Encopresis (Soiling) Management in Children

An article by Secure Start Intern, Inke Jones

Toilet training can be an exciting time for parents and children. On the other hand, faecal incontinence, or encopresis, can put severe strain on families. Encopresis can either occur in a child who has never been properly toilet trained (primary) or in children over the age of four who have already learnt to use the toilet (secondary). While encopresis is generally marked by the passing of stool in inappropriate places, there are two different types: retentive and non-retentive encopresis.

Children suffering from retentive encopresis have mostly involuntary stool accidents, with stools of abnormal and unhealthy consistency. Non-retentive encopresis is comparatively rare and involves mostly voluntary bowel movements in inappropriate places without constipation or other medical causes. It is considered a behavioural condition, in which children usually have normal bowel movements but refuse to use the potty or toilet.

Retentive encopresis is generally caused by chronic constipation. This leads to a hard faecal mass obstructing the bowel, weakening the sphincter muscle and distending the colon. Consequently, children lose the ability to feel the urge to defecate and soft, liquid stool that collects around the hard faecal mass cannot be controlled and leaks out.

Retentive encopresis is most commonly treated both medically and behaviourally, with the goals of freeing the obstruction and establishing good bowel habits. A physician may prescribe stool softeners as well as recommend a high fibre diet, increased fluid intake, and regular exercise.

At the same time, a regular toilet routine should be established and maintained. Children should be encouraged to sit on the toilet for 15-20 minutes after breakfast, lunch, and dinner. It is important for parents to stay positive and encouraging throughout the process, to be involved in the toilet sessions, and make them as much fun as possible. A toilet diary or poo chart can be used to keep track and collect reward stickers for successful toilet visits. Depending on the age of the child and the degree to which fear of attending the toilet may have developed (due to painful experiences of passing a stool), children may be rewarded and praised for the act of sitting on the toilet, as much as for managing to defecate into the toilet. For very fearful children, establishment of a desensitisation program may be necessary. Additionally, school-aged children may benefit from the development of a routine around accident management.

If the encopresis is occurring in relation to acute stressful life events or family situations, these issues may need to be addressed in separate therapy.

If you require a psychology service in relation to your child’s encopresis, please call Secure Start on (08) 82789358 or email admin@securestart.com.au.