Elimination Disorder & Encopresis | Psychology | Child Psychologist

Eradication disorder occurs in children who face problems in going to the bathroom both urination and defecation. Although it is common for young children to face these problems, it can be a problem if this behavior occurs repeatedly for more than three months, especially in children older than 5 years.

There are two types of elimination disorders:

Encopresis means passing feces in places other than the toilet, such as on the floor or in underwear, but this behavior doesn't always happen.

Enuresis is a frequent occurrence in places other than the toilet and it is the most common type of eradication disorder caused by night or bedwetting.

What Are the Symptoms of Encopresis?

A child with encopresis may have the following symptoms in addition to defecation in inappropriate locations.

1. Loss of appetite
2. Stomach ache
3. Loose, watery stool 
4. Return from friends and family
5. Lack of interest in physical activity
6. Rubbing the anal area due to burning with watery stool
7. Incognito behavior associated with bowel movement

Risk factors related to Encopresis:

Encopresis is mainly common in boys and the following risk factors increase the likelihood of encopresis.

1. Using medications that may cause constipation, such as cough  suppressant
2. Anxiety or depression
3. Autism spectrum disorder
4. Attention-deficit / hyperactivity disorder (ADHD)

What Causes Encopresis?

Chronic constipation is the common cause of encopresis that causes the inability to release feces from the bowel. This can happen for a variety of reasons, such as stress, not drinking enough water, and pain in or near the anus. A large mass of feces develops when a child is constipated which can expand the rectum and the child won't need to go to the bathroom. Stool mass can also be affected and become too large or too hard to pass without pain.

Eventually, the muscles holding the stool in the rectum can't hold it back for a long time. Although large, hard stool doesn't pass, yet liquid or loose stool can leak and affect the mass and the baby's clothes.

The following are the factors that can contribute to this disorder:

1. Lack of exercise
2. A diet low in fiber
3. Not taking time to use the bathroom
4. Bathroom routine changes; For example, scheduled bathroom breaks at school
5. Fear or reluctance to use unfamiliar bathrooms 

A physical problem in the intestine's ability while moving feces can also be a possible cause of encopresis or the child can develop this problem because of the frustration related to toilet training. This disorder can also occur in a child's life because of stressful events such as the arrival of a new sibling, and family illness and the child can refuse to use the toilet.

How Is Encopresis Diagnosed?

The physicians evaluate the symptoms of encopresis by performing a physical examination and complete medical history. They also perform another test like X-rays to know about the other possible causes of constipation, such as intestinal disorders.

The physicians diagnose this disorder by the child's current bowel habits and symptoms if they don't find any physical disorder.

How Is Encopresis Treated?

To encourage good bowel habits and prevent them from constipation is the main goal of this treatment and also educating the family and child is also another goal of this treatment.

Generally, it is better if the treatment begins for encopresis very earlier. The first phase involves cleansing the colon of intact and the next steps involve encouraging healthy bowel movements. And in some cases, psychotherapy is also a treatment for this disorder.

To clear the colon of impacted stool:

There are several methods to cleanse the colon and relieve constipation. The following will be recommended by your child's doctor:

1. Enemas
2. Certain laxatives
3. Rectal suppositories

To encouraging healthy bowel movements:

It is important to encourage your child to have a bowel movement regularly after the colon is cleared. The following will be recommended by your child's doctor:

Train your child to go to the toilet as soon as possible if they wish to have a bowel movement. Once the bowels return to normal function, the laxatives slowly close them. Changes in a diet that include more fiber and sufficient amounts of fluids. If indicated, a small test to check cow's milk intolerance or closure to cow's milk.

Behavior modification:

Your child's doctor or mental health professional can also tell behavior modification or bowel retraining to teach your child to have bowel movements regularly. Your child's physician recommends psychotherapy from a mental health professional if encopresis is related to emotional issues such as guilt, depression, shyness.

Lifestyle and home remedies:

It is very important to encourage regular bowel movements if your child has been treated for encopresis. The following are some home remedies:

1. Focus on fiber: Give your child a balanced diet that includes plenty of vegetables,  fruits, whole grains, and foods high in fiber, which can help create soft stools.
2. Encourage your child to drink water: You should encourage your child to drink water that prevents stool from hardening and other liquids can also be useful but you should watch calories before taking.
3. Arrange toilet time: You should arrange toilet time for five to 10 minutes every day to have your child sit your child on the toilet. It is better if this is done after meals because then the bowel becomes more active.
4. Put a footstool near the toilet: This makes your baby more comfortable because by changing the position of the feet he can put more pressure on the abdomen that makes stools easier.
5. Stick with the program: You should stick with the program because it takes months to resume normal bowel sensations and develop new habits.
6. Be encouraging and positive: You should be encouraging and positive while helping your child to overcome encopresis and you should also offer him support.
7. Limit cow's milk: You should give limited cow's milk to your child because in some cases it can contribute to constipation.

Conclusion:

Finally, I can say that encopresis is a problem that improves as the child grows up but no doubt it can also come and go for years. Children facing the problem of encopresis can also become depressed, refuse to socialize with other children, and not want to attend parties or events. This problem can contribute to the child's social isolation and increase the child's self-esteem problems when they are teased by their family members or friends for this problem.