Does your child also poop in his underwear? Let's learn about encopresis!

Sometimes you must have been worried and upset when you saw your little one's underwear stained with poop, right? It's especially hard when your child is well-accustomed to going to the toilet. This is actually something that happens to some children, in medicine we call it Encopresis, or some people also call it ``functional fecal incontinence''. Simply put, it is when a child unintentionally defecates in their underwear. Don't worry, we will talk about this in detail today.

So what is encopresis? What are the symptoms?

Simply put, encopresis is the involuntary passage of stool into the child's underwear, usually by the age of 4 or older, after they have become toilet trained . Most of the time, this happens by accident. It is slightly more common in boys than in girls. It affects between 1% and 4% of 4-year-olds, but the incidence decreases with age.

If your child has encopresis, you may notice symptoms like these:

• Difficulty holding in stool until you go to the toilet.
• Feces leaking into underwear.
• Hiding the act of defecating from others, trying to keep it a secret.
• Hiding dirty clothes.
• Not having bowel movements at the same time every day (loss of a bowel movement pattern).
• Feeling full, having stomach pain.
• The food is tasteless.

Why is this happening to our children?

There are several main causes of encopresis. Let's take a look at what they are.

1. Encopresis due to constipation

The main and most common cause of this condition is constipation . When a child is constipated, the stools become dry and hard like stones, causing them to get stuck in the colon, making it difficult to pass and causing pain.

Because of this pain, children try to hold back when they need to go to the bathroom. What happens then? The stool gradually accumulates in the large intestine. This causes the child's large intestine to gradually enlarge, like a balloon being inflated. When this happens, the child no longer feels the sensation of having to go. Imagine, when the intestine is very full, the newly formed liquid stool can leak out from around the stool like a stone that is stuck. Sometimes parents may mistake this for diarrhea. We call this condition of encopresis that occurs with constipation "retentive encopresis"

2. Could it be due to other underlying diseases?

Yes, sometimes encopresis can be a symptom of another underlying medical condition. Here are some possible conditions:

• Colonic inertia: This is when stool does not move properly through the large intestine.
• Digestive tract nerve damage:This can happen when the muscles at the end of the digestive system (around the anus) do not close properly.
• Hirschsprung disease: This is a condition in which some nerve endings in the intestine are missing, causing intestinal obstruction and inability to pass stool.
• Infection or tear in the rectum .
• Dehydration: If the child does not drink enough water.
• Malnutrition or diet consisting of too much fat and sugar: Eating too much food high in fat and sugar.

3. Do psychological factors also play a role?

Yes, of course. Encopresis can be caused by a child's emotional distress, a behavioral problem, or even a fear. Consider these things:

• When a child is playing, it's too late to stop and go to the toilet.
• Fear of the toilet (some children are even afraid of falling into the toilet).
• Changes in a child's life, stressful events. For example, starting school, family problems.
• Lack of a clean, private toilet, or reluctance to use public toilets.
• Oppositional defiant disorder: In this, the child displays a pattern of disobedience to adults and authorities.
• Behavioral problems: The child has difficulty following rules and behaving in a socially acceptable manner.

How does a doctor detect this?

When you take your child to a doctor, they will do the following to determine if encopresis is present:

• Asks questions: Asks about the child's past illnesses, current symptoms, the child's mental state (such as stress), toilet training, and food and drink.
• A physical examination is performed: The child's body is examined.
• Rectal examination: In this, the doctor inserts a gloved, lubricated finger into the child's rectum to check for any obstructions and the condition of the muscles. This may be a little uncomfortable for the child, but it is very important for diagnosis.
• Abdominal X-ray: An abdominal X-ray may be taken to see how much stool is stuck.
• Psychological evaluation: If you think that the child's condition is caused by stress, fear, or a behavioral problem, you can refer them to a psychiatrist for further investigation.

Sometimes, things like urine tests can be done to make sure there are no other conditions with similar symptoms.

What can be done to treat this?

Treatment for encopresis can vary from child to child, but it usually involves the following:

• Removing stuck stool balls:This is the first thing to do.
• Using stool softeners, laxatives , or enemas: These help the child pass stools regularly , without pain, and gently.
• Scheduled toilet sitting: Try to make your child sit on the toilet several times a day, especially after meals.
• Provide a diet rich in fiber: Add fruits, vegetables, and whole grains (whole-grain bread, brown rice) to your child's diet.
• Giving enough water to drink.

How can we help as parents?

Your child needs your love, support, and encouragement at this time. A "potty routine" is a way to help your child develop good toileting habits.

