Sometimes, long after potty-training has passed, some children still find themselves having problems with soiling themselves (called encopresis by doctors). While this can be especially frustrating for parents, it’s a common enough problem that there are many solutions. Find out more below.
Encopresis: What Does It Mean?
This disorder, which is also sometimes referred to as fecal intolerance (or soiling) is the involuntary, repeated passing of feces into places other than a traditional toilet (such as clothing or on the floor.) Encopresis usually occurs after the age of four, or when children typically have already learned how to use the bathroom on their own (without the use of a diaper or parental assistance.) Typically, Encopresis occurs when impacted (retained or “stuck”) stools collect in the colon and rectum of a patient – the colon becomes too full and liquid stool leaks around the retained stool and leaks into a patient’s clothing. If this bowel retention continues, it can eventually cause swelling and the loss of bowel movement control.
Stats: How Many Suffer from Encopresis?
Encopresis, which can be caused by constipation or emotional distress, impacts about 1.5% of school-aged children, and the onset of this disorder can happen at any time during a young child’s development, but usually occurs after the age where children are generally potty-trained. Boys who have Encopresis outweigh girls by a ratio of six to one – although this is the case, scientists are unsure why this disparity occurs. Even though Encopresis occurs more in boys, this condition is not related to family size, birth order, age of parents, or socioeconomic class.
What Causes Encopresis?
This condition can occur in children because of a number of causes, including constipation and emotional distress. In most cases of Encopresis, the onset is caused by chronic constipation – in children, hard, painful to pass stools may cause them to avoid going to the bathroom altogether, which can only exasperate the condition further. The longer stools remain in the patient’s colon, the more the colon stretches. As the colon continues to extend, nerves are impacted – nerves that tell a child when to use the bathroom. When these nerves are impacted (and the colon becomes too full,) soft or liquid stool may leak into the child’s clothing. In addition to leakage, patients can also experience the loss of control of bowel movements. Some factors that can lead to constipation include fear of using the bathroom because of pain or being away from home, not eating enough fiber, not drinking enough fluids, and fear of interrupting play or other activities. Aside from constipation, some of the factors that can influence the emotional distress associated with Encopresis include stressful or overly-controlled potty-training, emotional stressors (such as the birth of another child or separation/divorce,) or dietary changes that may make bowel movements painful.
Signs and Symptoms of Encopresis
Many of the symptoms of Encopresis are physical and are easy to spot – but many of the emotional stressors, such as the birth of a sibling or divorce – may not seem as apparent to parents when attempting to diagnose this condition.
What are the Common Behaviors/Characteristics?
Some of the most common side-effects of Encopresis are:
- Abdominal pain
- Avoidance of using the bathroom
- Constipation, or dry, hard stools
- Lack of appetite
- Leakage of the stool into underwear, which may be mistaken for diarrhea
- Repeated infections of the bladder (more common in girls)
Testing: What are the Diagnostic Criteria Per the DSM-5?
The DSM-5, a tool used by mental health professionals to recognize and diagnose mental illnesses and conditions, lays out criteria for the diagnosis of conditions, and Encopresis is no exception. According to the DSM-5,
- The patient’s chronological age must be at least 4 years;
- A repeated passage of feces into inappropriate places, e.g., clothing or floor. This can be either intentional or involuntary;
- At least one such event must occur every month for at least 3 months;
- The behavior is not attributable to the effects of a substance, e.g., laxative, or another medical condition, with the exception of a mechanism involving constipation.
“In making the diagnosis, it is critical that the clinician, specify which of the following is present:
With constipation and overflow incontinence: through physical examination or medical history, there is evidence of constipation.
Without constipation and overflow incontinence: through physical examination or medical history, there is no evidence of constipation.”
Encopresis and Other Conditions
This condition is referred to as an elimination disorder because it deals with a child’s inability to use the bathroom – whether this is due to chronic constipation or emotional distress. There are, however, some related conditions to Encopresis.
Encopresis vs. Enuresis
Whereas Encopresis deals with a child’s inability to pass fecal matter, Enuresis is the repeated passing of urine in places other than the toilet. The most common form of Enuresis is its nocturnal form, which is referred to as bed-wetting. If a child experiences this during the day, it is referred to as diurnal Enuresis. A child may experience a combination of daytime and nighttime symptoms.
Encopresis vs. Fecal Incontinence
Fecal Incontinence is another way to phrase Encopresis – another phrase commonly used to describe this condition is soiling. Fecal matter builds up in the rectum, which can cause stretching – this stretching can cause loss of control of bowel movements or leakage.
Encopresis in Adults/Children
Although this condition is primarily found in children, it can impact any age group. Senior citizens are especially at risk of Encopresis because the rectum weakens as we become older. Encopresis can impact adults of any age, and reactions to medications such as antidepressants, iron supplements, and antacids can increase the likelihood of Encopresis occurring. In women, pregnancy can also cause Encopresis to occur – the growing womb can press against the bowel and cause discomfort that may exasperate constipation, and hormonal imbalances can also play a role in constipation.
