk factors that can contribute to the development of encopresis in children. These include:

• Genetic predisposition
• Eating disorders
• Neurological disorders
• Emotional or behavioral issues
• History of traumatic events
• Prolonged use of certain medications

It’s important for parents and caregivers to be aware of these risk factors and to seek professional help if they suspect a child may be struggling with encopresis.

Why is encopresis of concern?

Encopresis can cause physical discomfort such as abdominal pain and loss of appetite, as well as emotional distress. Other health conditions like diabetes, hypothyroidism, and inflammatory bowel disease can also lead to chronic constipation. Children with encopresis may feel ashamed, embarrassed, and may avoid social situations, impacting their self-esteem and interactions with others.

Additional Information about Encopresis

Encopresis, also known as fecal incontinence, is a condition where a child or individual has bowel movements in places other than the toilet. It is often associated with constipation and the retention of feces in the colon. This can lead to leakage of liquid stool around the impacted mass of stool, resulting in soiling of undergarments.

Other symptoms of encopresis may include abdominal pain, bloating, decreased appetite, and urinary tract infections. It is important to address these symptoms promptly and consult a healthcare provider for proper diagnosis and treatment.

How is encopresis diagnosed?

To diagnose encopresis, doctors assess the child’s symptoms and medical history, and may conduct tests like abdominal X-rays and barium enemas. Treatment involves removing impacted stool, maintaining soft bowel movements, and retraining the intestine. Medications may be prescribed as needed.

Dietary changes

Incorporating more fiber-rich foods like fruits, vegetables, and whole grains into your child’s diet can help alleviate constipation. Including moderate to high-fiber foods can promote healthy bowel movements.

What are good fiber sources?

Fiber-Rich Foods:

Opt for whole wheat bread, granola, bran cereals, vegetables, fruits, and legumes to increase fiber intake in your child’s diet.

Other good sources of fiber include:

• Chia seeds
• Flaxseeds
• Nuts and seeds
• Quinoa
• Brown rice
• Oats

Remember to increase fiber intake gradually and make sure your child drinks plenty of water to help the fiber move through the digestive system effectively.

Other suggestions

If dietary changes are ineffective, laxatives or enemas may be recommended by a doctor to alleviate symptoms. Until intestinal and rectal muscle tone is restored, occasional accidents may occur, and disposable training pants can be used for added comfort in young children.

Encopresis, also known as stool soiling, commonly arises in children aged 4 and above due to chronic constipation. It can be a source of embarrassment for children.

It is important for parents and caregivers to provide support and understanding to children experiencing encopresis. Addressing the underlying cause of chronic constipation, such as dietary issues or psychological factors, is key in treating encopresis.

In addition to medical treatment, behavioral therapy, and counseling may be beneficial for children with encopresis. It is important to create a supportive and non-judgmental environment for the child to feel safe and comfortable discussing their symptoms.

Regular monitoring and follow-up with a healthcare provider are essential in managing encopresis and preventing further complications. With proper treatment and support, most children can overcome encopresis and regain control of their bowel movements.

What causes encopresis?

Typically stemming from chronic constipation, encopresis results from the accumulation of hard, dry stools causing discomfort. This may lead to leakage of liquid stool, staining clothing. Other causes may include colonic inertia, nerve damage, fear of using toilets, and rectal issues.

It is important to note that psychological factors can also play a role in the development of encopresis. Issues such as stress, anxiety, or a history of abuse can contribute to a child’s difficulty in controlling bowel movements.

Treatment for encopresis often involves a combination of dietary changes, behavioral therapy, and possibly medication. It is crucial for individuals experiencing symptoms of encopresis to seek medical attention in order to address the underlying causes and find relief from this condition.

Who is at risk for encopresis?

Children with chronic constipation are susceptible to developing encopresis due to factors such as diet, inadequate water consumption, lack of exercise, stress, and changes in routine. Boys are more affected than girls, although the exact reasons are not fully understood.

What are the symptoms of encopresis?

Symptoms of encopresis can vary but might include loose stools, involuntary bowel movements, anal area irritation, withdrawal from activities, and hiding of soiled underwear. Boys are more likely to develop encopresis than girls, although the exact cause remains unclear.

