Soiling (Encopresis) in Children
If your child has bowel movements (BMs) in places other than the toilet, you understand how annoying it can be. Many parents presume that kids who soil their pants are just misbehaving or that they’re too lazy to use the bathroom when they have the urge to go.
The truth is that many kids beyond the age of toilet mentor (generally older than 4 years) who often soil their underclothing have a condition called encopresis. They have an issue with their bowels that dulls the regular urge to go to the bathroom– and they cannot control the mishaps that typically follow.
Encopresis affects about 1% to 2% of kids under age 10. Yet, problems with encopresis and constipation account for more than 25% of all visits to pediatric gastroenterologists (physicians who specialize in conditions of the stomach and intestinal tracts).
Most encopresis cases (90%) are due to “functional constipation”– that is, constipation that has no medical cause. The stool (or BM) is hard, dry, and hard to pass when an individual is constipated. Lots of kids “hold” their BMs to prevent the pain they feel when they go to the bathroom, which sets the stage for having a poop accident.
Well-intentioned suggestions from member of the family and friends isn’t always useful since many people mistakenly think that encopresis is a behavioral concern– an easy absence of self-discipline. Disappointed parents, grandparents, and caretakers may suggest different punishments and repercussions for the soiling– which only leaves the child feeling a lot more alone, mad, depressed, or humiliated. As much as 20% of kids with encopresis have sensations of low self-esteem that require aid from a psychologist or counselor.
Punishing or humiliating a child with encopresis will just make matters worse. Instead, speak with your doctor, who can assist you and your child through this difficult however treatable issue.
Encopresis is among the more frustrating disorders of middle youth. It is the passing of stools into the underclothing or pajamas, far past the time of regular toilet training. Encopresis affects about 1.5 percent of young school children and can develop remarkable anxiety and humiliation for children and their families.
Encopresis and Its Causes
Three to six times more common in boys, encopresis isn’t a disease, but rather a symptom that may have different causes. To comprehend encopresis, it is essential to comprehend constipation.
There’s a wide variety of typical when it comes to having a BM. The frequency of BMs varies with a person’s age and specific nature. “Regular” pooping may range from one or two BMs daily to only three or four weekly. Some kids do not poop regularly, however a child who passes a soft, medium-sized BM without difficulty every 3 days is not constipated. However, a child who passes a difficult BM (small or large) each day is. Other kids may go every day, but they only release bit, hard balls and there’s constantly poop left behind in the anus.
So, what causes the hard poop in the first location? Any variety of things, including diet, disease, reduced fluid intake, worry of the toilet during toilet mentor, or restricted access to a toilet or a toilet that’s not personal (like at school). Some kids might develop chronic constipation after difficult life events such as a divorce or the death of a close relative.
Although rectal surgery or abnormality such as Hirschsprung disease and spina bifida can cause constipation or encopresis without constipation, this is uncommon.
Whatever the cause, when a child begins to keep in BMs, the poop begins building up in the anus and might support into the colon– and a vicious cycle begins.
The colon’s job is to remove water from the poop prior to it’s passed. The longer the poop is stuck there, the more water is eliminated– and the more difficult it is to push the large, dry poop out. The large poop also extends the colon, compromising the muscles there and affecting the nerves that tell a child when it’s time to go to the bathroom. Because the sagging colon can’t press the hard poop out, and it’s painful to pass, the child continues to avoid having a BM, typically by dancing, crossing the legs, making faces, or walking on tiptoes.
Ultimately, the anus and lower part of the colon becomes so complete that it’s difficult for the sphincter (the muscular valve that manages the passage of feces out of the rectum) to hold the poop in. Partial BMs might go through, causing the child to soil his/her trousers. Softer poop might also leak out around the big mass of feces and stain the child’s underclothing when the sphincter unwinds. The child cannot prevent the soiling– nor does he or she have any idea it’s occurring– because the nerves aren’t sending the signals that control pooping.
In the beginning, parents may believe their child has a simple case of diarrhea. But after duplicated episodes, it ends up being clear that there’s another issue– especially due to the fact that the staining occurs when the child isn’t really sick.
Parents are often irritated by the reality that their child appears unfazed by these accidents, which happen mainly during waking hours. Denial may be one reason for the child’s nonchalance– kids just can’t deal with the pity and guilt related to the condition (some even aim to hide their soiled underpants from their parents). Another factor may be more scientific: Since the brain ultimately gets used to the smell of feces, the child might no longer observe the odor.
