It was a warm Thursday afternoon, and my clinic was running as usual, filled with the sounds of bustling children and the rustling of paperwork. As I reviewed my next patient’s file, I noticed it was for an 8-year-old named Jake. The appointment had been made by his grandmother, who brought him in. She described an ongoing issue that many parents and caregivers struggle to discuss—Jake had been soiling his underwear regularly, a condition known as encopresis.
When Jake and his grandmother, Mrs. Thompson, arrived, I could see the worry etched on her face. Jake sat quietly, looking down, clearly uncomfortable with the situation. It wasn’t long before Mrs. Thompson started explaining the situation.
“Dr. Priya, Jake has been having accidents for a while now. He keeps soiling his underwear, and I don’t know what to do. He was potty-trained years ago, and it seemed fine until recently,” she said, her voice betraying her anxiety.
I gave her a comforting smile and reassured her, “Let’s go through this step by step, Mrs. Thompson. This is more common than you might think, and I’ll help you understand what’s happening and how we can support Jake.”
What Is Encopresis?
Encopresis is the involuntary passage of stool into inappropriate places like the underwear, and it often happens in children over the age of 4 who were previously toilet-trained. It is more common in boys, occurring about three times as frequently compared to girls. In Jake’s case, this condition had been happening for a few months, causing considerable stress for both him and his grandmother.
As I explained this, Mrs. Thompson looked relieved but also curious. She wanted to know why this was happening—why Jake, a child who had successfully learned to use the toilet years ago, suddenly seemed to lose control.
Features of Encopresis
I explained some of the common features of encopresis, which were evident in Jake’s situation:
- Bowel Movements in Underwear: Jake was experiencing spontaneous bowel movements in his underwear. Sometimes the stools were partially formed, and other times they were soft.
- Duration: The soiling had been happening for more than a month.
- Lack of Control: Jake often didn’t even realize he was having an accident until it had already occurred.
- Accompanied by Bedwetting: Sometimes, Jake also had issues with bed-wetting (enuresis), which is quite common in children with encopresis.
What Causes Encopresis?
Encopresis is often rooted in constipation—a cycle that starts when children hold their bowel movements, leading to large, hard stools that are painful to pass. This results in fear of bowel movements and avoidance of going to the toilet. The stool continues to accumulate in the rectum, and liquid stool leaks around the blockage, causing soiling.
I explained to Mrs. Thompson, “Children like Jake might have gone through a period where they avoided going to the toilet—this can be because of stress, embarrassment, or even a bad experience with painful bowel movements. This leads to chronic constipation, and eventually, the buildup of stool results in leakage.”
Common Causes Include:
- Constipation: This is the primary cause. The accumulation of stool creates a blockage, and eventually, liquid stool leaks out.
- Toilet Avoidance: Jake’s grandmother mentioned that he often tried to avoid using the school toilets because they were not always clean, and he felt embarrassed.
- Dietary Factors: A low-fiber diet can lead to constipation, making the problem worse.
- Stress or Emotional Factors: Stressful changes, such as the start of a new school or family changes, can also lead to encopresis.
Mrs. Thompson looked thoughtful as she said, “Jake has been avoiding the school toilet a lot lately. He doesn’t like using it. And it all seemed to start around the time when he moved to his new class.”
What is False (Spurious) Diarrhea?
Another interesting aspect of encopresis is false or spurious diarrhea. Mrs. Thompson had noticed that sometimes Jake’s stools were watery, which she assumed was diarrhea. I explained that this watery stool was actually a trick played by the body—when hard, compacted stools remain in the bowel for a long time, liquid feces can escape around the blockage, giving the appearance of diarrhea.
Jake’s eyes widened as I spoke. “See, Grandma, I told you I wasn’t doing it on purpose,” he said quietly. I could see the tension easing between them—understanding what was happening made a huge difference.
What Can Be Done?
