Even if a child has already mastered the use of the toilet, a number of circumstances can cause them to suddenly start pooing again, either noticed or unnoticed. It is then important for the parents to remain calm and not put any additional pressure on the child. The encopresis can be diagnosed and treated by the pediatrician.
What is encopresis?
According to ETAIZHOU, encopresis is understood to be the faecal defecation of children from around four years of age if it occurs at least once a month for a period of six months. The disease distinguishes between primary and secondary encopresis.
While the primary form of the disease refers to children who are not yet clean after the age of 4, the secondary form affects children who defecate again after a long period of regular bowel movements.
It is therefore assumed that the illness is a mental disorder and that the children are otherwise physically healthy. In most cases, there is also renewed wetting. Boys are generally more than twice as likely to suffer from encopresis as girls.
In 80 to 95 percent of children, permanent constipation is the cause of the faeces. The disease is then also referred to as retentive encopresis. Non-retentive encopresis, on the other hand, has psychological causes such as stress and occurs in 5 to 20 percent of children.
Long-term constipation often triggers a cycle that is subsequently difficult to break. Due to the hard stool, the child experiences the evacuation as stressful and painful. Painful cracks can form in the anus.
Therefore, the child’s bowel movement is delayed further and further. The intestine expands and loses sensitivity. The affected children no longer notice that the intestine is overflowing. They feel ashamed and sometimes try to hide their soiled clothes. Parents also perceive their child’s encopresis as a burden.
Symptoms, ailments & signs
In encopresis, those affected primarily suffer from very severe fecal incontinence. This occurs when the patient has actually already learned to defecate and can occur several times in a day. The quality of life of the person affected is thereby considerably restricted and reduced. Especially in children, encopresis can lead to bullying or teasing.
In many cases, parents think that the bowel movement is diarrhea when it is not actually diarrhea. Because of the frequent bowel movements, pain or itching of the anus (itching of the anus) is not uncommon. This can also lead to a tear in the anus and a bloody stool.
In some cases, because of encopresis, those affected intentionally eat less food so that incontinence does not occur as often. Since the children often withhold bowel movements, they appear irritable and stressed. Also blockages may occur there and cause abdominal pain or bloating. If the encopresis is not treated, permanent damage to the anus or the intestinal organs can occur, which can no longer be treated.
The diagnosis of encopresis is usually made by the pediatrician based on the symptoms described by the parents. The physical examination consists of a scan of the abdomen in order to feel the solid stool.
The doctor will also check whether painful cracks have already formed in the anus, as these are very painful and require additional treatment. A stool examination is also often ordered to assess whether there is blood in the stool and thus whether there are other physical causes for the encopresis, which must first be clarified.
As a rule, uncontrolled urination occurs during encopresis, which can especially occur in children. The symptom leads to severe psychological complaints and depression. These can occur not only in the child themselves, but also in the parents. In many cases, bowel movements and urination are painful.
The children then try to hold back their bowel movements or urinate, which usually makes the incontinence worse. It also leads to severe constipation and a reduction in the quality of life. Most of all, children can be the victims of teasing and bullying.
Treatment first deals with releasing the constipation. To do this, various drugs are used that do not lead to further complications. If the problem is of a psychological nature, discussions with a psychologist are necessary. Parents also need to be informed so as not to stress the child further.
Often the encopresis can be treated relatively well through targeted training. Possible feelings of fear can be treated by the parents or by a psychologist. The course of the disease is always positive and there are no further complications.
When should you go to the doctor?
If the child suddenly pees again, this is already a reason for a doctor’s visit. If the child also complains of pain when defecating or has blood in the stool, encopresis may be present. A medical examination should then no longer be delayed. A visit to the therapist is advisable if psychological complaints have already set in due to fecal incontinence. This applies to both the affected child and parents who suffer from the additional stress.
Children who show signs of stress also have encopresis in some cases. Parents should therefore consult a pediatrician at the first suspicion. In the event of constipation, bleeding, and other complications, it is best to go to a hospital straight away. If there are signs of an intestinal obstruction, the emergency doctor must be called or the child should be brought to the clinic immediately. Further therapeutic measures are then recommended, in which the child learns to have normal bowel movements again.
Treatment & Therapy
To treat encopresis, chronic constipation is first treated. Laxatives are usually used for this. Alternatively, there are also drugs that soften the bowel movement and thus make it easier for the child to empty it.
It is also important to educate the affected family about the disease in order to reduce existing feelings of guilt and shame. To avoid constipation again, stool-softening medication usually has to be taken for several months until normal toilet training is successful and the child has got used to emptying as a normal process. Daily training should take place at a fixed time of day.
However, under no circumstances should the child be put under pressure to succeed. A suitable toilet seat and a footstool are helpful for a relaxed sitting posture for the child. They have to be able to sit on the toilet relaxed and without feelings of fear in order to lose negative associations that they might associate with going to the toilet and thus to overcome encopresis.
Outlook & forecast
Encopresis usually only occurs in children who cannot properly control their bowel movements. Since encopresis is not an explicit disease, but rather an appearance, it is very difficult to make an exact prognosis and outlook. In general, however, it can be said that encopresis subsides with increasing age.
Children between the ages of 0 and 4 are often affected and cannot control their bowel movements at all. However, this appearance gradually decreases from the age of about 5 years. Medical or drug treatment is not necessary in such a case. An existing encopresis can also be eliminated entirely without consulting a doctor.
If the uncontrolled defecation also occurs at a later age, a discussion with the child should be sought as a matter of urgency. This can have a positive influence on the prospect and prognosis of eliminating the encoding price. An encopresis is not a clinical picture that urgently requires medical treatment. However, this can guarantee a positive forecast.
The most effective way of preventing encopresis is to avoid permanent clogging. In the case of short-term constipation, plenty of fluids and fruit should be given so that the stool does not harden any further. Glycerine suppositories can help soften the stool, but should only be used for a short time and primarily serve to avoid pain in the child. If the bowel movement is felt to be uncomfortable and painful, encopresis is almost inevitable.
In the case of an encopresis, the options for follow-up care are very limited. The patient is primarily dependent on direct treatment of this complaint in order to prevent further complications. Above all, the parents must support the child and must not ask too much or put pressure on the child.
Even after successful treatment of the encopresis, the child’s toilet should be checked and checked regularly to prevent the encopresis from recurring. In some cases this can also lead to self-healing, so that the encopresis disappears on its own. Above all, parents and other relatives should be patient and calm. The life expectancy of the child is not negatively affected by this disease.
If the encopresis is treated with medication, it is important to ensure that these medications are taken correctly and regularly. It is above all the parents who have to control the correct intake. Furthermore, the child must be relaxed so that there are no longer any feelings of fear. Contact with other affected parents of encopresis can also be useful and make everyday life easier.
You can do that yourself
In many cases, encopresis does not require direct medical treatment. However, parents should definitely stay calm and not panic the child with this disease. This could adversely affect the disease and continue to make symptoms worse.
If the encopresis occurs due to permanent constipation, the constipation should be treated first. Ordinary laxatives can be used for this. The person affected does not necessarily have to resort to drugs from the pharmacy, but can also use natural laxatives. These can also be purchased in the drugstore.
The parents must also release any feelings of fear from the child. Negative associations can increase the fear even more and should be avoided. The encopresis is also intensified by stress, so that this too must be avoided. Under no circumstances should the child be exposed to pressure to succeed.
Parents can also use it to set up a fixed training program. It is important that the training always takes place at a certain time. This combats the symptoms of encopresis. Any feelings of shame should also be resolved, as this can also further exacerbate the disease.