Anal irritation from watery stools

Isolation

Hidden soiled clothing

Symptoms of encopresis may resemble other conditions. Seeking a healthcare provider’s advice is crucial for an accurate diagnosis.

How is encopresis diagnosed?

During a healthcare provider visit, a physical examination, medical history review, and imaging tests like abdominal X-rays and barium enemas may be conducted to diagnose encopresis and rule out other issues.

Abdominal X-ray: Examines stool levels in the large intestine.

Barium enema: Uses barium fluid to inspect the intestine for blockages, constrictions, and other concerns.

Regular Follow-Up

It is important to follow up regularly with healthcare providers to monitor progress and make any necessary adjustments to the treatment plan.

Behavioral Therapy

In some cases, behavioral therapy may be recommended to address any underlying emotional or psychological issues contributing to encopresis.

Family Support

Encopresis can be stressful for both the child and the family. Providing a supportive environment and open communication can help in managing the condition effectively.

Patience and Persistence

Treating encopresis may take time and patience. It is important to remain consistent with the treatment plan and not get discouraged by setbacks.

Consultation with a Pediatric Gastroenterologist

In cases of severe or persistent encopresis, a consultation with a pediatric gastroenterologist may be beneficial to explore other treatment options.

By incorporating a comprehensive treatment approach, including dietary modifications, lifestyle changes, and professional guidance, children with encopresis can experience improvement in their symptoms and overall quality of life.

What are the complications of encopresis?

Encopresis can lead to physical pain, loss of appetite, and emotional distress. Retention of stool in the intestine may cause discomfort and increase the risk of bladder infections. Accidents may affect a child’s self-esteem and social interactions.

Can encopresis be prevented?

Treating underlying health issues can help alleviate encopresis. Emotional toilet training experiences can contribute to constipation and encopresis. Wait until the child is ready for toilet training and maintain a high-fiber diet and hydration.

Additionally, encouraging regular physical activity can also help prevent constipation and reduce the likelihood of encopresis. Providing a supportive and understanding environment for the child during toilet training can also make a difference in preventing encopresis.

Living with encopresis

Diet and lifestyle modifications may prevent constipation and stool soiling. Avoid expressing anger or using punishment when accidents occur. Coordinate with schools to establish a restroom plan if necessary.

When should I call my child’s healthcare provider?

Discuss concerns about hard stools or soiling with a healthcare provider.

Key points about encopresis

Encopresis is unintentional stool leakage in children aged 4 and above who are toilet-trained. It primarily results from chronic constipation and can present physical and emotional challenges.

Some important additional information about encopresis includes:

• It is important for parents and caregivers to recognize the signs of encopresis, such as soiled underwear or clothing, frequent stomach aches, and withholding stool.
• Chronic constipation is often a primary cause of encopresis, leading to a build-up of hardened stool in the rectum and involuntary leakage around the blockage.
• Treatment for encopresis typically involves a combination of dietary changes, increased fluid intake, laxatives, and behavioral therapy to establish regular bowel habits.
• Emotional support and encouragement are essential for children dealing with encopresis, as they may experience embarrassment, shame, and low self-esteem due to their condition.
• Consulting with a healthcare professional, such as a pediatrician or gastroenterologist, is recommended for proper diagnosis and management of encopresis.

Next steps

Tips for a productive healthcare provider visit:

Prepare questions and understand objectives.

Take notes on diagnosis, treatments, and instructions.

Understand prescribed medications and alternatives.

Clarify recommended tests and procedures.

Attend follow-up appointments as necessary.

Contact your child’s provider after office hours for guidance.

If your child struggles with bowel movements, they may be experiencing constipation.

Constipation can manifest differently in each child, with symptoms including large, painful stools, small, hard bowel movements, difficulty passing stool, and frequent accidents.

Encopresis, involuntary stooling, can be a sign of underlying constipation. Prolonged constipation can result in messy accidents. Watch the video to learn more.

Does stuck mean sick?

Most childhood constipation (95%) is classified as functional constipation.

