<p><span style="font-family: helvetica;"><img src="/nairobi/PublishingImages/encopresis%20body%20image.jpg" alt="" style="margin: 5px;"/></span> </p><p><span style="font-family: helvetica;">Is your child already potty-trained but still soils himself and is mostly constipated, has hard stool and avoids using the toilet or goes for long periods without bowel movements?</span></p><p><span style="font-family: helvetica;">Well, your child could be suffering from encopresis. Also called functional faecal incontinence or soiling, encopresis is the repeated involuntary passing of stool when not on the toilet hence soiling clothing. Typically, it happens when compacted stool collects and fills up in the colon and rectum, causing leaking of liquid stool around the retained stool hence staining underwear and might be mistaken for diarrhoea.</span></p><p><span style="font-family: helvetica;">Encopresis mostly affects up to four percent of children aged four years, and it is more prevalent in boys. Its frequency decreases with older age. It is perhaps due to its low prevalence that there is little awareness about the disease. Most often it is mistaken for just constipation. Parents may also think that a child who does not excrete regularly is merely afraid to use the potty or the toilet.</span></p><p><strong style="font-family: helvetica;">But what causes encopresis?</strong></p><p><span style="font-family: helvetica;">Your child&#39;s age matters when considering the causes of constipation. In infants and toddlers, we think more of an organic cause as opposed to a functional cause. While it could be caused by emotional issues, constipation is the most common cause of encopresis. This type is called &#39;retentive encopresis&#39;. In this case, the child&#39;s stool is hard, dry and may be painful to pass.  As a result, the child avoids going to the toilet - making the problem worse.</span></p><p><span style="font-family: helvetica;">Other causes of constipation include withholding stool due to fear of using the toilet (especially when away from home), or because passing stool is painful, or not wanting to interrupt play or other activities.</span></p><p><span style="font-family: helvetica;">The longer the stool remains in the colon, the more difficult it becomes to push out. Ultimately the colon stretches, affecting the nerves that signal when it&#39;s time to go to the toilet. When the colon becomes too full, soft or liquid stool may leak out and loss of control over bowel movements may occur. Stool build-up in the colon may cause it to enlarge, making it hard for the child to feel bowel movements.</span></p><p><span style="font-family: helvetica;">Far less frequently, encopresis occurs without constipation and may be the result of emotional issues like stress. A child may experience stress from premature, difficult or conflict-filled toilet training.</span></p><p><span style="font-family: helvetica;">Changes in the child&#39;s life, such as dietary changes, starting school, altering schedule, the divorce or separation of parents or the birth of a sibling can cause emotional stressors in your child and trigger encopresis. For school going children, it is important to inform the school of the child&#39;s need to use the toilet regularly. Sometimes teachers perceive requests to use the toilet as naughtiness and turn the students down which can worsen the problem.</span></p><p><span style="font-family: helvetica;">Certain risk factors may also cause encopresis. These may include using medications that may cause constipation such as cough suppressants, attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder, anxiety or depression.</span></p><p><span style="font-family: helvetica;">Encopresis could also be a symptom of an underlying medical condition such as colonic inertia, where the child&#39;s colon doesn&#39;t move stool as it should, or digestive tract nerve damage - muscles at the end of the digestive tract (anus) which do not close properly.</span></p><p><span style="font-family: helvetica;">It could also be that nerve endings in the bowel are missing, causing blockage of the intestine. Moreover, the child could be suffering from an infection or tear in the rectum.</span></p><p><strong style="font-family: helvetica;">How is this problem diagnosed and treated?</strong></p><p><span style="font-family: helvetica;">To diagnose encopresis, your healthcare provider will carry out several tests including asking some questions about your child&#39;s medical history, symptoms, emotional wellbeing (stress), toilet training and diet. A rectal examination will also be necessary to check for blockages and muscle tone.</span></p><p><span style="font-family: helvetica;">The doctor may also conduct an x-ray of your child&#39;s abdomen and a psychological evaluation to determine if emotional stress, fear or behavioral challenges could be the cause of encopresis. Moreover, your doctor might order additional urine tests to rule out similar conditions. If there is no diet changes and toilet use modifications, the doctor may then look for possible food allergies.</span></p><p><span style="font-family: helvetica;">Treatment of encopresis is unique to each child. It could include removal of any stool ball, taking stool softeners, laxatives or enemas to ensure regular, soft stools. Scheduled toilet sitting, eating a diet high in fibre and drinking plenty of water are other ways to manage encopresis.</span></p><p><span style="font-family: helvetica;">Because most children with the condition have retentive encopresis as a consequence of chronic constipation, therapy is initially focused on evacuating the distal colon. This can be done by softening the stool using oral cathartics or a series of enemas. After the colon is evacuated, long-term laxative therapy is started, aiming to produce one to two soft stools daily.</span></p><p><span style="font-family: helvetica;">While it may be frustrating for parents, a child with encopresis may experience a range of emotions, including embarrassment, frustration, shame and anger. If your child is teased by friends, criticized or punished by adults he may feel depressed or have low self-esteem. However, with patience and positive reinforcement, treatment for encopresis is usually successful.</span></p><p><span style="font-family: helvetica;">Early treatment, including guidance from your child&#39;s doctor or mental health professional, can help prevent the social and emotional impact of encopresis.
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