Encopresis - anyone familar with this

suzanne4, RN · Jun 16, 2004

An enema is a liquid in a small bottle that has a long neck and is inserted into the rectum, contents placed, and then the patient tries to hold it at least for about twenty minutes, then expells it and the contents of the bowel.

A suppository is about 1/2 the size of your little finger and is placed into the rectum above the sphincter muscle.

Before giving your son either of those, I would definitely speak to his pediatrician first. I wouldn't give him something to empty him out. You will get in the habit of doing this and then you have created a real monster. His bowels will only work when they are stimulated. Not a good thing.

I would be more concerned at getting to the problem of why he doesn't want to poop in the toilet. Perhaps he is concerned with falling in. Does he have a smaller potty that he can use, or even one of the training seats that can go on the toilet, similar to the ones that you use for training a cat to use the toilet so he doesn't think that he fall in.

Just my two cents...............

elkpark · Jun 16, 2004

i am a child psych CS, and can tell you that kids biologically develop consistent bladder control quite a while before they develop consistent bowel control. It is not abnormal to still be having problems with bowel control at 3-1/2, and some kids just take longer than others. Be v. cautious about using laxative products on a young child -- as Suzanne4 noted, you can create a greater problem than you are attempting to solve. If you want to speak to his pediatrician about recommendations, that's always appropriate, but this is not a crisis. Keep working on helping him to develop good habits and a regular schedule. Often, kids at that age get busy playing, feel the urge to move their bowels, and just ignore it because they don't want to leave what they're doing at the moment. Over time, that develops into chronic constipation. If he has a problem with sitting on the potty chair, that's something to look at, but it may be something much more benign and simple! :)

chris_at_lucas_RN, RN · Jun 16, 2004

Hi--I'm a licensed therapist and have worked with people with encopresis.

What you describe really isn't a problem until your son is well past the age where using the commode to have a BM really should have been accomplished. Three-and-a-half isn't quite old enough to be beyond the upper age limit.

Some kids train easy and early, others need a little more time.

It helps if you be sure he has enough bulk and fluid in his diet.

Definitely check with your pediatrician--you need some reassurance! But also consider that your focusing on his BM's so much can create quite a lot of psychological chaos, in addition to the dependency on 'help" that Suzanne wrote about.

My suggestion is to make a little potty available to him, all his own, and reward him for using it. If he soils his diaper, then, as you are changing him, calmly have a little "chat" like a conversation, about how big boys use the potty, and then let it go.

It also helps if you (or his Daddy) will take him with you when you "go." He can even take his little book and read it, like an adult might read the paper or whatever. Children at this age learn a lot from imitation. Thgis also helps if your little one gets busy, is too distracted (or focused) to accomodate his body's message that it's time to go, and then it is too late!

If you make a subtle game of it, stop seeing this as a problem, and give your son the freedom to do what he needs to do on his own time, you will both be happier. I promise.

I once knew a very, very bright kid who could read and do math in his head by the time he was 4-1/2, but was still pooping his pants. Mother tried a reward system, and gave him a nickel for every time he used the potty. The boy calculated how much he needed to get a particular toy, and then "metered out" his poops--as many as six little ones a day!--until he "earned" enough!!! Then he went back to soiling his pants! What finally cured him was we told him that they would not let him in kindergarten unless he ONLY used the potty. This worked because 1) he obviously had incredible control and 2) he REALLY wanted to start school.

Give yours another year or so.... I bet it won't take that long!

(Hug your boy a lot--that's good medicine for everything!)

studentdeb · Jun 16, 2004

Thanks for your posts. I did make him an appt with his doctor to go over this and see what he says.

I do not believe it's a potty issue because he sits (not ready to stand yet) on the potty to pee and is not afraid. I do think part of his problem is fear of it hurting because awhile back he made a huge poop in the potty and cried because it hurt and it appears since then he holds it as long as he can. Now what is happening is he has what I call "skidmarks" or more in his pants throughout the day. Most of the time he doesn't even realize it has happened so it seems. I know over the last few days he is backed up because of what is coming out. It is very soft and sometimes very small pieces.

He is a big milk drinker and the more I read that can cause even more problems. I am cutting his milk down and will give him more water and juice and will encourage more fruit. If I can get him unblocked and try to get him more regular, I know that will help.

We had a problem with my daughter (who is now 6) when she was around 3 with her holding it. I bought over the counter enema (it was liquid) and used it twice on her and after that if she was holding it, all I had to do was put the medicine on the counter where she could see it and she would automatically get to the toilet and go. It was kind of funny because I scared her into it. She now goes fairly regular and never had a problem with it again.

So hopefully the doctor will enlighten me on helping him getting "unclogged".

Thanks again

kids · Jun 18, 2004

We had a problem with my daughter (who is now 6) when she was around 3 with her holding it. I bought over the counter enema (it was liquid) and used it twice on her and after that if she was holding it, all I had to do was put the medicine on the counter where she could see it and she would automatically get to the toilet and go. It was kind of funny because I scared her into it. She now goes fairly regular and never had a problem with it again.

I have not been able to get this comment off my mind since reading it a few days ago.

