Encopresis (Soiling Underwear)

This is when the child (almost all boys) have bowel movements(BMs) in their pants. This starts during grade school but the problem actually begins way back at 2-4 years old. The child is busy and doesn't want to come in to have BM (or urinate either) and holds it back till the last minute. It then hurts to go and this causes more retention and more constipation and more pain and a vicious cycle is started. Plus they are busy and if they need to have a BM they just release a small amount and leave.  They don’t stay long enough to empty the colon.  Then they go to school and do not want to use the nasty bathrooms there and hold it all day. The rectum stretches and loses its feeling so that the child does not feel the sensation to move his bowels. Then any laughing, climbing, or movements that increase the abdominal pressure, will cause the feces to come out in the pants. He really does not feel it or know it is going to come out.

The way to treat it and this is 95% effective if you can stay with it. You have to do these things for 6 months to a year. Yes I said that long because this came on over years and will take a long time to get control back. However they stop soiling quickly. But keep this regimen going for almost a year.

1. Clean out the bowels with a laxative. A tablespoon on Milk-of-Magnesia, or mineral oil, or use dulcolax or high dose of Miralax. Use this for 3 days and clean him out.
2. Then start a stool softener every day.  Many people recommend fiber but I have not found that effective.  You can use mineral oil --- it is not habit forming, it just softens, and lubricates.  It does not cause diarrhea or cramps. Start with 2-3 tsp. a day and go up till they have some leaking on the underwear, or having soft to mushy BMs. Or you can use Miralax or its generic form.  Start with ½ capful of powder into any liquid or food if they are preschool and a whole capful in school age.  Increase till stools are soft or even mash potatoes consistency.  Continue giving this for several years if not forever.  They are not habit forming. 
3. Simultaneously start potty times. You cannot make them move their bowels but you can make them sit there twice a day for 5 to 10 minutes. They can read, eat a snack, cry, or kick but they are on there for the whole time or you set the clock back to the whole 10 minutes and they start over. They are to also sit an extra time if the soil their pants. Do not check if they go or not, nor should you make a big deal if they go or not. The problem is they usually just get on the toilet for a second and get rid of a few lumps and jump back down. We need to teach them to stay on the toilet long enough to empty their rectum and colon like Dad. (Men are full of it…. Right ladies?)  Notice men go in there with the newspaper or I-pad forever!!! That is because men have a harder time moving their bowels genetically. Girls train at 2 and boys not till 3-4 yr. old. That is why it is usually boys that have this problem. So keep him on there for 5-10 min. and as he does better, you can decrease the minutes or go to once a day.  There is a reflex that when you eat you have the urge to have a BM. That is why little babies mess their diaper every time you nurse them and children want to go to the bathroom during the meal.  That is the normal reflex and if they have a stomach ache during or after the meal, then let them go and use the reflex to keep them regular. Use that as one of their potty times. If you do not let them go, you are teaching them to hold it back and not follow the urge.  Keep this up for a long time and I promise this will work.

 

 Dr. Knapp