This type of constipation presents without any underlying disease or anatomical issues, and treatment aims to restore normal gut function.

Unstuck myth #1

Constipation is often attributed to medical conditions.

False: The majority of childhood constipation is functional and can start due to illness, dietary changes, or withholding stool.

Symptoms of stuck

Signs of chronic constipation may encompass:

• 2 or fewer bowel movements per week
• 1 or more poop accidents per week (encopresis)
• Pain during bowel movements
• Large, hard stools
• Avoidance of bowel movements
• Inability to sense the need to poop
• Decreased appetite
• Fatigue

Unstuck myth #2

Children can be constipated even if they have daily bowel movements.

False: Regular but small bowel movements can still indicate constipation.

The cycle of stuck

Childhood constipation is common, and it may cause anxiety in kids and parents about its effects. Remember that occasional difficulty with bowel movements is normal.

Unstuck myth #3

Chronic constipation can occur at any age.

False: It is frequently observed during toilet training and adjustment to school restrooms.

Unstuck glossary

Key terms related to constipation:

• Bowel movement (BM): Passing stool.
• Encopresis: Involuntary stooling.
• Functional constipation: Constipation without a medical cause.
• Stool: Feces.

First steps

Simple ways to promote a healthy gastrointestinal system in children:

1. Increase fiber: Add 5 grams daily, divided between meals based on their age.
2. Stay hydrated: Consume 6-8 glasses of water daily.

Unstuck myth #4

Increasing fiber and fluids may not always resolve constipation.

It’s important to also consider other factors that may contribute to constipation, such as lack of physical activity, certain medications, or underlying medical conditions. Encouraging regular exercise, maintaining a balanced diet, and discussing any concerns with a healthcare provider can help address and manage constipation more effectively.

Getting unstuck

If dietary and hygiene adjustments do not alleviate constipation, further measures may be required. Your doctor may recommend a “cleanout” procedure to unblock the bowel.

The cleanout

Following a cleanout, daily laxatives may be necessary to prevent the return of constipation. It takes time for the colon and the child’s habits to recover.

Cleanout tips

Encourage children dealing with constipation through positive reinforcement during treatment.

• Focus on the goal: Offer support to your child throughout the process.

• Encourage with incentives: Inspire your child with rewards or fun activities.
• Affirm progress: Celebrate and praise every little advancement made.

A new routine

Establish a daily routine to assist constipated children in forming regular bathroom habits.

1. Select a specific time: Work up to spending 3-7 minutes on the toilet, starting right after meals.
2. Begin with short periods: Gradually increase the time spent sitting on the toilet.

• Offer a small reward: Let your child choose a prize for simply sitting down, regardless of having a bowel movement or not.
• Use distractions: Books, toys, blowing bubbles, or playing with a balloon can help relax your child and engage the necessary muscles. Be cautious with electronics as they may be too distracting.
• Be patient with any disruptive behavior: Kids may resist sitting, so wait for them to calm down before encouraging them to try again. Minimize distractions and wait through tantrums quietly to avoid reinforcing the behavior.
• Stay persistent: Disruptive behavior might increase before it gets better, especially if your response changes. Remain patient and consistent for positive results in the end!

Still stuck?

If you have exhausted home remedies and consultations with your family doctor without success, consider the BRICK Clinic, which provides comprehensive care addressing various aspects of pediatric constipation.

Part of the Division of Gastroenterology at Children’s Mercy, the BRICK Clinic caters to patients who are at least 3 years old and developmentally ready for toilet training.

• Is your child a suitable candidate for the BRICK Clinic? Consult your pediatrician for a referral or explore other healthcare options.

If your child meets the clinic’s criteria, an initial one-hour consultation will be conducted to go over your child’s medical history and conduct a physical examination. Follow-up appointments typically last 30 minutes, with the first follow-up scheduled a month after the initial visit and subsequent visits arranged as needed.

Let’s collaborate to overcome this challenge!

DISCLAIMER: This document provides general information on specific health conditions and is not a substitute for professional medical advice. Consult a healthcare professional for personalized guidance. No guarantees are made regarding the accuracy of the content.