Childhood Constipation and Encopresis

I had never heard the word Encopresis before and until my son was born, I had no reason to understand or care about the condition.  At five-years-old, my son was diagnosed with Encopresis or fecal incontinence.  He is self-conscious and afraid that people, mainly his peers will find out. 

At the beginning, we tried everything- diet changes, timed sittings, medications, even rewards- but nothing helped.  The soiling would happen anytime, anywhere.  I would get angry because I believed that my son wasn’t trying.  That he didn’t care. 

Beyond Childhood Challenges

When my son, Peter, was two-years-old he was diagnosed with childhood constipation.  His pediatrician said he would grow out of it.  In the meantime, Peter was to use suppositories on his bad days.  His doctor also suggested that I change Peter’s eating habits and increase his fiber intake by adding Metamucil to his diet.  In addition, Peter was prescribed a non-habit forming laxative to regulate his bowel movements.  I was to continue with his potty training, which would eventually alleviate the constipation. 

Despite the challenges, Peter was effectively potty trained by the age of three.  But no matter how many times a day he would use the bathroom he would always have stains in his underpants.  Even with his diet, medication and potty training the constipation continued.  Painful gas, bloating and bowel movements caused Peter to withhold his movements, which in turn exacerbated the constipation.  And so the cycle continued with his soiling becoming more frequent and heavier. 

As Peter got older, he began to hide his soiled underpants and was easily embarrassed because of his odor.  The children at school would tease him and refuse to play with him because he smelled funny.  He was afraid to use the bathroom at school because he was afraid the kids would “hear” him. 

When he came home from school, he would lie to me and tell me that he didn’t need to use the bathroom.  He would tell me that he didn’t have an “accident” that the odor was just gas.  Then shortly after I would notice, he was in different clothes.  I would find his soiled clothes hidden somewhere in his room or bathroom.  When I confronted him, Peter would tell me that he didn’t know- that he couldn’t feel himself soiling.  At the time, I didn’t believe him.  I was always so frustrated and angry.  How could he not tell that he had soiled himself? 

Demanding Answers

 Peter missed three-fourths of kindergarten, half of first grade and almost all of second grade due severe stomachaches, soiled clothes and doctor visits.  His pediatrician suggested we wean him off the laxative suggesting it would diminish the “accidents” and gas build-up. 

 What we discovered was that after five years his body could no longer function without the laxative. 

 Fear, determination and frustration provided me the courage to demand that Peter see a specialist.  There had to be someone who knew what was going on with Peter’s body.  Six months later a pediatric gastroenterologist diagnosed Peter with Encopresis. 

 He defined Encopresis as fecal incontinence or the repeated passage of stool into inappropriate places, such as underwear, by a child who was four years of age or older physically and mentally.  The specialist said Encopresis was a medical condition that arises from untreated childhood constipation.  When the constipation is not treated or is treated improperly, the leakage can be present even if the child is sitting daily- hence the “accidents.”  There is no known cause for Encopresis and no known cure.  It is not a disease but a learned behavior with long-lasting consequences. 

 Peter missed most of third grade due to appointments with specialists.  He had surgeries to rule out intestinal blockage and missing nerve cells. Blood work and allergy tests were done, as were psychological tests.  In the end, Peter begged me to stop.  The pain was unbearable, he hated the anesthesia, and it’s after effects.  I promised him that if the biopsies and blood tests came back acceptable we would stop. 

 The biopsies showed an enlarged colon due to continuous constipation but no other physical abnormalities.  Another test showed that the build up of methane gas in Peter’s body desensitized the nerve cells at the end of rectum causing him to lose sensation, which was why he could not feel himself soiling.  The blood tests were negative but he did have a high allergy to lactose. 

 After many long trips and painful procedures, we finally had some answers. 

Starting Anew

 Knowing that there was nothing physically or emotionally causing Peter’s Encopresis was a relief.  Knowing that he was lactose intolerant gave us a starting place in controlling the Encopresis.  The specialist told us that it took ten years for Peter’s body to get this way and it could take up to ten years for his body to heal itself.  Patience and setbacks were a major part of the healing process. 

 We continued the laxative and added a probiotic to decrease the methane gas build-up in his body.  At home, we began using a calendar to mark the dates and times when he voided with and without “accidents.”  Special books and small rewards were used during timed sittings.  We also set up a special calendar for the days when he did not have any “accidents.”  We also educated ourselves with information on Encopresis from the specialist and from websites like Wikipedia and MayoClinic. 

 Peter is now in the fifth grade.  The soiling is still a part of our lives but thanks to the laxative and probiotic, it doesn’t rule our lives.  We have no control over the Encopresis.  Occasionally it flares up and sets him back a few days but we deal with it and move on because now we know what to expect and how to deal with it both physically and emotionally.