Even if a child has already mastered going to the toilet, he or she may suddenly begin to defecate again, either noticed or unnoticed, due to a number of circumstances. It is then important for parents to remain calm and not put additional pressure on the child. Encopresis can be diagnosed and treated by a pediatrician.
What is encopresis?
Encopresis is the defecation of children from about four years of age, when it occurs minimally once a month for a period of six months. The condition is divided into primary and secondary encopresis. While the primary form of the disease refers to children who are not clean after the age of 4, the secondary form concerns children who defecate again after a prolonged period of regular bowel movements. Therefore, it is assumed that the disease is a psychological disorder, and the children are otherwise physically healthy. In most cases, rewetting also occurs. Boys are generally more than twice as likely to be affected by encopresis as girls.
Causes
In 80 to 95 percent of children, permanent constipation is the cause of enuresis. The condition is then called retentive encopresis. Non-retentive encopresis, on the other hand, has psychological causes such as stress and occurs in 5 to 20 percent of children. Constipation that lasts for a long time often triggers a cycle that is subsequently difficult to break. Because of the hard stool, the child experiences defecation as stressful and painful. Painful fissures may form on the anus. Therefore, defecation is increasingly delayed by the child. The bowel expands and loses sensitivity. The affected children no longer notice that the bowel is overflowing. They feel ashamed and sometimes try to hide the soiled clothes. Parents also find their child’s encopresis a burden.
Symptoms, complaints, and signs
In encopresis, the affected person primarily suffers from very severe fecal incontinence. This occurs when the patient has actually already learned to defecate and can also occur several times in one day. The quality of life of the affected person is considerably restricted and reduced as a result. Especially in children, encopresis can lead to bullying or teasing. In many cases, parents think that the bowel movements are diarrhea, when in fact there is no diarrhea. Due to the frequent bowel movements, it is not uncommon for pain or anal itching (itching of the anus) to occur. This can also lead to a tear in the anus and thus to bloody bowel movements. In some cases, those affected deliberately eat less food due to encopresis so that incontinence does not occur as frequently. Because the children often hold back bowel movements, they appear irritable and stressed during this process. Constipation can also occur during this process, leading to pain in the abdomen or bloating. If encopresis is not treated, it can cause permanent damage to the anus or intestinal organs that can no longer be treated.
Diagnosis
Diagnosis of encopresis is usually made by the pediatrician based on the symptoms described by the parents. In this case, the physical examination consists of palpation of the abdomen to feel for solid stool. The doctor will also check to see if painful fissures have already formed on the anus, as these are very painful and require additional treatment. A stool examination is often ordered as well to assess if there is blood in the stool and thus if there are other physical causes of encopresis that need to be addressed first.
Complications
As a rule, encopresis results in uncontrolled urination, which can occur especially in children. Due to the symptom, there is severe psychological discomfort and depression. These can occur not only in the child itself, but also in the parents. In many cases, bowel movements and urination are affected by pain. The children then try to hold back bowel movements or urination, which usually further aggravates the incontinence. This also results in severe constipation and a reduction in quality of life. Children can be victims of teasing and bullying in particular. Treatment first deals with relieving the constipation.For this purpose, various drugs are used, which do not lead to further complications. If the problem is psychological, discussions with psychologists are necessary. Parents also need to be educated so as not to put additional stress on the child. Often encopresis can be treated relatively well by specific training. Possible anxiety can be treated by the parents or likewise by a psychologist. The course of the disease is always positive and no further complications occur.
When should one go to the doctor?
If the child suddenly wets his pants again, this is already a reason for a visit to the doctor. If the child also complains of pain during defecation or has blood in the stool, there is possibly encopresis. A medical examination should then no longer be delayed. If psychological complaints have already developed as a result of the fecal incontinence, a visit to a therapist is advisable. This applies both to the affected child and to parents who are suffering from the additional stress. Children who show signs of stress also suffer from encopresis in some cases. Parents should therefore consult a pediatrician at the first suspicion. In case of constipation, bleeding and other complications, it is best to go directly to a hospital. If there are signs of intestinal obstruction, the emergency doctor must be called or the child should be taken to the hospital immediately. Subsequently, more extensive therapeutic measures are recommended, during which the child learns to have a normal bowel movement again.
Treatment and therapy
To treat encopresis, chronic constipation is treated first. Laxatives are usually used for this purpose. Alternatively, there are also medications that soften the stool and thus make emptying easier for the child. It is also important to educate the affected family about the condition to reduce existing feelings of guilt and shame. To prevent recurrence of constipation, stool softening medications usually need to be taken for several months until normal toilet training has been successful and the child has become accustomed to voiding 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 of the child. It must be able to sit relaxed and without feelings of anxiety on the toilet to lose negative associations that it may associate with going to the toilet and thus overcome encopresis.
Outlook and prognosis
Encopresis usually occurs exclusively in children who cannot properly control their bowel movements. Because encopresis is not an explicit disease, but rather an appearance, it is very difficult to give an accurate prognosis and outlook. In general, however, it can be said that encopresis subsides with increasing age. Children between 0 and 4 years of age are often affected and cannot control their bowel movements at all. However, this appearance slowly decreases from the age of about 5 years. Medical or drug treatment is not necessary in such a case. Even without consulting a doctor, it will be possible to eliminate the existing encopresis. If the uncontrolled defecation still occurs at a later age, a discussion with the child should be sought urgently. This may positively influence the prospect and prognosis for elimination of encopresis. Encopresis is not a clinical picture that requires urgent medical treatment. However, it can guarantee a positive prognosis.
Prevention
Encopresis can be most effectively prevented by avoiding permanent constipation. If constipation is short-lived, plenty of fluids and fruit should be given so that the stool does not harden further. Glycerin suppositories can help soften the stool, but should only be used for short periods of time and are primarily used to prevent pain in the child. If bowel movements are found to be uncomfortable and painful, encopresis is almost inevitable.
Follow-up
In the case of encopresis, the options for aftercare are very limited. Here, the patient is primarily dependent on direct treatment of this complaint to prevent further complications.Parents, above all, must support the child and not demand too much of it, nor should they put pressure on the child. Even after successful treatment of encopresis, the child’s bowel movements should be regularly checked and controlled to prevent the recurrence of encopresis. In some cases, self-healing can occur, so that the encopresis disappears on its own. In this case, the patience and calmness of the parents and other relatives is most important. The life expectancy of the child is not negatively affected by this disease. If encopresis is treated with the help of medication, it is important to ensure that this medication is taken correctly and regularly. Especially the parents have to control the correct intake. Furthermore, the child must be relaxed so that there are no more feelings of anxiety. Contact with other affected parents of encopresis can also be useful in this regard and make everyday life easier.
What you can do yourself
In many cases, encopresis does not require direct and medical treatment. However, parents should definitely remain calm in this condition and not panic the child. This could have negative effects on the disease and also continue to worsen the symptoms. If encopresis occurs due to permanent constipation, the constipation should be treated first and foremost. Ordinary laxatives can be used for this purpose. Here, the affected person does not necessarily have to resort to drugs from the pharmacy, but can also use natural laxatives. These can also be purchased at the drugstore. Likewise, parents must remove any feelings of anxiety from the child. In doing so, negative associations can further increase anxiety and should be avoided. Likewise, encopresis is exacerbated by stress, so this must also be avoided. Under no circumstances should the child be subjected to pressure to succeed. Likewise, parents can use this to set up a fixed training program. It is important that the training always takes place at a specific time. This will combat the symptoms of encopresis. Any feelings of shame should also be resolved, as this can also further exacerbate the condition.