Treating Encopresis

If you think your child has encopresis, it's extremely important to call your child's doctor immediately. That's because the longer you wait, the harder it is to treat. As the colon is stretched by the buildup of stool, the nerves' ability to signal to the brain that it's time for a BM is diminished. If untreated, not only will the soiling get worse, but kids with encopresis may lose their appetites or complain of stomach pain. A large, hard poop may also cause a tear in the skin around the anus that will leave blood on the stools, the toilet paper, or in the toilet. Constipation can also lead to wetting and urinary tract infections (UTI), which can also occur because the poop-filled colon puts pressure on the bladder.

The treatment for encopresis includes three phases performed under the care of your child's doctor. Most cases of encopresis can be managed by the child's doctor. If initial efforts with your child's doctor fail, he or she may refer you to a gastroenterologist.

1. The first phase involves emptying the colon of hard, retained poop. Every doctor may have a different way of helping your child. Depending on the child's age and other factors, the doctor may recommend medicines, including a stool softener (such as mineral oil), laxatives, and/or enemas. (Laxatives and enemas should be given only under the supervision of your child's doctor; never give these treatments at home without first checking with your child's doctor.) As unpleasant as this first step sounds, it's necessary to clean out the bowels to successfully treat the constipation and end your child's soiling.
2. After the large intestine has been emptied, the doctor will help the child begin having regular BMs with the aid of stool-softening agents, most of which aren't habit-forming. At this point, it's important to continue using the stool softener to give your child's bowels a chance to shrink back to normal size (the muscles of the intestines have been stretched out, so they need time to be toned without the poop piling up again). Parents will also be asked to schedule potty times twice daily after meals (when the bowels are naturally stimulated), in which the child sits on the toilet for about 5 to 10 minutes. This will help the child learn to pay attention to his or her own urges. It's especially helpful for parents to keep a record of their child's daily BMs.
3. As regular BMs become established, your child's doctor will reduce the child's use of stool softeners.

Keep in mind that relapses are normal, so don't get discouraged if your child occasionally becomes constipated again or soils his or her pants during treatment, especially when trying to wean the child off of the medications.

A good way to keep track of your child's progress is by keeping a daily poop calendar. Make sure to note the frequency, consistency (i.e., hard, soft, dry), and size (i.e., large, small) of the BMs.

Patience is the key to treating encopresis. It may take anywhere from several months to a year for the stretched-out colon to return to its normal size and for the nerves in the colon to become effective again.

In the meantime, diet and exercise are extremely important in keeping stools soft and BMs regular. Also, make sure your child gets plenty of fiber-rich foods such as fresh fruits, dried fruits like prunes and raisins, dried beans, vegetables, and high-fiber cereal. Because kids often cringe at the thought of fiber, come up with create ways to incorporate these foods into your child's diet so that it doesn't become a chore to eat the high-fiber fare needed to treat encopresis:

• Bake cookies or muffins using whole-wheat flour instead of regular flour. Add raisins, chopped or pureed apples, or prunes to the mix.
• Add bran to baking items such as cookies and muffins, or to meatloaf or burgers, or sprinkled on cereal. (The trick is not to add too much bran or the food will taste like sawdust.)
• Serve apples topped with peanut butter.
• Create tasty treats with peanut butter and whole-wheat crackers.
• Top ice cream, frozen yogurt, or regular yogurt with high-fiber cereal for some added crunch.
• Serve bran waffles topped with fruit.
• Make pancakes with whole-grain pancake mix and top with peaches, apricots, or grapes.
• Top high-fiber cereal with fruit.
• Sneak some raisins or pureed prunes or zucchini into whole-wheat pancakes.
• Add shredded carrots or pureed zucchini to spaghetti sauce or macaroni and cheese.
• Put lentils in your child's favorite soup.
• Make bean burritos with whole-grain soft-taco shells.

In addition to making sure your child is eating a balanced diet high in fiber, don't forget to have your child drink plenty of fluids each day, including water and 100% fruit juices like pear, peach, and prune to help draw water into the colon. Try mixing prune juice with another drink to make it a little tastier. Also be sure to limit your child's total daily dairy intake (including cheese, yogurt, and ice cream) to 24 ounces or less.

Successful treatment of encopresis depends on the support the child receives. Some parents find that positive reinforcement helps to encourage the child throughout treatment. Give the child a small incentive, such as a star or sticker on their poop calendar, for having a BM or even just for trying, sitting on the toilet, or taking medications. Whatever you do, don't blame or yell - it will only make your child feel bad and it won't help manage the condition. Show lots of love and support and, assure your child that he or she isn't the only one in the world with this problem. With time and understanding, your child can overcome encopresis.

Updated and reviewed by: Stephen Shaffer, MD
Date reviewed: February 2004
Originally reviewed by: Wendy Kutz, MSN, RN