When to Call the Doctor
Call the doctor if your child shows any of these symptoms:
- poop or liquid stool in the underclothing when your child isn’t ill
- hard poop or pain when having a BM
- toilet-clogging BM
- abdominal pain
- anorexia nervosa
Dealing with Encopresis
As the colon is stretched by the buildup of stool, the nerves’ ability to indicate the brain that it’s time for a BM is hurt. If untreated, the staining will worsen and kids may lose their hungers or experience stomach pain.
A large, difficult poop may also cause a tear in the skin around the rectum that will leave blood on the stools, the toilet paper, or in the toilet. Constipation is likewise related to wetting and urinary tract infections (UTI).
If you believe your child has encopresis, call your doctor. The problem probably can be managed by your doctor, however if preliminary efforts do not work, you might be described a gastroenterologist.
Treatment is done in 3 phases:
- The first phase involves clearing the anus and colon of tough, kept poop. Various medical professionals can have various ways of doing this. Depending on the child’s age and other factors, the doctor might suggest medications, including a stool conditioner (such as mineral oil), laxatives, and/or enemas. (Laxatives and enemas ought to be given only under the guidance of a doctor; never offer these treatments at home without first checking with your doctor.) As undesirable as this initial step sounds, it’s required to clear out the bowels to effectively treat the constipation and end your child’s soiling.
- After the large intestine has been cleared, the doctor will assist your child begin having routine BMs with the aid of stool-softening representatives, most of which aren’t habit-forming. It is necessary to continue using the stool softener to give the bowels an opportunity to shrink back to regular size (the muscles of the intestinal tracts have actually been extended, so they require time to be toned without the poop piling up once again).Parents likewise will be asked to schedule potty times two times daily after meals (when the bowels are naturally promoted), where the child sits on the toilet for about 5 to 10 minutes. This will assist the child discover how to take note of the prompts to go.
- As regular BMs become established, your doctor will reduce the child’s use of stool softeners.
Remember that relapses are normal, so don’t get prevented. Your child might get constipated once again or soil his/her trousers during treatment, particularly when being weaned off of the medications.
An excellent way to track your child’s progress is by keeping a day-to-day poop calendar. Ensure to note the frequency, consistency (hard, soft, dry), and size (large, little) of the BMs.
Perseverance is the key to treating encopresis. It may take anywhere from numerous months to a year for the stretched-out colon to go back to its regular size and for the nerves in the colon to end up being efficient once again.
Diet and Workout
Diet and exercise are exceptionally essential in keeping stools soft and BMs routine. Also, ensure your child gets lots of fiber-rich foods such as fresh fruits, dried fruits like prunes and raisins, dried beans, vegetables, and high-fiber bread and cereal.
Because kids frequently wince at the idea of fiber, try these creative methods to add it to your child’s diet:
- Bake cookies or muffins utilizing whole-wheat flour instead of regular flour. Add raisins, chopped or pureed apples, or prunes to the mix.
- Add bran to baking products such as cookies and muffins, or to meatloaf or burgers, or sprinkled on cereal. (The technique is not to add excessive bran or the food will taste like sawdust.).
- Serve apples topped with peanut butter.
- Develop yummy treats with peanut butter and whole-wheat crackers.
- Top ice cream, frozen yogurt, or regular yogurt with high-fiber cereal for some included crunch.
- Serve bran waffles topped with fruit.
- Make pancakes with whole-grain pancake mix and top with peaches, apricots, or grapes.
- Leading 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.
- Add lentils to soup.
- Make bean burritos with whole-grain soft-taco shells.
And always remember to have your child drink lots of fluids every day, particularly water. Watered down 100% fruit juice (like pear, peach, or prune) is a choice if your child is not drinking enough water. Also, restricting your child’s day-to-day dairy intake (consisting of milk, cheese, and yogurt) may assist.
Successful treatment of encopresis depends upon the assistance a child gets. Some parents find that positive reinforcement helps to encourage the child throughout treatment. For instance, put a star or sticker label on the poop calendar for having a BM (or perhaps just for attempting to), sitting on the toilet, or taking medicines.
Whatever you do, do not blame or scream– it will just make your child feel bad and it will not help manage the condition. With great deals of love, assistance, and peace of mind that he or she isn’t the only one on the planet with this issue, your child can overcome encopresis.