Encopresis – Diagnosis and Treatment

Diagnosis

Doctors use several steps to determine if a child has encopresis or another type of bowel control problem.

A physical examination usually comes first. This helps the doctor look for signs of constipation or other medical problems. They may also ask questions about eating habits, bathroom use, and overall health.

The doctor often performs a digital rectal exam to feel for stool that might be stuck in the bowel.

Sometimes, an abdominal X-ray confirms if there is a blockage. In some cases, the doctor checks for other conditions, such as low thyroid hormone or cystic fibrosis.

Additional Details

• Fecal incontinence and bowel incontinence in children can have similar symptoms.
• The doctor may suggest a psychological evaluation if stress or emotional problems are present.
• These steps help tell the difference between primary and secondary encopresis.

Treatment

Removing Retained Stool From the Colon

The first step is to get rid of any hard or stuck stool in the colon (fecal impaction). Doctors may advise using certain laxatives, enemas, or rectal suppositories to help clear the bowels.

This process is important, as old stool can block new bowel movements and make leakage worse. Health care providers often check that the colon is clear and the stool is passing easier.

Promoting Regular and Healthy Bowel Habits

Once the colon is clear, the next goal is to keep bowel movements soft and regular. This includes:

• Eating foods high in fiber like fruits, vegetables, and whole grains.
• Drinking plenty of fluids each day.
• Using stool softeners or medicines such as polyethylene glycol or lactulose when necessary.
• Sometimes trying a short period without cow’s milk, if suggested.
• Encouraging children to use the toilet whenever they feel the urge.
• Creating a routine, such as sitting on the toilet after meals.

Supporting Positive Bathroom Routines

Sometimes children need to change behaviors to improve bowel control. Bowel training programs or biofeedback can help children develop better bathroom habits.

A rewards system can motivate children to use the toilet. In some cases, meeting with a mental health professional may provide support for emotional stress linked to chronic constipation or bathroom accidents.

Daily Routines for Support

Self-care plays an important role in keeping children comfortable and helping with symptoms like abdominal pain and anxiety. Parents can help by giving plenty of high-fiber foods, such as whole grains, fruits, and vegetables.

Foods high in fiber help keep stools soft so they are easier to pass. Drink water throughout the day to help prevent stools from getting hard. Limiting drinks high in sugar or calories is useful, but make sure the child stays hydrated.

Here are some simple self-care actions:

• Plan Regular Toilet Times: Try having the child sit on the toilet for five to ten minutes after meals. After eating, the bowels are more likely to move, which can help train the body to go at regular times.
• Use a Footstool: Putting a small stool under the child’s feet while on the toilet can help them feel more comfortable. This position puts gentle pressure on the stomach and may make having a bowel movement easier.
• Follow the Routine: Good habits take time. It may take several weeks or even months to see big changes. Keeping up with the routine can help prevent relapses and lower overall stress for the child.

Emotional support matters, too. Children dealing with encopresis often feel shame or embarrassment, which can lead to stress, depression, or other emotional problems.

Support and praise from parents can help boost the child’s confidence. It is best not to criticize or blame the child for accidents. Instead, celebrate effort and progress using positive encouragement.

Always check with a doctor before using enemas, laxatives, or herbal products. Some children may need to limit cow’s milk if it makes constipation worse, so advice from a doctor is important.

Getting Ready for Your Child’s Medical Visit

Steps You Can Take Before the Appointment

Careful planning before seeing the healthcare provider can make the visit go smoothly.

Parents can help by putting together important information and questions. Being organized will help the healthcare provider understand the child’s needs.

Helpful tips to prepare:

• Write down all symptoms. Include when they started and how often they happen.
• List any stress or changes at home. This could include starting a new school, moving, or family changes.
• Gather all medications. Bring names and dosages for any prescription, over-the-counter medicine, vitamins, or supplements.
• Track daily diet and drinks. It helps to write what types of foods and beverages the child eats and drinks in a day, including dairy products and water.
• Create a list of questions. This can help parents remember to discuss everything they are concerned about.

Sample questions for the healthcare provider:

Question	Purpose
What could be causing my child’s symptoms?	To understand possible reasons behind the problem.
Are there other possible causes?	To consider all options.
Will my child need any tests, and how should we prepare?	For planning and preparation.
How long could this issue last?	To help manage expectations.
What are the treatment options and risks?	For making informed decisions.
Are there other ways to help?	To learn about alternative treatments.
Are there diet changes we should try?	To improve symptoms.
Would physical activity help?	To discuss lifestyle changes.
Do you have educational materials or resources?	For extra support at home.

Keeping this information in a folder or notebook makes it easy to bring to the appointment.

What the Healthcare Provider Might Ask and Do

During the visit, the healthcare provider will ask for details to understand the child’s condition. Parents should be ready to talk about their child’s toilet training experience, family history, and other related topics.

Topics the healthcare provider may discuss:

• When the child learned to use the toilet and if there were any challenges
• If the child has had hard stools that clog the toilet
• Frequency of bowel movements and if the child avoids using the toilet
• Whether painful bowel movements occur
• The appearance of stool stains in underwear or accidents
• Any recent life changes or family events (such as school changes or divorce)
• If the child feels upset, embarrassed, or frustrated by the issue
• How the family has addressed the problem
• Medical history, including any medicines the child takes

Possible areas of focus:

Area	Example Questions
Toilet Habits	How often does your child go to the bathroom?
Family Events	Has your family moved recently?
Emotional Response	Is your child embarrassed or unhappy?
Sibling History	How did toilet training go for other children in the family?
Health and Fever	Has your child had any illnesses or fever recently?

The healthcare provider may refer the child to a digestive specialist or a counselor if necessary. Having this information ready helps the appointment go faster and ensures the provider receives all important details.