Encopresis in children prior to four years of age may be a potty training or developmental issue and typically is not considered a behavior problem. The problem is when the bowel movement is placed somewhere other than into the toilet by the older child at regular intervals, at least once a month. The passage of the stool may be voluntary, involuntary, formed, semi-formed, or liquid.
First, a parent should rule out medical, mental, or developmental issues for the encopresis by scheduling a complete physical and or psychological exam. If the child is found competent then a behavior problem exists. The child should begin regular therapy with a therapist who is experienced in helping to resolve this behavior.
Here is an example of the problem, which I located on the internet.
Katy has encopresis: she deliberately defecates in her pants at home and at school as
one of her primary means of communication. Adults are annoyed, peers are distant, her mother is overwhelmed, and her stepfather is
disgusted, and her siblings are confused.
Katy is “alone” and headed towards a high¬level out¬of¬county group home.
Through a team approach, Katy was able to identify her anger and develop new coping skills. She learned to identify the risk factors that would lead to crisis situations and improve her communication skills. She was successful in giving up her encopresis.
A parent must avoid severe reactions to episodes of encopresis. When our daughter went through this phase, she cleaned up the mess that she made and took a shower. When she spread feces on the walls and other objects, she was given a bucket of soapy bleach water and a brush. When she defecated in her clothing, she got to rinse the items in the toilet until they were no longer soiled. Before she rejoined the family, she had to shower and put on fresh clothing. The behavior lasted less than a year.
Another daughter arrived in our home already under the care of a gastrointestinologist. She would only have a bowel movement about once a week and she would hide during those episodes. Because she was withholding stool so they were giving her mineral oil everyday. That caused dark slimy stools that she had trouble controlling.
We discontinued the mineral oil and put her on a high fiber diet consisting of fresh fruits, vegetables, popcorn, and whole grain products. We sprinkled Metamucil on her cereal as if it were sugar. She was rewarded for successfully defecating in the toilet and we noticed that warm baths help to initiate the process.
When she began to have bowel movements daily, they were smaller and not as painful. She enjoyed rewards and responded well to praise, candy, and stickers. She was fully potty-trained in about six weeks.
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Definition of Encopresis from:University of Michigan Health System. Functional constipation and soiling in children. Ann Arbor (MI): University of Michigan Health System; 2003 Feb. 10 p. [8 references]