What is Encopresis?
Dealing with toileting troubles is one of the most unappealing aspects of raising a child, especially when the challenges come with going number two. Encopresis, more commonly known as soiling, is a disorder where a child, age four or older, consistently poops in inappropriate places. Rather than using the toilet, a child with encopresis will eliminate in their underwear or on the floor instead of the toilet. For some children, the challenge can be constipation and for others, it may be anxiety or fear about pooping that causes them to hold it. Either way, holding in their poop for a long time results in a lack of control when their body can no longer do so. Overall, encopresis affects around 1.5 percent of young children, and is a manifestation of a complex interaction between the body and the experience of stress.
Constipation is often the main culprit in encopresis. When experiencing constipation, pooping can be very painful. Children can have these painful experiences, and develop a fear of going number two, which can then lead to avoidance of going poop. By avoiding pooping, they exacerbate the constipation, and it becomes even more painful when they finally do poop.
Encopresis can also be the result of social experiences around toilet use that can induce anxiety. For example, if a child has a bad experience toilet training, they might be more resistant to going to the bathroom in the way we would expect and experience the same cycle of avoidance. Some kids might experience encopresis when they must use a public or shared bathroom for the first time, like the restrooms at school. Changing the toileting environment and introducing new people to these moments can increase stress that inhibits toileting for kids. Research has found that different kinds of stressful events in a child’s life, like parental divorce or moving, can be connected to constipation that can lead to encopresis.
To confirm that a child has encopresis, they must be at least four years old, and poop in inappropriate places at least once a month for three months. It also needs to be clear that the toileting issues are not a result of allergies, medication, or other medical issues.
How Can We Treat Encopresis?
To address active encopresis, it’s often most pressing and important to address the immediate medical challenges associated with constipation. Visiting and consulting with a pediatrician about the built-up poop in the child’s system will take precedent. They will likely provide medicine to help clear up their system, if appropriate. Then, some doctors may prescribe medicine to help soften poop in the coming days for the child so that the pain the child experiences when pooping is reduced.
Once the immediate medical issues are taken care of, behavioral interventions can be useful to help teach the child healthy and adaptive pooping behaviors. One common intervention is creating structure within the family routine for the child to sit on the toilet 10-15 minutes per day, at the same time, to get them used to pooping in a regular and anticipated way. Scheduling this time can reduce anxiety and can teach a child and their body when the appropriate time and place to poop is. Mental health professionals can be helpful in implementing interventions and problem-solving specific challenges with intervention methods that can come up for each individual family. Therapists can also be useful for helping children through any feelings of guilt or shame that they might feel about their pooping challenges and can help parents learn how to talk to their children about it too.
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