Example Case of Encopresis
Joshua, age 5, has already passed the age where he has been potty-trained. His father notices that he is using the bathroom less (to pass bowel movements,) and while doing the laundry, Joshua’s underwear has fecal matter marks, which he initially mistakes for diarrhea. This pattern continues for about two weeks when he receives a call from Joshua’s teacher saying he passed a bowel movement during recess. Joshua is extremely embarrassed and his father is concerned, so they go to the doctor – after a rectal examination, the doctor finds hard fecal matter lodged in Joshua’s rectum. In order to treat this example of Encopresis, the doctor prescribes a laxative and tells Joshua’s father to keep a log of what his son eats, in order to see if Joshua needs to adjust his diet.
How to Deal/Coping with Encopresis
Living with Encopresis can be quite difficult and frustrating at times – the inability to pass a bowel movement or leakage into clothing can be embarrassing, so it is important to be upfront with family members when discussing your condition. There are a number of medications that can help with Encopresis, so talk to your doctor about these options in addition to dietary changes (if necessary.) If medications are taken as prescribed and you follow the instructions of the doctor, the symptoms of Encopresis will subside with time.
Look out for These Complications/Risk Factors
Although it is unknown if Encopresis is genetic, having a family history of constipation will increase the likelihood that you or your children will suffer from Encopresis. Complications that may occur while suffering from or being treated for Encopresis include vomiting, dry mouth, and pain in the abdomen. Certain side effects of laxatives, such as weakness or dizziness, may become serious – if you experience any of these symptoms, call your doctor right away.
Encopresis Treatment
Although the treatment of Encopresis is more often than not physical, this doesn’t mean there cannot be psychological stressors that cause this condition. Consulting with a doctor or mental health professional will help you or your child get the best care possible.
Possible Medications for Encopresis
Your doctor can recommend a number of medications for Encopresis, including over-the-counter or prescribed laxatives. In older patients with this condition, enema treatment can be used to help evacuate the bowel. Because cramping and abdominal pain can occur during this treatment, it is generally accepted that it should not be administered to children. In addition to medication, therapy can be administered if the fear of using the bathroom comes from emotional trauma.
Home Remedies for Encopresis
In addition to any over-the-counter or prescribed medications or therapy, people suffering from Encopresis may keep a log of what they eat in order to understand their dietary pitfalls such as lack of fiber or in rare cases, over-consumption of cow’s milk. If your child is suffering from Encopresis, try to reassure them and offer to sit by the bathroom when they pass a bowel movement in case any abdominal pain occurs.
Living with Encopresis
Sometimes, children may be anxious about discussing Encopresis with you out of embarrassment or fear. Living with this condition can also be quite painful because of the frequent and uncomfortable constipation that is associated with it. Be sure to talk to your child about this condition and establish that it is okay and you are there to help. Children often outgrow the symptoms of Encopresis with a mixture of therapy, medication, and diet, and these methods can help your child readjust to everyday life.
Insurance Coverage for Encopresis
Because every insurance policy varies, it is best to discuss treatment options with your insurance agent. Explain your child’s condition, and explain the mixture of diet, medication, and therapy you are choosing to use in order to treat your child’s Encopresis. Insurance coverage for therapy can vary from no co-pay to high fees depending on your insurance policy’s mental health coverage, and the same goes for any potential medications your child may take due to Encopresis. Even though navigating insurance can be frustrating at times, clearly explaining your situation to the insurance company will help both you and your child. If you cannot afford therapy or medication, there are a number of state and federally-funded programs you can take advantage of.
How to Find a Therapist
There are many therapists currently practicing today – although it may seem impossible at times to find the perfect therapist for your child, there are a number of steps you can take in order to ensure the right care for your child.
What Should I be Looking for in an LMHP?
When looking for an LMHP (licensed mental health professional) to help your child overcome Encopresis, be sure to ask your potential therapist if they have experience dealing with children. Although many therapists deal with all age groups, Encopresis is a condition that primarily impacts children, so this experience is important. In addition to age specialty, it is important to find out which psychological perspective the therapist adheres to – some psychologists practice Freudian psychology, which focuses on the role of the conscious and subconscious mind, while others practice behavioral-cognitive, which looks at the relationship between thought processes and behaviors. This information can be crucial when determining which therapist your child will visit.
Questions to Ask a Potential Therapist
For the treatment of Encopresis, age experience is one of the most important factors. In addition to age, ask the therapist if they have a history of treating patients with Encopresis, and which methods they used to help treat those children. Also, ask how frequently/for how long your child will be in therapy for.
Encopresis Resources and Support
In addition to a mental health professional and other parents who have had children with Encopresis, there are a number of hotlines you can call to receive help navigating your child’s condition. NAMI, or the National Alliance on Mental Illness, offers a mental health hotline you can call in order to discuss Encopresis and possible treatment options. In addition to this hotline, which can be reached at 1-800-950-NAMI Monday through Friday, 10 a.m.– 6 p.m. ET, there are also a number of blogs featuring parents sharing their stories about the condition and its treatment.