Encopresis in Children – Causes, Signs and Treatment

Sometimes kids may soil their clothes unknowingly, and parents may think that it may have been accidental or probably their kid is misbehaving. However, sometimes this may not be the reason, and the soiling could be due to encopresis. Never heard of this condition? Worry no more as this article deals with encopresis in children, its causes, symptoms and various treatment measures.

What Is Encopresis Disorder in Children?

If a child is beyond the age of getting toilet trained (between 3 to 7 years of age) and he may still soil himself, then it may be due to a condition called encopresis. This condition may develop due to long-term or chronic constipation in children. Constipation results in harder stools, which are difficult for the kid to pass.  The impacted stool may not move easily and may cause the rectum and intestines to become swollen or enlarged. The makes the anus lose and also hampers the rectum’s ability to sense the presence of stool. This causes the liquid stool to leak and soil your kid’s clothing, and this is what soiling or encopresis is all about.

What Causes Encopresis in Kids?

The main causes of encopresis are:

1. Constipation: This is a leading cause of encopresis. Some of the reasons that constipation may occur include:

• Less fibre in the diet.
• Holding the stools with the fear of going to the toilet.
• Inadequate fluid or water intake.
• Excessive consumption of cow’s milk.

2. Emotional Factors: Sometimes emotional factors may trigger encopresis in kids too such as:

• Dealing with emotional stress for example parent’s divorce, the birth of a sibling or the death of a parent.
• Improper, conflict-filled or premature toilet training of the child.
• Sudden changes in the life of the child such as starting school, dietary changes etc.

How Does It Happen?

Due to any of the above-mentioned causes, the child may start holding back his bowel movements. This may cause the poop to start building up in the rectum and up till the colon. The function of the colon is to expel water from the poop before it actually passes down from the rectum. When the poop stays there longer, the water gets removed leaving behind the drier and harder stool, which gets difficult and painful to pass. This weakens the nerves and muscles of the colon, and the rectum and the child may not know when to use the bathroom. Eventually, there is too much pressure around the colon and the rectum, making really hard for the sphincter to hold back the poop. This may cause leakage, and the child may soil his clothes. The child may not understand and know what is happening because it is not under his control.

Signs and Symptoms of Encopresis in a Child

Paying heed to the following signs and symptoms may help you in knowing if your child is suffering from encopresis:

• Your child may have watery or loose stools.
• Your kid may experience abdominal pain.
• Your child may have UTI or urinary tract infection.
• Your child may scratch his anal area often.
• Your child may hide his underpants or soiled clothes.
• Your child may distance himself from friends or family members.
• Your child may experience involuntary bowel movements.
• Your child may experience a lack of appetite.

Which Children Are at the Risk of Getting Encopresis?

Children who have chronic or prolonged constipation are more at risk of getting encopresis. However, it is also seen that it is more common in boys than in girls. In an estimate in the US, it was observed that approximately 1 to 2 per cent of children below ten years suffer from encopresis and out of these children 80 per cent are usually boys. However, the risk factor increases in the following children too:

• Children who may be suffering from ADHD or attention-deficit/hyperactivity disorder.
• Kids who may be suffering from depression or anxiety.
• Children who may be suffering from autism spectrum disorder.
• Children who may be using certain medications, which may cause constipation.

How Is the Diagnosis Done?

If you suspect or register any of the above-mentioned signs and symptoms of encopresis in your kid, you should seek immediate medical attention. Your doctor may conduct the following diagnosis:

• Physical Exam: Your doctor may conduct a physical exam and ask about your kid’s diet, soiling habits and other such concerns.

• Rectal Exam: The doctor may conduct a rectal exam by inserting a gloved finger inside your kid’s rectum to check for the impacted poop.

• Abdominal x-ray: In order to confirm the impacted poop, your doctor may suggest an abdominal x-ray.

• Psychological Help: In case your child is dealing with some emotional stress, anxiety or depression, your doctor may advise for psychological help.

How Is Encopresis Treated in Kids?

The treatment of encopresis or encopresis cure may involve doing the following:

• Clearing the Blockage: It is very important to clear the blockage and get rid of the constipation of the child. For this, your doctor may administer enemas, laxatives or mineral oils.

• Making Changes in the Lifestyle: Your doctor may advise making various lifestyle changes to overcome constipation. This may include dietary changes, drinking more water, exercise etc.

