and Treating Encopresis in Children: A Guide for Parents

Regarding the issue of fecal incontinence?

Hello Dr.
Hsiao: Previously, I asked you about my younger brother who experiences some watery discharge from the anus before having a bowel movement, and you mentioned that this is likely referred to as "overflow incontinence." I would like to ask how overflow incontinence should be treated.
I found some information online suggesting that enemas may help relieve constipation; is this true?

Zhuang Tai Tai, 30~39 year old female. Ask Date: 2013/12/16

Dr. Xiao Kaiwen reply Pediatrics

You can first go to the hospital for an abdominal X-ray to check if there is a significant amount of fecal impaction in the intestines.
If necessary, a glycerin enema may be administered to relieve constipation (this will help to expel any hard stool at the anal opening; otherwise, softening agents will not be effective on the hard stool).
After that, adjustments should be made to lifestyle habits (respond to the urge to defecate promptly, establish a regular bowel habit, and ensure thorough evacuation rather than rushing out to play) and dietary habits (increase the intake of fruits and vegetables, and drink plenty of fluids).

Reply Date: 2013/12/16

More Info

Encopresis, commonly referred to as fecal incontinence, is a condition that can affect children, often resulting from chronic constipation. It can manifest as the involuntary passage of stool, which may include liquid stool leaking around hard, impacted feces. This condition can be distressing for both the child and the parents, and it is essential to approach it with understanding and appropriate treatment.

Understanding Encopresis
Encopresis typically occurs when a child has difficulty with bowel movements, leading to constipation. Over time, the rectum can become stretched and desensitized, making it difficult for the child to recognize the urge to defecate. When liquid stool leaks around the hard stool, it can lead to what is known as "overflow incontinence" or "soiling." This can be embarrassing for the child and may lead to social and emotional issues.

Treatment Options
1. Dietary Changes: One of the first steps in treating encopresis is to ensure that the child has a diet high in fiber. Foods such as fruits, vegetables, whole grains, and plenty of fluids can help soften the stool and promote regular bowel movements. It is essential to encourage the child to drink enough water throughout the day.

2. Regular Bathroom Routine: Establishing a regular bathroom schedule can help the child learn to recognize the urge to go. Encourage the child to sit on the toilet for a few minutes after meals, as this is when the body is most likely to have a bowel movement.

3. Laxatives and Stool Softeners: In some cases, a pediatrician may recommend the use of over-the-counter laxatives or stool softeners to help relieve constipation. These medications can help to soften the stool and make it easier to pass. It is crucial to follow the pediatrician's guidance on the appropriate type and dosage.

4. Enemas or Suppositories: In more severe cases, a healthcare provider may recommend using enemas or suppositories to help clear the impacted stool. While this can be effective, it should be done under medical supervision to avoid dependency on these methods.

5. Behavioral Therapy: If the encopresis is linked to behavioral issues or anxiety, working with a child psychologist or therapist can be beneficial. They can help the child develop coping strategies and address any underlying emotional challenges.

6. Education and Support: Educating both the child and the parents about the condition is vital. Understanding that encopresis is a medical issue and not a behavioral problem can help reduce feelings of shame or frustration. Support from family members can also create a more positive environment for the child.

When to Seek Professional Help
If the encopresis persists despite home treatment, or if the child experiences significant pain, bleeding, or other concerning symptoms, it is essential to consult a pediatrician or a specialist in pediatric gastroenterology. They can perform a thorough evaluation to rule out any underlying medical conditions and provide tailored treatment options.

Conclusion
Encopresis can be a challenging condition for children and their families, but with the right approach, it can be effectively managed. A combination of dietary changes, regular bathroom habits, and, if necessary, medical interventions can help the child regain control over their bowel movements. Remember, patience and understanding are key, as this condition often takes time to resolve. Encouraging open communication and providing emotional support can significantly aid in the child's recovery process.

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