• Take your child to the toilet after meals: At least two or three times a day, make your child sit on the toilet for 5-10 minutes 15-20 minutes after eating.
• Praise your child when they go to the toilet properly, and give them a small treat: If your child poops in the toilet, praise them by saying, "Very good, son/daughter." You could even use something like a sticker chart to mark the days they go to the toilet, and give them a small treat once a week.
• Don't scold or yell at your child if he makes a mistake: This is the most important thing. If you get angry when your child pees in his underwear, your child will be even more scared and will try to hide it from you the next time it happens. So speak patiently and lovingly.

"When a child makes a mistake, your response is very important. Instead of getting angry, comfort the child by saying, 'It's okay, son, let's try again.'"

Do you need to see a specialist?

Depending on the severity of your child's condition, your doctor may refer you to specialists such as:

• A psychiatrist or counselor (psychologist): can help the child overcome their fear of going to the toilet, shame, guilt, or other mental stress.
• Gastroenterologist: This doctor can help if you have complex problems with your digestive system, especially the large intestine.

What foods are not good for children? What foods should be given?

It is very important to reduce high-fat and high-sugar foods from your child's diet as much as possible.

Instead, add foods high in fiber to your child's diet. Foods high in fiber include:

• Legumes like beans and lentils.
• Vegetables (e.g. broccoli, asparagus).
• Fruit (e.g. berries, apples).
• Whole grains (e.g. bran bread, pasta, brown rice).

How quickly will I recover after treatment?

This is a bit time consuming.The goal of treatment is to help your child learn to defecate regularly and without pain. This goal can take several months to achieve. You will need to be very patient as your child gradually gets used to using the toilet.

It takes time for children who have had a bowel movement due to constipation to start feeling the sensation of having to go to the toilet again. This also requires patience.

Always encourage and praise your child after they go to the toilet. Some parents use something like a sticker chart. They put a sticker on their child when they sit on the toilet, when they poop, and give them a small treat at the end of the week. Small things like these can encourage your child to go to the toilet on their own.

Can't this situation be prevented from happening?

Yes, you can. You can prevent encopresis by preventing constipation and giving your child a good experience with going to the toilet. To do this, do the following:

• Give a diet rich in fiber.
• Make sure you drink plenty of water and don't let your body become dehydrated.
• Give your child plenty of exercise (run, jump, play).
• Set aside time to go to the toilet after meals.
• When toilet training your child, make it a positive experience for them. Encouragement and support are very important.

What should you expect as a parent?

Although some improvement may be seen in the early stages of treatment, it can take months for a child to completely overcome encopresis. Mistakes can happen during this time. As a parent, it is important to continue to support your child and not panic. Many children who receive treatment grow out of constipation and these mistakes.

When should I see a doctor?

If you notice signs of encopresis in your child, see a doctor right away. The sooner you recognize this condition and constipation, the easier it is to treat. If your child doesn't poop for several days, complains of stomach pain, or refuses to eat because of discomfort, see a doctor right away.

What questions should you ask the doctor?

When you see a doctor, you can ask questions like these:

• "Doctor, should I add more fiber to my child's diet?"
• "Should I give my child a laxative or some other type of medication?"
• "Will this encopresis condition affect the child's schoolwork?"

How do you teach a child to wait until he goes to the toilet?

It's normal for your child to make mistakes when toilet training. Sometimes those mistakes are because your child doesn't get to the toilet in time. Here are some things you can do to help your child understand their body signals that they need to go to the toilet:

• Set aside time to go to the toilet throughout the day, especially after meals.
• Teach your child what it feels like to go to the toilet.
• When going to a new environment, show your child where the toilet is.
• No matter what game your child is playing, when he needs to go to the toilet, stop it and encourage him to go to the toilet.

Sometimes children with encopresis don't feel their body's signals to them that they need to go to the toilet. When constipation causes the large intestine to become distended, they don't feel the urge until they have a lot of stool. Once your child starts treatment to soften their stool, they will have to learn to recognize their body's signals again. This process can take several months, so be patient as your child learns about their body.

As a caregiver, dealing with encopresis and constantly washing dirty clothes can be a challenge. Always be patient. If you get angry when your child makes a mistake, your child will notice it and may try to hide it from you the next time it happens. Always give your child positive reinforcement and be patient when toilet training. If your child has a good experience with the toilet, he will be less afraid of the toilet and will make fewer mistakes.

The most important things for you to remember

Okay, so, these are the most important things to keep in mind from what we've talked about:

• Encopresis is a treatable condition that some children develop. It is not the child's fault.
• Patience and support are the greatest strengths you and your child will have on this journey.
• Speak to your child with love , without scolding or blaming them.
• A good diet (especially one rich in fiber) and plenty of water are very important.
• Develop a good habit of going to the toilet on time.
• If you have a problem, don't be shy and talk to a doctor. Early treatment can lead to better results.

May you and your child find the strength to recover from this situation soon!

` Encopresis, bowel movements, constipation, child health, toilet training, parenting advice, digestive system