• Making Changes or Modifications in Your Child’s Behaviour: Your doctor may advise you to make few changes in your child’s behaviour and thus advise for encopresis therapy. This may not only include your psychotherapy but may also require the parent’s efforts too.

Medication for Child Encopresis

Following are some commonly used medication for child encopresis:

• Enema.
• Suppositories.
• Laxatives: Osmotic laxatives, Emollient laxatives and Stimulant laxatives.

However, it is strictly recommended that you refrain from giving medication on your own. If you register any symptoms of encopresis in your child, you should seek expert medical advice and treatment for the same.

Complications Child With Encopresis Experience

The drawbacks or complications of encopresis may not only be physical, but the child may experience emotional distress too. Following are some of the complications a child with encopresis may experience:

• The child may have an enlarged and weakened colon.
• The child may lose sensations around the anal area.
• The child may feel ashamed, humiliated and frustrated.
• The child may get teased in school or amongst his friends.
• The child may develop low self-esteem and may feel depressed.

Home Remedies

Here how you may effectively manage encopresis treatment at home or some tried and tested home remedies for encopresis in children:

• Include more fluids and water in your child’s daily diet. More amounts of fluids help in softening the stools.

• Including a more fibre-rich diet may help in curing the symptoms of this ailment. The encopresis diet plan for your kid should include fresh fruits, fresh vegetables, whole grains and other fibre-rich food items.

• Making a toilet schedule really helps in overcoming this problem. Even if your kid does not feel the urge to pass the stool, you should make him sit on the toilet seat for 5 to 10 minutes every day.

• Sometimes cow’s milk may be the culprit for constipation. If it is so, do not give cow’s milk to your child. Your doctor may recommend other milk or dietary supplements to compensate for your kid’s calcium requirements.

• Stick to the dietary schedule and other lifestyle changes as it may take a few months for your child’s bowel movements to become normal and regular.

• Create a comfortable bathroom experience for your child. If he is short for the toilet seat, keep a stool handy for your kid to rest his legs on.

• Always keep a positive attitude towards your child and help him overcome this problem. A parent’s positive attitude helps the child to overcome any difficult situation with ease and comfort.

Diet Your Child Should Follow

Here are some dietary options that your child should follow in his diet:

• Fresh fruits and dried fruits: Apples, pears (preferably with skin), apricots, sultanas, prunes and dates.

• Fresh and cooked vegetables: Give loads of fresh vegetables like salads and cooked vegetables (preferably with skin).

• Bread and Cereals: Wholemeal bread, wholemeal crackers, high fibre pasta etc. are some good options.

• Legumes: Chickpeas, baked beans, kidney beans, lentils should be included.

Management

Parents need to understand that encopresis is a complex problem that involves a more comprehensive treatment approach. The first and foremost thing that you are required to do as a parent is, get medical help for the child because the longer this conditions remains untreated, the more complex it becomes to treat. Parents need to empathise and be understanding towards their child and never make the child feel ashamed or guilty.

Children who respond well to behavioural modification treatment recover well. However, children who may be dealing with much more complex emotional turmoil or distress may face difficulty with the treatment program. Parents need to make their child understand that it is absolutely ok to face this treacherous situation and with effort and some determination, it will get better.

In some cases, the problem may relapse, which is extremely normal. This may happen usually in earlier stages, and sometimes a child may take from a few months to few years to overcome this ailment.

Dealing With Soiling in Children at Schools

Here are some tips on dealing with soiling in children at schools:

• It will be a good idea that your child carries an extra pair of underpants or shorts to school on an everyday basis.

• Parents can communicate with the teacher and the school nurse about their child’s condition.

• Encourage your kid to use the bathroom on a regular basis.

How Can Encopresis Be Prevented?

Wondering how you can prevent this ailment in your child? here we have some suggestions for you:

• The most important preventive measure to keep encopresis at bay is by keeping constipation at bay. Let your child eat a fibre-rich diet and stays hydrated by consuming ample amounts of water and other fluids.

• Being active goes a long way in combating various illnesses, and encopresis is no exception to this. Make sure your kid stays physically active.

• And finally, it is important that you encourage your child to spend some time sitting on the toilet seat every day.

Encopresis can strain a child’s physical as well as emotional well being too. Therefore, get immediate medical help for your child. Waiting longer to get treatment for your child may further complicate your child’s condition and it may longer to heal.

Also Read: Bedwetting (Nocturnal Enuresis) in Kids