What if your child is very good at using the toilet and is doing it very well, and suddenly starts to wet his clothes again? You might be angry. You might feel very frustrated and sad. "Why is my child doing this?" You might be thinking. But wait a minute. This may not be something your child is doing on purpose. In medical terms, we call this condition encopresis. Let's talk about it all in simple terms today.
What exactly is encopresis?
Simply put, if a child over the age of 4, who is well accustomed to going to the toilet, defecates outside the toilet, that is, in his underwear or somewhere else, we call that condition Encopresis. This is sometimes something that happens unconsciously. Some children even try to hide it by putting poop in their clothes.
Remember, this is neither the child's fault nor yours. This is a treatable medical condition. So instead of scolding or punishing your child, you need to give them your love and support more than ever at this time.
What are the symptoms of this condition? How do you recognize it?
At first you may notice this by the smell. Then you may notice that the child's underwear is slightly soiled with loose stools, similar to diarrhea. This is the main symptom. In addition, there are several other symptoms.
| Symptom | Description |
|---|---|
| Hiding clothes and feces | The child tries to hide the clothes that have been soiled. Perhaps in a corner of the room, under the bed, etc. |
| Avoiding going to the toilet | The child doesn't go to the toilet for several days. When asked about it, he avoids it. |
| Stomach pain and bloating | "I often say, 'My stomach hurts.'" When you touch your stomach, it may feel a little hard and bloated. |
| Appetite | A child who used to eat well suddenly eats less. He says he feels "full." |
| A rash around the anus | Frequent contact with feces can cause the skin around the anus to become red and blister-like. |
If you notice these symptoms in your child, it's a good idea to keep a little diary. Write down things like how often your child poops, what type of poop they have, and when they poop. This information will be very important when you go to see the doctor.
Why does this happen to little ones? What are the main reasons?
There are three main categories of reasons that contribute to this. Let's look at them one by one.
1. Constipation - the main culprit!
The cause of 95% of children who develop this condition is chronic constipation, which means dry stool. Think about it this way.
The stools in the child's large intestine (colon) accumulate and become hard like stones. Then, when he goes to the toilet, he feels very difficult and painful. After it hurts like this once or twice, the child is afraid to go the next time he has a bowel movement. So he holds it in and doesn't poop.
When you strain like this, a hard lump of poop gets stuck in your intestines. But because there's nowhere for the newly formed liquid stool to go, the stuck lump leaks out and ends up in your underwear without you even realizing it. That's what makes you feel like you're having diarrhea. We call this Overflow Incontinence .
If encopresis occurs due to constipation in this way, it is called retentive encopresis .
2. Other medical reasons (Underlying Medical Conditions)
This is not seen very often. However, very rarely, this condition can also occur as a symptom of another illness. In such cases, in addition to the diaper rash, the child may also show other symptoms such as weight loss, poor growth, blood in the stool, and vomiting .
There are several possible reasons for this:
- Some conditions are congenital - like `(Hirschsprung disease)`, `(Tethered spinal cord)`.
- Some neurological diseases - Cerebral palsy, injuries to the spinal cord.
- Digestive system diseases - `(Celiac disease)`, `(Inflammatory Bowel Disease)`.
- Problems related to the rectum.
If this condition occurs without constipation, it is called Non-retentive Encopresis .
3. Psychological and behavioral causes (Psychological Triggers)
Sometimes this can happen due to stress, fear, or a behavioral problem in the child's mind.
- Fear of the toilet: Some children are afraid of the toilet, especially public toilets. This may be because they are not clean enough, or for other reasons.
- Life changes: This can be caused by the stress a child experiences, such as starting a new school, having a new sibling, or moving house.
- Love of play: Some children are too lazy to stop playing and go to the toilet, so they hold their breath.
- Behavioral problems: Some children may have conditions like Oppositional Defiant Disorder or ADHD, which can be associated with disobeying parents' instructions and breaking rules.
This is not a mental illness. However, this condition can have a significant impact on the child's mind. The child may experience feelings of shame, fear, and social isolation.
Doctor, how exactly do you find this?
When you take your child to the doctor, he will ask you and your child a lot of questions.
- When did this start?
- Does it happen more during the day or at night?
- What is the color and texture of the stool? Is there any blood?
- Is the child afraid to go to the toilet? Is he/she holding back?
- How are your eating and drinking habits?
- Has there been a big change in your life recently?
Then the doctor examines the child.
- Abdominal examination: The abdomen is palpated and checked for any lumps of stool.
- Rectal examination: Checks for anal sores and fissures.
- Digital Rectal Exam: If the child is willing, the doctor can insert a gloved finger into the rectum to check for any stool that is stuck inside.
- Other tests: Sometimes, things like an abdominal X-ray or a urine test (urinalysis) may be recommended.
What are the treatments for this?
This is a treatable condition. The treatment usually consists of two steps.
Step 1: Bowel Cleanout
Treatment begins with a complete bowel cleansing, which involves expelling all the old, hard stool that is stuck in the colon. The doctor will prescribe medications for this.
- Laxatives: Powdered laxatives (Propylene glycol) or liquid laxatives (Magnesium hydroxide solution) can be given.
- Suppository or Enema: Medicines that are inserted into the rectum. These help to quickly loosen and expel stuck stool.
If the stool is very severely obstructed, it may be necessary to hospitalize the child for this cleaning.
Step 2: Maintenance Program
After cleansing the colon, you need to stop the constipation from recurring. This requires a long-term maintenance program.
| Action | What to do |
|---|---|
| Continuing to use medication | Stool softeners or laxatives prescribed by the doctor should be continued for several months. |
| Sending the toilet on a schedule | After main meals, make your child sit on the toilet for 5 to 10 minutes. It doesn't matter if he doesn't poop, just instill that habit. |
| Changes in diet | Give more fiber-rich fruits, vegetables, greens, and whole grains. Reduce milk and dairy products. Reduce things like sugary drinks, biscuits, and cakes. |
| Giving water to drink well | Let your child drink plenty of water throughout the day. |
| Exercise | Let your child run, jump, play, and be active. |
Sometimes the doctor may also refer the child to special treatments, such as biofeedback training , which helps the child control the muscles around the anus and train them to pass stool properly.
How can you as a parent help your child?
Your role in this journey is very important.
- Be patient: These treatments can take months. You may experience some discomfort during the process. During this time, be patient and don't get angry or upset.
- Don't blame your child: Never say things like, "You're such a bad kid," or "Aren't you ashamed?" This will only make the child feel even more depressed.
- Encourage: Even if your child sits on the toilet or poops, praise their efforts, no matter how small. Say things like, "That's great," "You're so smart." You can do things like make a sticker chart, put a sticker on the day your child goes to the toilet, and give them a small gift at the end of the week.
- Speak openly: Tell your child lovingly, "This isn't just happening to you, it happens to other children too. Let's work through this together."
If you have any further questions about this condition, or if you notice any changes in your child's behavior, don't hesitate to talk to your doctor. If necessary, you may be referred to a pediatrician or a pediatric gastroenterologist.
Take-Home Message
- Encopresis is not a deliberate act of bad behavior by a child, it is a treatable medical condition.
- The main cause of this is prolonged constipation (dry bowel movements). So be careful about your child's diet and toilet habits.
- Punishing or blaming your child can only make things worse. Instead, give them love, patience, and support.
- Treatment takes time, so don't expect quick results, and follow the doctor's instructions exactly.
- If you can't figure anything out about this, don't worry about it alone, see a doctor soon.
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