What is encopresis?
‘Encopresis’ is when children past toilet training age regularly ‘have accidents’, or do poos places other than the toilet. They can’t control when, or where, this will happen, so it can become very upsetting for both children and parents.
Whilst this can be understandably frustrating for parents, teachers, day-care etc., it’s important to remember children suffering from encopresis aren’t soiling on purpose, or as a way of ‘acting out’; most children are very embarrassed when this does happen, and are often just as distressed as parents or carers dealing with the problem.
Whilst all children achieve bowel control at their own rate, regular soiling after the age of four years may be a sign of an underlying medical condition, such as encopresis, and may warrant a visit to the GP. Encopresis can occur even for children who may have previously mastered toilet training, or not had any difficulties with toileting in the past.
What causes encopresis?
Faecal soiling in encopresis usually has a physical origin, but emotional stress can also trigger encopresis in some cases. For example, stress associated with premature toilet training, birth of a younger sibling, or other major life changes.
The most common cause of encopresis is chronic constipation (not being able to go to the toilet, or straining very hard when going to the toilet). When a child has been constipated for a long period of time, their poo becomes very hard, meaning it will get stuck and stretch their rectum when they try to go to the toilet.
Sometimes, because their rectum feels stretched, children no longer feel the ‘urge’ to go to the toilet, so accidents occur more frequently. Other times, liquid poo can form around the hard ‘stuck’ poo without the child feeling it, and start to ‘leak’ out.
Aside from soiling, children with encopresis often suffer other symptoms including:
- Pain when doing a poo (which can lead to your child becoming less likely to want to try – and therefore avoid the toilet!)
- Tummy pains that come and go
- Bed wetting (this occurs in approximately 30% of children with encopresis).
Other causes of encopresis can include rare neurological disorders, or anus abnormalities. If your child is four years or older and experiences persistent soiling and/or constipation, you should see your doctor.
OK, so if they can’t help it… how can I?
Treatment of encopresis depends on the cause – if chronic constipation is the main problem, your doctor will be able to give advice and work out a treatment plan to bring back healthy bowel habits. This can include dietary changes and laxative medications to promote good bowel habits, and alleviate tummy pains.
If your child has behaviour problems associated with encopresis, or is emotionally distressed about toileting (including toilet avoidance), your doctor might also suggest individual psychotherapy.
A psychologist can help you and your child with a treatment plan to manage toileting anxiety, as well as behavioural strategies to help your child get back into a good toileting routine. A psychologist can also help with other strategies to help manage and deal with emotional stress that may be related to the development, or as a result of, encopresis.
Written by Natalie Avery,
Psychologist at Benchmark Psychology