Constipation in Children: Part Two - Encopresis

Encopresis is a common pediatric problem. It is defined as having fecal soiling. Often the child will be unaware that they have liquid stool leak in the underwear and not notice the smell. Encopresis often is a result of chronic constipation. Constipation first occurs because of a recent viral illness or happens because they are withholding. Kids at school and camp often don’t want to go in public restrooms and will ignore the body’s urge to go. This makes the stool back up and become even harder, which makes having a stool painful and the child withholds even more stool and the cycle continues. If this cycle is left to perpetuate it will cause encopresis. If you remember the colon’s “job” is to extract water. If the stool builds up and stays in the colon, water will be extracted. The stool will get harder and the colon stretches to accommodate the new larger amount. A colon that is over stretched doesn’t work correctly, and then the child doesn’t feel the urge to go which leads to more stool holding. This cycle results in encopresis. It’s because the new stool that’s being formed has nowhere to go, and it leaks around the hard stool into their underwear.

To help the colon return to its normal size, you need to get rid of the stool. You can do this with enemas and suppositories under your pediatrician’s guidance. Too many enemas or laxatives may interfere with the body’s ability to use the bathroom. You may also use oral medication to help clean your child out and keep them regular. Again your pediatrician can help.

If the colon is kept clear and regular, it will go back to its normal size and the child should then be able to have spontaneous regular bowel movements. This takes a lot of dedication on the parent’s part and it may also take to help of a pediatric gastroenterologist to make this work. I see a lot of parents who give up too early or stop once the child’s bowel movements normalize a little. You have to continue the treatment and talk with your pediatrician. The North American Society for Pediatric for Gastroenterology, Hepatology and Nutrition’s website is an excellent resource. You may access them at http://www.naspghan.org/.

They can help you find a pediatric gastroenterology specialist in your area. Tomorrow I’ll give you tips regarding the prevention and treatment of constipation.

Sheila Cason, MD

Sources: The North American Society for Pediatric for Gastroenterology, Hepatology and Nutrition http://www.naspghan.org/

Read Part One - Constipation in Children

Read Part Three- Constipation in Children