Encopresis is a frustrating experience for children, parents, and teachers. Encopresis is generally defined as the passage of feces in inappropriate places, like underwear or the floor, by children who are past the age of toilet training. A variety of different factors can contribute to encopresis, including both physical and behavioral factors. This is why it is essential to involve both medical and behavioral health clinicians in the treatment of encopresis.
One common physical contributing factor for encopresis is constipation, which may lead to overflow bowel incontinence (stool leakage).
Behavioral factors can also contribute to constipation, and in turn encopresis. These include ignoring physical cues associated with passing stool as well as voluntary withholding of bowels. For example, a child may have had a particularly painful bowel movement. Then the child may voluntarily withhold their stool for fear of experiencing pain.
Although constipation may contribute to encopresis, it is important to note that not all children with encopresis will have constipation.
Behavioral Interventions for Managing Encopresis in Children
First, it’s important for the family to work closely with a medical provider to identify any medical reason for encopresis, such as constipation. The provider can then implement a bowel cleanout if appropriate.
If a bowel cleanout is appropriate, it is important this occurs prior to the implementation of behavioral techniques. Once the child has completed the bowel cleanout, the following interventions may be helpful:
- Increase your child’s awareness of their physical cues associated with passing stool. Parents may need to point out to their children when they are demonstrating physical signs that they need to use the restroom like “the potty dance.”
- Implement scheduled sitting – regular times each day that the child will sit on the toilet. To encourage sitting on the toilet, parents can give the child a special toy or electronic device that can only be used on the toilet.
- Parents should provide praise for sitting on the toilet regardless of whether or not the child passed a bowel movement while sitting. For example, “I like how you sat on the toilet,” or “I’m really glad that you tried.”
- Encourage your child to implement deep breathing to help them relax on the toilet.
- If your child has an accident in between scheduled sitting times, remain calm and encourage your child to clean up.
- Implementing a reward system may also be helpful.
If interested in receiving support from a behavioral health specialist in terms of implementation of behavioral interventions, please contact your pediatrician or call 454-TEEN (8336) for referrals.