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Encopresis (Holding Bowel Movements)


What is encopresis?

Encopresis is a problem that children can develop due to chronic (long-term) constipation. With constipation, children have fewer bowel movements than normal, and the bowel movements they do have can be hard, dry, and difficult to pass. Once a child becomes constipated, a vicious cycle can develop. The child may avoid using the bathroom to avoid discomfort. Stool can become impacted (packed into the rectum and large intestine) and unable to move forward. The rectum and intestine become enlarged due to the hard, impacted stool. Eventually, the rectum and intestine have problems sensing the presence of stool, and the anal sphincter (the muscle at the end of the digestive tract that helps hold stool in) loses its strength. Liquid stool can start to leak around the hard, dry, impacted stool, soiling a child's clothing.

Which children develop encopresis?

Any child with chronic constipation may develop encopresis. Some of the situations that lead to constipation include the following:

For unknown reasons, boys develop encopresis six times more than girls do. Even though family stress can be linked to constipation, there does not seem to be any association between developing encopresis and how many children are in a family, a child's birth order (i.e. first, middle, last), a child's age, or the family's income.

Why is encopresis of concern?

Encopresis can cause both physical and emotional problems.

Impacted (backed up) stool in the intestine can cause abdominal pain, as well as loss of appetite. Some children develop bladder infections.

Other health problems may cause chronic constipation, including diabetes, hypothyroidism, Hirschsprung's Disease, and inflammatory bowel disease.

Children with encopresis can certainly feel emotionally upset by the "accidents" they have when they soil their clothes. They usually do not have control of this leakage of stool. Their self-esteem and interactions with other people can be affected. Children are often ashamed or embarrassed. They may avoid going to school, playing with friends, or spending the night away from home. Parents may feel guilt, shame, anger, or distaste by the problem. The child will often be aware of a parent's feelings and become even more emotionally affected.

What are the symptoms of encopresis?

The following are the most common symptoms of encopresis. However, each child may experience symptoms differently. Symptoms may include:

Symptoms of encopresis may resemble other conditions or medical problems. Please consult your child's physician for a diagnosis.

How is encopresis diagnosed?

A physician or healthcare provider will examine your child, and obtain a medical history. Imaging tests may also be done to evaluate the intestine and rule out other health problems. These tests may include:

Treatment for encopresis:

Specific treatment forencopresis will be determined by your child's physician based on the following:

Treatment for encopresis may include:

An enema may be prescribed by your child's physician to help remove the impacted stool. An enema is a liquid that is placed in your child's rectum and helps loosen the hard, dry stool. (DO NOT give your child an enema without the approval of a physician or healthcare provider.)

Your child's physician will often prescribe medications to help keep your child's bowel movements soft for several months. This will help prevent stool impaction from occurring again. Please do not give your child stool softeners without the approval of a physician.

Diet changes

Often, making changes in your child's diet will help constipation. Consider the following suggestions:

What are good fiber sources?

BREAD Whole wheat bread, granola bread, wheat bran muffins, Nutri-Gran® waffles, popcorn  
CEREAL Bran Flakes®, Raisin Bran®, Shredded Wheat®, Frosted Mini Wheats®, oatmeal, Muslix®, granola, oat bran All-Bran®, Bran Buds®, Corn Bran®, Fiber One®, 100% Bran®
VEGETABLES Beets, broccoli, brussel sprouts, cabbage, carrots, corn, green beans, green peas, acorn and butternut squash, spinach, potato with skin, avocado  
FRUITS Apples with peel, dates, papayas, mangos, nectarines, oranges, pears, kiwis, strawberries, applesauce, raspberries, blackberries, raisins Cooked prunes, dried figs
MEAT SUBSTITUTES Peanut butter , nuts Baked beans, black-eyed peas, garbanzo beans, lima beans, pinto beans, kidney beans, chili with beans, trail mix

High-fiber meal vs. a typical meal:

Typical Meal High-fiber Meal
Cornflakes 1/2 cup
Donut 1
Milk 1/2 cup
Orange juice 1/2 cup Total grams of fiber = 0.5 grams
Raisin bran 1/2 cup
Bran muffin
Milk 1/2 cup
Orange juice 1/2 cup Total grams of fiber = 5 grams
Beef patty 3 ounces
Hamburger bun
French fries
Green beans 1/2 cup
Canned pears 1/2 cup
Milk 1 cup Total grams of fiber = 5 grams
Beef patty 3 ounces
Whole wheat bun
Baked potato with skin
Baked beans 1/2 cup
Pear with skin
Milk 1 cup Total grams of fiber = 15 grams
Grilled chicken 3 ounces
Lettuce salad
White rice 1/2 cup
Watermelon 1/2 cup
Milk 1/2 cup Total grams of fiber = 1.5 grams
Grilled chicken 3 ounces
Broccoli 1/2 cup
Brown rice 1/2 cup
Strawberries 1/2 cup
Milk 1/2 cup Total grams of fiber = 6 grams

Increase exercise

Increasing the amount of exercise your child gets can also help with constipation. Exercise aids digestion by helping the normal movements the intestines make to push food forward as it is digested. People who do not move around much are often constipated. Encourage your child to go outside and play rather than watch TV or engage in other indoor activities.

Proper bowel habits

Have your child sit on the toilet at least twice a day for at least 10 minutes, preferably shortly after a meal. Make this time pleasant; do not scold or criticize the child if they are unable to have a bowel movement. Giving stickers or other small rewards, and making posters that chart your child's progress can help motivate and encourage him/her.

If these methods do not help, or if your physician notices other problems, he/she may recommend laxatives, stool softeners, or an enema. These products should ONLY be used with the recommendation of your child's physician. DO NOT use them without consulting your child's physician first.

Until the intestine and rectum regain their muscle tone, children may still have "accidents" and soil their underwear on occasion. Pre-school children may be able to wear a disposable training pant until they regain bowel control. Taking a change of underwear and/or pants to school can help minimize your child's embarrassment and improve his/her self-esteem as bowel control improves.

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