Dealing with the problem of encopresis in children

By Donya Betancourt

SANUR, Bali (JP): Encopresis, the soiling of clothing with stool, is a symptom of poor bowel control, the result of withholding bowel movement and the persistent retention of stools.

It is a much less common problem than bed-wetting; the incidence is only 2 percent to 3 percent of school-age children and almost always occurs in boys. It can occur any time after four years old, as the majority of children are bowel trained by three years.

The causes of encopresis are mostly psychological in origin; such as friction between child and parents. Some children withhold bowel movements during toilet training through fear of using the potty or toilet, while others are unwilling to accept training from overbearing parents.

A child can begin soiling after a stressful situation in the family, such as a sudden separation from an important family member, the birth of a new baby, a divorce or other changes (like going to a new school or camp and feeling uncomfortable in using a private toilet). Physical problems that cause pain in bowel movements, such as an anal fissure or a crack at the skin around the anus after passing a hard stool, can play a role in encopresis. In mild cases such as the painful passing of a hard stool, a few days of prescribed laxatives is usually helpful in reliving discomfort until the crack is healed.

The problem is difficult and unpleasant both for the child and the family. The child exudes an offensive smell and is shunned and unmercifully teased by other children as well as by adults. Intense confrontations occur within the family, and the child becomes quite devious about holding and hiding soiled underpants. As the problem continues, parents usually become angrier and the child becomes more and more isolated.

Parents can help by recognizing the importance of soiling, which can seriously interfere with their child's relationship with others and their self-esteem, by seeking professional help promptly and by never shaming, embarrassing or criticizing the child. Nutritional changes to a high fiber diet with lots of fluid and limiting dairy products to prevent constipation are also important.

In encopresis or chronic constipation, the child must first be treated with large dosages of laxatives to completely clear the impacted stool so the colon can recover its diameter and muscle tone. Some children will remain free from symptoms but others will need several cleanouts. A structured toilet training program can be planned with your child's doctor.

It's also necessary for both child and parent to be seen by a child's psychiatrist; the longer the problem persists the more difficult and prolonged the psychological treatment is likely to be. It is important to acknowledge the child's embarrassment and to let them know it is not their fault. Allow the child to understand that it is a physical problem that can be treated. Monitor your child's food intake and hygiene and, most importantly, install a sense of acceptance and love and the problem of encopresis will be overcome.

The writer is a pediatrician based in Sanur, Bali. If you have questions, please feel free to write to her at drdonya@hotmail.com, or you can reach her at features@thejakartapost.com.