Three year olds are learning autonomy and that they have control over their body and bodily functions. An enema may be necessary to treat constipation but its use in this context (to frighten a child into moving her bowels) was inappropriate.

Please, NEVER use medical procedures as a threat to gain a child's compliance or co-operation, it creates a fear of medical procedures (and personnel) that can last a lifetime and can result in their failing to seek both routine and life saving health care as adults.

studentdeb · Jun 18, 2004

I should have known when I posted this that someone would take it wrong and maybe it was the way it was worded. I didn't mean it the way it sounded. My daugther would hold her poop and not go for days and days and then she would become constipated and that is when we had to use the enema and it was under the advice of our pedetrician. She knew perfectily well how to use the toilet and had done so for quite sometime. The only reason I would put the medicine out on the counter when she would not go for days is so that she would go on her own before she became constipated again. It just let her know that if she held it too long, it would cause problems again and we might have to use the medicine. Sorry if I made it sound like I was being cruel. I would never do that to my children and actually I didn't even push her to be potty trained, I am one of those people who waited until she was ready (of course with lots of criticism).

I have not been able to get this comment off my mind since reading it a few days ago.
Three year olds are learning autonomy and that they have control over their body and bodily functions. An enema may be necessary to treat constipation but its use in this context (to frighten a child into moving her bowels) was inappropriate.

Please, NEVER use medical procedures as a threat to gain a child's compliance or co-operation, it creates a fear of medical procedures (and personnel) that can last a lifetime and can result in their failing to seek both routine and life saving health care as adults.

kids · Jun 18, 2004

Thank you so much for replying and expanding on the story.

My biggest reason for pointing it out was because this is a public board someone could come across this thread (Thank You Google), and not knowing better assume that "we" (as in nurses) endorse intimidating children or that threats are appropriate.

I can't begin to count the number of times I have heard a parent tell their child "you better behave or that nurse will give you a shot". (Um, no...but I am recommend the Physician refer you for parenting classes:rolleyes:).

OCCHCanada · Jun 18, 2004

I remember my youngest doing the same - holding it for days until he started getting sick. He actually start to cry if his bowels moved while sitting on the potty. I think he was scared to use "the potty" as he definitely didn't have problems soiling his diapers.

I knew if he could just go once - the fear would go away so I bought him some bubbles and made it a game that he could sit on the potty and blow bubbles while we waited. His very vigorous bubble blowing and laughing caused him to strain enough that he pooped - never had a problem with him again and it worked on the first try.

studentdeb · Jun 19, 2004

that's a good story. I have tried doing things with him, reading etc. to get his mind off of going once on the potty but he just tenses up and you can tell that if he would just relax, he probably would go. Just doesn't make sense that he pees without a problem but can't doing the pooping. Maybe I should try using bubbles, he loves them.

Thanks for sharing.

I remember my youngest doing the same - holding it for days until he started getting sick. He actually start to cry if his bowels moved while sitting on the potty. I think he was scared to use "the potty" as he definitely didn't have problems soiling his diapers.
I knew if he could just go once - the fear would go away so I bought him some bubbles and made it a game that he could sit on the potty and blow bubbles while we waited. His very vigorous bubble blowing and laughing caused him to strain enough that he pooped - never had a problem with him again and it worked on the first try.

Beaner · Jun 19, 2004

I am a pediatric nurse and our unit spends a lot of time with children with encopresis. I would recommend that you talk with your pediatrician about your sons soiling. He/She may refer you to an Gastroenterologist. The pediatric Dr. we work with is absolutely wonderful with his patients. Usually he will start out with high fiber diet and mineral oil. There is a prescription medication that works wonders. It is called Miralax. It is a powder that can be mixed in with liquids and had very little taste. The kids do great with it and they are usually very proud of themself when their stools become regular and comfortable to expell. Good luck.

I believe my son has this after doing some research last night. He is 3 1/2 and pees very good on the potty but we have had many problems with him soiling in his pants. After reading about encopresis I am certain this is his problem. Would you take him to the doctor and let them prescribe something to "empty" him out or try something over the counter.
What is the difference between an enema and a suppository?
Any info would be appreciated.

chris_at_lucas_RN, RN · Jun 19, 2004

The only reason I would put the medicine out on the counter when she would not go for days is so that she would go on her own before she became constipated again. It just let her know that if she held it too long, it would cause problems again and we might have to use the medicine. Sorry if I made it sound like I was being cruel.

I don't think we have to be cruel to do things that frighten our children into being "obedient." When that happens, we are planting the seeds of irrational fear in their adulthood.

For a variety of reasons, bottoms are very protected in our species. (Think of how you protect your own!) Your child's running to the toilet at the very sight of an enema is your proof she was afraid. No amount of rewording changes that image or, assuming you were being accurate, the fact.

Sometimes as parents it is important to remember that just getting them to do what we want them to do, regardless of our tactic, may not be the best course of action. Teaching them in a loving way to want to do what we want them to do is a better plan. Safety is the lone exception (I don't worry too much about a child's interpretation of the parent's roughly grabbing them when it is the only way to get them out of the way of a train, for example.)

You do sound like you have some real insights and caring. Toilet training is complicated. I'm glad you came to our site for help--and that you received some.