encopresis

Encopresis (en-co-PRE-sis) refers to the leakage of stool in the underpants - fecal soiling. It is a common childhood problem, affecting many school age children, almost always boys, and causing much needless shame and guilt. The problem rarely has any great antecedent emotional overtones, but to the extent that the child is shamed and humiliated by peers and adults, has to inflict great emotional distress. Because the basic facts of causation and cure are so straightforward, this condition is doubly distressing to me.

Many adults can remember knowing or knowing of such a child growing up. Typically a boy, he was the object of hushed discussion or outright mocking. Moreover, "Stinky" typically seemed not to care about the fact that he messed his pants and smelled bad. It would seem so unacceptable for a school age child to have a bowel movement in the pants, that adults and other children cannot conceive how such a thing might happen. Actually, it usually happens rather simply.

On the great bell curve of life, some folks are by nature rather more colonically sluggish than others. That is to say, they are by nature prone to constipation. The typical modern low residue diet does not help them a bit, either. The result is stools that tend to become too firm to pass easily and resultant irregular bowel habits.

A child who tends to constipation and is also by nature somewhat shy may face real difficulty having a stool at school. Here the gross insensitivity of the largely female educational establishment in forcing little boys to use the toilet without the privacy of a door on the stall takes its toll. The child begins to withhold stool during the day, and may become quite constipated with large, hard, dry stool in the vault of the lower colon. This large mass of hard stool distends the rectum and anus and allows fresh soft or liquid stool to leak around it and out of the anus into the pants. The distending fecal mass also causes dulling of the sense of urgency to have a bowel movement, and the child loses the necessary sensitivity to this urge. By chronic suppression of the urge to have a stool, he eventually becomes quite unaware that there is a three or four pound fecal rock in his lower colon.

The child can of course do nothing to stop the process of rectal distension and leakage and does not have a clue why it is happening. Neither do his parents, who may scold, spank, lecture, and plead to no avail. They will report to the doctor that the child "has a soft BM every day," which of course he does. Unfortunately, it is just the leakage around the impaction.

The seeming indifference of the child to the problem is frustrating to the adults in his life, but understandable in light of the fact that the child is faced with daily humiliation and uses the common defense mechanism of denial.

Eventually, the child reaches competent pediatric care and is placed on a regimen of stool softeners to prevent impaction, and bowel habit retraining to get the child resensitised to his own urges and going on a regular basis. While relapses are not uncommon, the child will eventually learn to adapt to his personal colonic heritage and the school system's quirks and successfully master the problem for good.

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