Encopresis

What is encopresis?

Most children are potty trained by the age of four. However, if your child continues to have a lot of bowel movement accidents this is called encopresis.

What causes encopresis?

Potty training teaches children to use the toilet. They learn how their body feels when it is time to go to the bathroom. But sometimes they can’t feel the signals. They can’t tell when it is time to use the toilet. Encopresis isn’t a problem “in the child’s head.” It isn’t a “behavior problem.” Encopresis happens because a child’s colon doesn’t work the way it should.

Sometimes a child doesn’t go to the bathroom regularly. The colon is never empty. The bowel movement, or feces, fills the colon. It can get hard and dry. Going to the bathroom can hurt. The colon and rectum stretch too much. This can keep the nerves from working normally. It can stretch the muscles so they cannot push the stool out completely. Then the colon can’t signal the brain that it is time to go to the bathroom. Wet feces can leak out. They get past the hard, dry stool. They stain a child’s clothes and cause accidents.

How can I tell if my child has encopresis?

Some signs of encopresis are:

• Your child often has BM accidents and stained underwear.
• Your child complains about clothes being too tight around the waist.
• You can feel a hard mass at one side of your child’s stomach.
• Or you can feel a mass that goes around the outside of your child’s stomach, like a big upside-down U.
• Your child says it hurts to have a bowel movement.
• Your child is often too full to eat, or vomits after eating.
• Your child frequently plugs the toilet when they do have a BM.
• Your child does not have a BM about every other day.

Why worry about encopresis?

Encopresis can lead to other problems. They are:

Mega colon : When the colon gets bigger and bigger. This hurts the colon’s muscles and nerves. Then they can’t signal it’s time for a bowel movement.

Fissures : When the skin around the rectum cracks and bleeds. Fissures hurt.

Bladder Infection : The big colon can press on your child’s bladder. It can keep the bladder from emptying. When urine stays in the bladder, it can cause an infection. It can also cause wetting accidents.

Patience is the key!

You can often cure encopresis. To do this you and your child need to be patient. It takes a long time to cure encopresis. Don’t scold your child about BM accidents. Instead, praise them each time they go to the bathroom on schedule. Every time your child eats, it makes the bowels active. This is called the gastro-colic reflex. This lasts for about 30 minutes after every meal. Every single day you should have your child sit on the toilet and push to have a bowel movement for about 5 minutes after EVERY meal, breakfast, lunch, and dinner. It can help to have a footstool for them to use, because then they can push better.

Use laxatives. Laxatives make it easier to have a bowel movement. They make the feces softer. They help your child have a regular BM. Don’t worry about your child becoming “addicted” to laxatives. This won’t happen. Using laxatives helps clean out the BM. It also helps the colon heal. Use an enema or suppository if necessary. Your nurse will show you how to use an enema or suppository. Using an enema or suppository cleans out the colon and rectum.

The Big Four – Fiber, Fluids, Exercise, Routine!

Your child needs:

Fiber : Lots of high fiber foods, like fresh vegetables and fruits

Fluids : Plenty of fluids, all day long

Exercise: Your child needs to get up and move regularly, take some long walks.

Routine : Have a bathroom routine. Your child should try to have a BM after each meal. When they eat, the intestines squeeze. This moves the food along. It also makes it easier to have a BM. Your child should also try again at bedtime.

Keep track of when your child has a bowel movement. Write down whether you used laxatives or suppositories, and when they were given.

Teach your child the Valsalva maneuver. This can help your child go to the bathroom. Have your child hold her breath, squeeze in her stomach muscles, and push hard to have a BM.

How long does it take to cure encopresis?

Curing encopresis takes at least as long as the length of time the child has had it. It may take only 6 months, or it may take 48 months or longer. About half of the children with encopresis take more than a year to have normal bowel movements without laxatives.

Questions?

If you have any questions about encopresis, you can contact:

June Masbruch, RN, 319-384-7375, june-masbruch@uiowa.edu

Joni Bosch, FNP, 319-356-4686, joni-bosch@uiowa.edu

Where can I get more information?

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