Encopresis Health Article

Encopresis

Repeated involuntary or inappropriate bowel movement in children age four or older.

Encopresis is defined as repeated involuntary defecation somewhere other than a toilet by a child age four or older that continues for at least one month. Soiling, fecal soiling, and fecal incontinence are alternate terms used for this behavior. When there is no physical cause for encopresis, psychiatrists classify problems with urination and defecation as elimination disorders. Because bowel control is usually easier for a child to achieve than bladder control, problems with soiling are less common than those associated with wetting. In addition, encopresis is more likely to be a symptom of emotional problems or dysfunction in the parent-child relationship. In such cases, parents are likely to need the advice of a professional to devise a strategy for dealing with encopresis.

For some children, the cause of the inappropriate bowel movement is biological, requiring medical attention. Pediatricians refer to this problem as organic encopresis. Inappropriate defecation may be accompanied by withholding of feces, which can lead to bowel problems.

Bowel habits, although necessary to physical health, are private and rarely discussed openly. As a result, bowel problems such as constipation and encopresis are often ignored or left untreated for a long period of time. Parents wait and hope for the child to "grow out of it." When a child is learning appropriate toilet habits during toddlerhood and preschool years, involuntary or inappropriate bowel movements are common, and do not constitute encopresis. When parents treat a bowel problem as a cause for embarrassment or shame, they may unintentionally aggravate or prolong it. It may be reassuring to most parents to realize that encopresis rarely persists beyond late childhood.

When there is no physical cause for the soiling, psychological or emotional factors are often at work. The child may have received inadequate toilet training, or she may be using bowel movements as a display of hostility, anger, or frustration. Other emotional problems sometimes exhibited by children with encopresis include short attention span and hyperactivitiy, low tolerance of frustration, and lack of coordination. Encopresis may also be triggered by a change in the child's environment, such as the birth of a sibling, parents' divorce, move to a new home, or other serious family problems.

Treatment

Before beginning treatment for encopresis, the pediatrician will first look for any physical cause for the inappropriate bowel movements. If none is found, he or she will then work with a counselor or psychiatrist to analyze the variables that characterize the encopresis. For example, the following questions may be investigated:

Was the child ever consistently toilet trained?

Is the soiling random or does it occur in response to specific environmental or emotional triggers?

Have there been any changes in diet or physical growth and development that correspond to the onset of soiling?

Is soiling part of a pattern of problems reported by a parent?

Psychotherapy may be needed to help the child deal with emotional conflicts, while parents are simultaneously reinforcing appropriate toileting behaviors. Psychoanalysis focuses on the underlying psychological causes of encopresis. Advocates of this approach believe that encopresis is a symptom of an underlying conflict experienced by the child. Psychoanalytic therapy is usually carried out over a prolonged period of time, and it may be carried out simultaneously with behavior therapy focusing on the soiling itself. The therapist, the child, and his/her family concentrate on modifying the inappropriate soiling behavior while investigating the emotional conflicts that may trigger it.

See also Enuresis

Books

Galvin, Matthew. Clouds and Clocks: A Story for Children Who Soil New York: Magination Press, 1989. [juvenile fiction]

Schaefer, Charles E. Childhood Encopresis and Enuresis: Causes and Therapy. Northvale, NJ: Jason Aronson, 1993.

Audiovisual Recordings

Understanding Incontinence. Cleveland, OH: Cleveland Clinic Foundation, 1994.
(Two-hour videotape covering urinary and fecal incontinence.)