Mrs. Thompson wanted to know what steps we could take to help Jake, so I outlined a comprehensive treatment plan that included the roles of both Jake’s caregivers and medical intervention.
The Role of Parents or Caregivers
Parents and caregivers play a crucial role in managing encopresis. I reassured Mrs. Thompson that this wasn’t Jake’s fault and that it was essential for him to feel supported and not ashamed.
- Support and Understanding: Avoid blaming or shaming Jake for his accidents. Instead, be patient and reassuring.
- Consistent Toilet Routine: Establish a regular toilet routine to help Jake regain bowel control. I recommended that Jake sit on the toilet for 5 minutes after each meal. This would help train his body to pass stool regularly.
- Avoid Harsh Punishments: Punishment can make a child feel ashamed, exacerbating the problem. Instead, positive reinforcement works much better.
Bowel Clean-Out Program
The next part of the treatment was a bowel clean-out program designed to clear out the compacted stool and establish regular bowel habits.
- Laxatives and Stool Softeners: To address Jake’s constipation, I prescribed a combination of lactulose (a gentle laxative) and Movicol (a stool softener). These would help soften the stools and make them easier to pass, breaking the cycle of fear and withholding.
- Duration: This program might need to be followed for 6 to 12 months. Patience is crucial, as the bowel needs time to recover fully and for Jake to develop normal toilet habits again.
Diet and Lifestyle Adjustments
- High-Fiber Diet: Increasing fiber in Jake’s diet was critical. Foods like whole grains, fruits, and vegetables would help make his stool softer and easier to pass. I provided Mrs. Thompson with a list of child-friendly, fiber-rich foods that Jake might enjoy.
- Adequate Fluid Intake: Plenty of water and fluids would also help prevent constipation and keep things moving smoothly.
- Physical Activity: Encouraging Jake to be physically active would also help stimulate his bowel movements and prevent constipation.
Additional Pointers for Parents
I also provided Mrs. Thompson with a few extra tips:
- School Cooperation: It would be helpful to inform Jake’s teacher about his condition. This way, the teacher could support Jake in using the school toilet without fear or embarrassment.
- No Return to Nappies: Although it can be tempting, returning to nappies isn’t recommended for older children. It might hinder progress in toilet training.
- Positive Reinforcement: Rewarding small successes—like trying to use the toilet—can motivate Jake. We discussed using a reward chart to track his progress, with small rewards for each successful attempt.
What Should Parents Remember?
Managing encopresis requires a combination of medical intervention and behavioral support. The key here is patience and consistency, as improvement can take time. I reassured Mrs. Thompson that, with the right approach, Jake could regain control and lead a happy, healthy childhood free from the stress of encopresis.
FAQs About Encopresis in Children
1. How Common is Encopresis in Children?
Encopresis is relatively common, affecting 1 to 2 children in every 100, particularly those over the age of 4. It is more prevalent in boys than in girls.
2. What Are the Early Signs of Encopresis?
Early signs include repeated soiling of underwear, presence of hard stools, and avoidance of using the toilet. Some children also experience abdominal pain or bed-wetting.
3. Is Encopresis Caused by Poor Toilet Training?
No, encopresis is usually not caused by poor toilet training. Instead, it often starts with constipation, which can lead to stool withholding and chronic issues. Emotional or behavioral factors can contribute to the condition, but it is not the child’s fault.
4. Can Encopresis Be Treated Without Medication?
Encopresis often requires a multifaceted approach—medications like stool softeners are usually used initially to relieve constipation. However, dietary changes, behavioral strategies, and establishing regular toilet habits are also vital for long-term success.
5. How Long Will Treatment Take?
Treatment for encopresis can take several months—often 6 to 12 months. It requires ongoing support, consistency, and patience, both at home and in the clinic.
6. Can Encopresis Lead to Emotional Issues?
If left untreated, encopresis can impact a child’s self-esteem and emotional well-being. It is essential to approach the condition with sensitivity, avoiding blame and offering positive support to help the child regain control.