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Establishing Regular Soft and Painless Bowel Movements
Establishing regular soft and painless bowel movements is mostly a matter of retraining the child to give up the habit of "withholding" stool. This is accomplished by giving a laxative or stool softener every day in doses sufficient to produce one or two soft bowel movements every day. If the bowel movement is soft enough, the child will not have to strain very hard to pass it, and perhaps more importantly, they will not have pain when they pass it. This will encourage the child to pass regular bowel movements rather than holding stool in. Remember that fecal retention and soiling go together and so, as long as the child has a large amount of stool retained in the rectum, the soiling will persist.
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.
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.
Medically Reviewed by a Doctor on 2/19/2016
Stephen Borowitz, MD
Bhupinder Anand, MD
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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."