Toilet training is a tricky business, and accidents are common. But, some parents are faced with something puzzling: their child is pooping in their pants way after toilet training is passed (like age four and up). And it’s not because of a stomach bug or food poisoning. It might, however, be due to a little-known diagnosis: encopresis.
Encopresis is the leakage of poop. It’s involuntary and usually due to a constipation issue. And while the treatment is involved, there is relief available for both you and your child.
Encopresis is Frustrating
The most common culprit in encopresis is constipation. Sometimes, this constipation is due to an underlying health issue. Most often, though, it’s more psychological in origin, but leads to this very physical problem.
According to Kids Health, “parents note that their kids with this condition often don’t acknowledge the accidents. This is sometimes due to denial, or that it’s become so common that the kid can’t even smell it anymore.” The key here is to not get mad, but to investigate with a doctor’s help.
A diagnosis might include an x-ray, or something called a contrast enema.
The Mechanics Behind Encopresis
The problem stems from chronic constipation. Although every child has different poop habits, passing hard little rabbit pellets is a sign of a chronic problem. When a child is constipated, passing it is unpleasant and sometimes painful…so the kid holds it.
Holding it, though, gives the poop more time in the colon. As the colon does its job of removing water from the poop, it gets harder and more impacted. It builds up and gets even more difficult to pass.
“In time, the rectum and lower part of the colon get so full that it’s hard for the sphincter (the muscular valve that controls the passage of feces out of the anus) to hold the poop in. Partial bowel movements (BM) may pass through, causing the child to soil his or her pants. Softer poop may also leak out around the large mass of feces and stain the child’s underwear when the sphincter relaxes,” Kids Health summarizes.
Thus, accidents start to happen. A lot. The kid is either upset or in denial. And the parent gets frustrated, beginning a vicious cycle of emotional stress and mess for everyone.
The Emotional Component Behind Encopresis
Often, the key to encopresis begins in toilet training. As Robert Collins, PhD, tells Parentology, “Pee training is easy to train, poo, not so much. Bladder urgency is easier to spot through parental observation. Its release as a liquid is easier and the reward of relief more immediate and pleasing. Also, it occurs 6-9 times a day and the habit is more rapidly established.”
Poop also creates a more visceral reaction in some parents. Since it is, after all, stinky and difficult to manage (how many parents have written about how much they hate wiping butts?).
“Parents and others have stronger emotional reactions to poo accidents. In a small number of cases an anxious holding habit may form instead of a relaxation and voiding release habit,” Collins says.
Learning to take the time with your child in sitting, going, and cleaning up, will go a long way to alleviating poop-related anxiety.
Treatment is Slow
Just like toilet training, retraining your child’s poop hygiene takes time. Indeed, Cincinnati Children’s Hospital notes, “This treatment will take many months of hard work for you and your child. There is no quick fix for this.”
First, the kid has to have impacted poop removed through gentle laxatives, stool softeners, and possibly enemas. Then, the dietary changes, habits and retraining can begin.
A diet containing ample fruits, vegetables, and natural fiber, will help. More water and less milk are also suggested. Stanford Children’s Hospital recommends a regular meal and elimination schedule to re-establish good poop habits.
“Have your child sit on the toilet at least twice a day for up to five minutes. Start with a very short amount of time–like 30 seconds–and slowly work up to five minutes. Try to do this just after a meal. Be sure to make this a pleasant time. Don’t get mad at your child for not having a bowel movement,” Stanford Children’s adds.
Expert Collins also offers a whole program on his site, pointing to Citrucel as a gentle, pectin-based fiber source. He also tells Parentology, “I greatly suspect that the use of a bidet insert on the standard toilet, or a handheld bidet, would assist clean up and be a more pleasant and hygienic experience.”