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Children with encopresis, also called soiling, have bowel movements or leak a small amount of stool in their underclothes or on themselves.
Soiling is very common, occurring in at least two out of 100 children.
Soiling is often the result of constipation. Constipation often begins when children hold back, or “with-hold,” their bowel movements. Children will tighten their bottoms, cry, scream, hide in corners, cross their legs, shake, get red in the face or dance around to try and hold in their poop. Parents often will confuse these behaviors for trying to pass poop when actually children are trying to hold in the poop. Some reasons that children start holding bowel movements include:
When children hold in their poop, the lower colon fills up. Over time this can stretch the lower colon out of its normal shape. The more a child holds in poop, the more the colon stretches and the poop gets larger and harder. This makes pooping even more painful. When this happens over and over again, the colon becomes so stretched and floppy that the muscles children use to help push out poop, do not work well. Hard poop can get stuck and only liquid can pass around the hard poop. The stretched nerves become less sensitive and the child does not feel the leaking poop.
Children who have emotional or behavioral issues can have trouble with soiling. There are more serious medical problems that children are born with that can cause encopresis, but these are rare. Your health care team can talk with you more about these causes.
Some children will hold their poop in for many days then pass a very large, hard stool. This poop can be so large that it clogs the toilet but children will also leak liquid poop at the same time. Often parents of children who soil will share that the children use a lot of toilet paper trying to clean themselves. Some children will refuse to poop in the toilet at all.
Other things you can see in children who soil:
A doctor or nurse practitioner will examine your child, and obtain a medical history. Testing is usually not required but might include:
Treatment for soiling will be guided by the child’s healthcare team with you and your child’s input.
Treatment within the bowel management program includes:
It is very important that you develop a routine and stick to it. Long-term success depends on how well you can follow the care plan. This treatment will take many months of hard work for you and your child. There is no quick fix for this.
Your child's doctor or nurse practitioner will often order medications to help keep your child's bowel movements soft. This will help your child not to hold in the poop and over time will allow the colon to return to its normal shape and function. Please do not give your child stool softeners without the approval of a doctor or nurse practitioner.
There are certain dietary changes to consider when helping a child with constipation and/or soiling.
Diets high in fiber usually help but sometimes can worsen constipation if your child does not drink enough water with a high fiber diet. Check with your healthcare provider about how much fiber your child needs every day.
Plan to serve your child's meals on a regular schedule. Often, eating a meal will cause children to feel the urge to poop. Serve breakfast early so your child does not have to rush off to school and miss the opportunity to poop.
Increasing the amount of exercise children get can also help. Exercise aids digestion by helping the normal movements the intestines make to push food forward as it is digested. Encourage your child to go outside and play rather than watch TV or play video games.
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