For parent and child alike, few problems cause as much shame and frustration as a child's repeated loss of bowel control, known medically as encopresis. Although many people (including a few child-care experts) contend that soiling is a result of an emotional disorder, the vast majority of cases are purely physical. Any emotional problems the children have are usually the result, rather than the cause, of the soiling.
By conservative estimates, encopresis (which is generally not seen as a problem until age four) affects about 1.5 percent of children in the early elementary grades. Five times as many boys as girls develop the problem.
WHAT CAUSES SOILING?
Soiling is usually the result of chronic constipation, which can, in turn, have a wide variety of causes. In a few cases, harsh toilet-training practices make children reluctant to use the bathroom. More often, however, the problem is caused by painful defecation. Because bowel movements hurt, the child voluntarily tightens the muscles that control the anal opening, holding feces in the rectum. Over time, withholding stool makes defecation even more painful. As the rectal walls are stretched, nerve impulses from the rectum become blunted so that the child eventually feels none of the sensations that signal a need to defecate, setting the stage for soiling.
When a child withholds stool, the rectum becomes distended, forcing the anus partly open and allowing liquid or mushy feces to leak. Such accidents, which usually take place in the later afternoon or early evening, may become a daily occurrence.
IS MEDICAL ATTENTION NECESSARY?
Yes. A caring pediatrician can help the parents and child put the problem in perspective, separating it from the misdirected guilt and shame that frequently arise. Once soiling is explained as a physical problem with a practical solution, everyone involved can deal with it in a more rational way.
The pediatrician prescribes laxatives or stool softeners to restore normal bowel function. In a severely constipated child, a one- or two-week program of enemas, suppositories, stool softeners and laxatives may be necessary. Thereafter, gradually tapering daily doses of mineral oil or stool softeners may be needed for several weeks or months. A concurrent program of bowel retraining—consisting of sitting on the toilet for 10 to 15 minutes at regular times each day usually after breakfast and supper—helps reestablish normal bowel habits. Even after symptoms have subsided, however, the parents need to watch that the problem does not recur.
PREVENTING SOILING
Make sure your child does not become constipated. To promote normal bowel function:
• Serve high-fiber foods, including whole-grain breads and cereals; fresh fruits and vegetables; and dried fruits, such as prunes and raisins.
• Encourage your child to be physically active and drink plenty of water.
COPING WITH SOILING
Parents can handle a child's soiling more effectively if they avoid the pitfall of assessing blame for the problem. Let the child know that that doctor can help him stop having accidents. As the same time, let the child know that he will participate by taking the medications prescribed and working on the retraining program.
DEALING WITH ACCIDENTS
Children with soiling problems usually feel considerable shame, which can get in the way of effective treatment. If your child loses bowel control:
• Do explain that big boys and girls must use the toilet.
• Do have the child help you with the cleaning up.
• Do look for signs that the child may need to have a bowel movement, and remind him to go.
• Don't let bowel movements become the focus of most of your interactions with the child.
• Do meet with school personnel, and inform them of treatment program.
SIGNS OF TROUBLE
Although soiling is rarely, in itself, a sign of a psychological disorder, some children with developmental or emotional problems do defecate in inappropriate places. Your pediatrician may recommend a consultation with a child psychologist or psychiatrist if your child:
• Persistently engages in stool smearing
• Deliberately puts feces where other family members will find them
• Shows no signs of distress over the problem
GETTING HELP
Call your doctor if your child:
• Complains of painful bowel movments
• Is over age four and has one or more bowel accidents per week over the course of a month
