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Stool Holding / Encopresis

Definition :
Encopresis occurs when your child resists having bowel movements, causing impacted stool to collect in the colon and rectum. When your child's colon is full of impacted stool, liquid stool can leak around the impacted stool then out of the anus, staining your child's underwear. Encopresis may also be called stool holding.

In most cases, encopresis is a symptom of chronic constipation. Less frequently, it may be the result of developmental or emotional issues. Encopresis usually occurs after age 4, when your child has already learned to use a toilet.

Treatment for encopresis consists of clearing the colon of impacted stool and taking self-care measures to encourage your child to have regular bowel movements. With patience and positive reinforcement, treatment is usually successful.

Causes :
In encopresis, stool collects in your child's colon and rectum and becomes impacted. When the colon is full of this impacted stool, some liquid stool may leak out of the anus, staining your child's underwear.

There may be two causes of encopresis :

  • Constipation. Most cases of encopresis are the result of chronic constipation. In constipation, the child's stool is hard, dry and may be painful to pass. As a result, the child avoids going to the toilet — making the problem worse. The longer the stool remains in the colon, the more difficult it is for the child to push out. The colon stretches, ultimately affecting the nerves that signal when it's time to go to the toilet. When the colon becomes too full, soft or liquid stool may leak out.
  • Emotional issues. Emotional stress, such as premature toilet training or an important change in the child's life — for instance, the divorce of a parent or the birth of a sibling — also may trigger encopresis.

Risk Factor :
The following risk factors may increase your child's chances of having encopresis :

  • Sex. Encopresis is more common in boys.
  • Chronic constipation. This may cause your child to avoid passing stool.
  • Not drinking enough fluids. This aggravates existing constipation.

When to seek medical advice :
Call your doctor if your child is older than age 4, is toilet trained and has :

  • Stool or liquid stool on his or her underwear when he or she isn't sick
  • Hard, dry stool or pain during bowel movements
  • Bowel movements at irregular intervals that clog or almost clog the toilet
  • Abdominal pain
  • Decreased appetite
Symptoms :
Signs and symptoms of encopresis may include :
  • Leakage of stool or liquid stool on your child's underwear when he or she isn't sick. If the amount of leakage is large, you may misinterpret it as diarrhea.
  • Constipation and dry, hard stool.
  • Passage of large stool that clogs or almost clogs the toilet.
  • Avoidance of bowel movements.
  • Lack of appetite.
  • Abdominal pain.

Diagnosis :
Your child's doctor will ask about his or her symptoms. The doctor may conduct a physical examination, including a digital rectal examination to check for impacted stool. During this exam, the doctor inserts a lubricated, gloved finger into your child's rectum while pressing on his or her abdomen with the other hand.

Your child's doctor may also recommend an abdominal X-ray to confirm the presence of impacted stool.

If the cause of encopresis is unclear, the doctor may recommend a psychological evaluation to help determine the cause.

Complications :
A child who has encopresis may experience a range of emotions, including embarrassment, frustration, shame and anger. If your child is teased by friends or chastised by adults, he or she may feel depressed or have low self-esteem.

Early treatment, including spending time with a mental health professional, can help prevent the social and emotional impact of encopresis.

Treatment of encopresis focuses on clearing the colon of retained, impacted stool and encouraging healthy bowel movements. This includes training your child to go to the bathroom as soon as reasonably able when the urge to defecate occurs.

There are several methods for clearing the colon and relieving constipation. Your child's doctor will likely recommend one or more of the following :

  • Stool softeners, such as lactulose or glycopyrrolate
  • Colon lubricants, such as mineral oil
  • Rectal suppositories
  • Enemas
  • More fluids

Your child's doctor may recommend abdominal X-rays to check the progress of the colon cleaning.

Once the colon has been cleared, it's important to encourage your child to have regular bowel movements. In addition to self-care measures such as recommending a high-fiber diet, your child's doctor may recommend the use of stool softeners for six to 12 months.

If your child feels shame, guilt, depression or low self-esteem related to encopresis, psychotherapy can be helpful. A psychologist can help your child deal with these feelings, and may also give you techniques for teaching your child not to hold stool. Ask your child's doctor for a recommendation.

Educate yourself on effective toilet training techniques. Avoid starting too early or being too forceful in your methods. Wait until your child is ready, then use positive reinforcement and encouragement to help him or her progress. Most children are not ready for toilet training until after their second birthday.

Help your child avoid constipation by providing a diet high in fiber and encouraging your child to drink plenty of water.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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