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Digest This – Constipation and Soiling

Is your child having problems pooping?  Constipation means having reduced frequency of bowel movements or painful passing of stools.  Most children over one year of age have poops one to two times per day, every one to two days.  Left untreated, constipation can lead to fecal soiling, also known as encopresis.  This is when children pass stool in their clothing due to overflow stool.  Overtime, the rectum in chronic constipation can get stretched out and lose its tone.  Stool builds up in the rectum, gets hard and blocks other poops from exiting.  The looser poops from higher up in the bowel will then seep around the large hard piece of poop and comes out as what seems like diarrhea.

Encopresis could be voluntary or involuntary, and affect a child at any age.  Voluntary encopresis occurs when a child passes normal stools in clothing and can be related to psychological problems.  Involuntary encopresis involves passing loose, liquid stools.  This is a more common problem and can be associated with stool withholding.  Children affected by constipation and fecal soiling, are usually not aware that they are about to have an accident.  They should not be punished for soiling episodes.

Soiling is a real challenge for caregivers and children.  Children can feel embarrassed and become anxious, withdrawn or sad from being teased.  Protect your child’s psychological health by shielding them from any blaming, shaming or name calling.  Always respect a child’s dignity and need for privacy and guidance.

Both constipation and fecal soiling are curable.  Get guidance from your doctor to help your child.  Your doctor may decide to do tests if necessary.  In general, treatment involves two phases.  The first is clearing out the bowel of impacted stool.  The second phase involves keeping your child on a regular treatment regimen to ensure daily soft stools.  Part of the therapy also includes getting your child to sit on the toilet on a daily basis, at least one to two times per day after meals.  Having patience is important.  This process may take several months to years to get better.

In part two of this article next month, we will delve further into the management of constipation and encopresis.


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