Home HealthTopics Health Centers Reference Library Research
Join us on Facebook Join us on Facebook Share on Facebook

Children's Health

Bowel Trouble

06/29/2009

Question:

My 11 year old has toilet issues. I had a hard time training hime when he was little. He is pooing and not getting himself clean and or he still has accidents. I will tell him he needs to go clean up. He will say it it not me or it was an accident. I don`t understand why at 11 years a person would still have problems.

Answer:

From your description it sounds very much as though your son has a condition called encopresis. Encopresis is the extreme of constipation from stool with-holding. The child fears a painful bowel movement and works hard to avoid it by not giving in to the normal urge to have a bowel movement. The stool mass grows in size and dryness as more and more stool builds up and the large intestine continues its job of drawing water out of the stool. It  is not a rare problem, but it is certainly a difficult problem for both children and their parents, peers and teachers.

As described above, encopresis results from the blockage of the lower intestines by a large mass of dry stool. Liquid stool continues to enter the large intestine from the small intestine and is forced by the normal movement of the intestines, called peristalsis, around the mass of dry stool. The liquid stool leaks out on the underwear. The child does not feel the stool and cannot control it because the rectum and lower bowel are stretched out so much by the dry stool mass that normal sensation and control is not possible.

Treatment for encopresis involves removing the large mass of dry stool and the daily use of stool softeners and laxatives to promote a return to normal bowel function. This takes a lot of time depending on how long established the problem is. The bowel muscles need time to recover from the prolonged over-stretching they have endured. The longer the period of encopresis, the longer the period of recovery in many cases. The bowel is similar to a stretched out rubberband. Fortunately, unlike a stretched out rubberband, it will recover elasticity given time to recover and the prevention of further injury from over-stretching. This is where the the daily use of stool softeners and laxatives comes in.

Stool softeners and fiber address the issue of painful bowel movements by assuring that the stool retains water and is easily passed. Laxatives provide a supplemental push to assure passage of the stool while the intestinal muscles recover their natural pushing ability.

In addition to these medicinal approaches,  the child must implement lifestyle changes. These include sitting on the toilet after every meal to take advantage of the normal gastrocolonic reflex that stimulates the bowel to empty after a meal introduces a new load of food to be processed and enter the intestines. He also needs an hour of vigorous activity each day to promote bowel peristalsis and daily stooling. Both regular toileting and exercise will allow him to stop using laxatives sooner rather than later
 
Your son needs to drink at least 8 and preferably 10 glasses of fluids/water (non-caffeine containing and non-sweetened) every day to supply plenty of liquid to keep the stool soft and easily passed. He also needs to revise his diet to include plenty of fruits, vegetables, and whole grains that supply naturally occurring fiber that will allow him to wean off of fiber supplements and stool softeners. 

The biggest hump to get over is cleaning out the bowel of the large obstructing mass. You should consult with your son's doctor about this or ask for a referral to a pediatric gastroenterologist, if the doctor does not feel confident in managing the problem.

A matching big "hump" is restoring your son's social confidence and competence with his peers  in school, church, and teams. There is no doubt about it. Smelling like poop causes kids and adults to avoid you. He may also sense your own frustration and embarrassment with this problem. It is important to address this issue ASAP as he moves into puberty and with all of its social demands. He may benefit from counseling to rehabilitate his self-confidence and help him build social skills. You may want to join him as well for some family sessions to assure a strong parent-child relationship as you both enter the demanding teenage years.

You will also need to communicate with your son's teachers about allowing him access to water and the bathroom on a more liberal basis than usually occurs in many school settings. Liberal water access is good for all students too, not just your son. They should be more than willing to help your son resolve his vexing problem.

I hope this information is helpful and the best of luck in reaching a quick solution over the summer to this very difficult problem.

You and other parents of children experiencing this problem may want to visit U-Can-Poop-Too! to see if you qualify for a research study using an Internet intervention to treat encopresis.

For more information:

Go to the Children's Health health topic, where you can:

Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University