Encopresis - The Types, Causes and Treatment of the Disorder

Encopresis, an elimination disorder that is found in children who in most cases were previously toilet trained. Encopresis affects approximately 1-2% of children. The main symptom of encopresis is repeated bowel movements in locations where it is inappropriate to do so. Any location other than a toilet, in most cases, is not somewhere that is considered appropriate to have a bowel movement. While children who have been toilet trained might occasionally, for example, have an accidental bowel movement while wearing underwear, if they continue to have bowel movements in places other than a toilet at least once a month for three months in a row, then they have met the criteria required to be diagnosed with encopresis.

There are two types of encopresis. The first type, retentive encopresis is the more common one and is the problem in the vast majority of cases. With retentive encopresis, there is an actual physical problem that is preventing the child from voluntarily having a bowel movement in a toilet. For example, the affected child may wish to defecate at the proper location at the right time, but may be unable to accomplish this due to being unable to feel the sensations usually associated before having a bowel movement. Another possible scenario is that the child may also have experienced pain while defecating before due to the hardened feces associated with constipation. Constipation is commonly caused by a lack of fiber, lack of physical activity, and inadequate hydration.

The less common type of encopresis is called nonretentive encopresis. In this case, the child simply refuses to have a bowel movement in an appropriate place, most likely being a toilet. Given that the child has already been toilet trained and is fully capable of doing so, then it is a behavioral issue rather than an inability to have a controlled bowel movement in the appropriate location. Constipation is not a factor in nonretentive encopresis. Current events that are causing stress in the child's life may contribute to their refusal to defecate in a toilet. Some other possible causes for nonretentive encopresis are the child consciously attempting to control their parents by engaging in behavior they know is unapproved of, or a fear of defecating in toilets or public locations.

In treating encopresis, it is essential to make sure the child does not feel guilt or shame that is unwarranted. If the child is already feeling guilt or shame about a situation they possibly have no control over, scolding them could possibly make the situation even worse. Professional medical advice is essential to the treatment of encopresis, as there is, in the vast majority of cases an underlying physical problem. If the parent is reprimanding a child for their "behavior" when, in fact, there is a blockage that is physically preventing a proper bowel movement from occurring, this is both emotionally and psychologically harmful to the child. Feeling shame about having conscious bowel movements in the appropriate locations is a harmful attitude for a child to possess, and they should be patiently taught that it is natural and expected for them to defecate in a toilet. In the case of possessing nonretentive encropresis, it may be beneficial for the child to see a counselor of psychiatrist in order to find out the underlying psychological issues that may be causing the unwanted behavior.

Sources:

Anonymous, Encopresis (Fecal Incontinence) Causes, Symptoms, and Treatment MedicineNet.
L. Fleming Fallon Jr, Encopresis Information Healthline