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Encopresis (cont.)

Maintaining Very Regular Bowel Movements

The final step in the treatment is working with the child to develop regular bowel habits. This step is just as critical as the first two steps and must not be abandoned just because the soiling has improved after starting treatment.

  • Establish regular bathroom times: The child should sit on the toilet for 5-10 minutes after breakfast and again after dinner every day. Some families must alter their daily routines to accomplish this, but it is a crucial step, particularly for school-aged children. Sitting on the toilet right after a meal takes advantage of the fact that the intestine contracts after eating. This is called the "gastrocolic reflex".
  • Behavioral techniques: Offer age-appropriate positive reinforcement for developing regular toilet habits. For young children, a star or sticker chart can be helpful. For older children, earning privileges, such as extra television or video game time may be useful.
  • Training: Children may respond to teaching about the appropriate use of muscles and other physical responses during defecation. This helps them learn how to recognize the urge to have a bowel movement and to defecate effectively.
  • Biofeedback: This technique has been used successfully to teach some children how to best use their abdominal, pelvic and anal sphincter muscles, which they have so often used to retain stool.

The duration of treatment varies from child to child. Treatment should continue until the child has developed regular and reliable bowel habits and has broken the habit of withholding his or her stool. This usually takes at least several months. Generally, it takes longer in younger children than in older children.

Many parents are reluctant to give their child laxatives or stool softeners because they have heard that they are harmful, cause more serious conditions (such as colon cancer) or can result in dependency. There is no convincing evidence that any of these things are true. Laxatives or stool softeners do not stop working if they are used every day for a long time.

Most cases of encopresis respond to the treatment regimen outlined above. If the soiling does not improve, your child's health care professional may refer you to a specialist in digestive and intestinal disorders (pediatric gastroenterologist), a behavioral psychologist, or both.

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Encopresis »

According to the Diagnostic and Statistical Manual of Mental Disorders, Third edition (DSM-III), encopresis is defined as the "repeated involuntary passage of feces into places not appropriate for that purpose...the event must take place for at least 6 months, the chronologic and mental age of the child must be at least 4 years."

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