Regular Stool or Bowel Movement Accidents in Children (Encopresis)

Definitions

Encopresis is a condition defined by stool or bowel movement accidents. There are two types.

• Retentive encopresis is an involuntary condition in which the child is unable to control his bowel movements.
  • It often has an underlying medical reason.
  • Constipation can be a contributing factor.
• Non-retentive encopresis is when a child refuses to have a bowel movement (poop) in the toilet.
  • This is a behavioral condition.
  • Constipation is not a factor.

• Medical problems.
• Emotional stress.
• Developmental delays.
• Abuse.
  Note: If you suspect the child is being abused or neglected, see Chapter D-3: Abuse and Neglect.

Be supportive of the child and the parents. Provide reassurance:

• That other children have this problem, and that it most often has a medical basis.
• That there are solutions to the problem.
• To the parent, that all children are unique in their development and challenges.

Children and their parents are likely to feel shame about encopresis.

• While the loss of bowel control is reason for concern, the BHA/P and the parents need to be careful that their concern doesn't translate into shame for the child.
• The child is more likely to be teased or rejected due to problems with encopresis. Help the child through these feelings.

Encourage parents to:

• Use positive discipline instead of shaming, punishing, or discouraging the child.
• Reward the child for successful toileting.
• Get a medical evaluation for the child and follow the treatment plan.

A variety of factors can contribute to encopresis. For example:

• The child may not be developmentally ready for potty training.
• The child may be afraid of the toilet and feel comfortable urinating but not defecating in it.
• Chronic constipation can cause a medical problem where the colon is distended. This causes the child not to feel the urge to poop.
• The child may have emotional or behavioral disturbances. She may try to control her bowels (poop) in an attempt to control her environment.

Referral information, including reports from medical providers, school staff, clinicians, or other sources regarding the client's wellbeing.

Releases of Information ( ROIs ) that are current or updated before getting information about the client from other sources.

Client history related to emotional stress, medical/physical concerns, being potty trained, developmental delays, family stressors, or child abuse.

Treatment Plan, including a history of presenting problem and recommended course of treatment. Review the DSM-5 for criteria on Encopresis.

See Chapter C-1: Development Across the Lifespan for information on typical development.

Personal history

• Developmental delays or disabilities
• History of abuse or trauma
• Low self-esteem
• Social withdrawal

Behavioral factors

• Defecating in inappropriate places or at inappropriate times
• Fear or anxiety related to using the bathroom
• Avoidance or secrecy in behaviors related to using the bathroom
• Refusing to go to the bathroom

Physical factors

• Allergies, such as to milk or milk products
• Digestive problems
• Abdominal pain
• Frequent or ongoing constipation
• No recent physical exam
• Reports or signs of child abuse
  Note: If you suspect the child is being abused or neglected, see Chapter B-5: Mandatory Reporting and Duty to Warn.

The following questions are written to be asked of the child. You can reword them to also ask them of the parents or caregivers. You may want to interview the caregivers and child separately because both might feel less comfortable speaking openly about the encopresis in front of each other.

• How old were you when you were potty trained?
• How often do you have accidents?
• Have you seen a doctor about your accidents?
• Have there been any recent changes in your family or life?
• Are you ever scared to go to the bathroom?
• Do you avoid going to the bathroom?
• Do you avoid going to certain bathrooms, such as the bathrooms at school or the store, but feel comfortable using the bathroom at home?
• Do you take laxatives, enemas, or home remedies for constipation or stool accidents?
• Are there times when you wait too long to go to the bathroom and have an accident?
• Do you ever have stomach pains?
• Do you have any redness, pain, bleeding, or raw skin around the anal area?
• Are there certain times of day or places where you have accidents more often?
• Has anyone else in your family had problems with accidents?
• Have you been tested for allergies that could be causing retentive encopresis, such as to milk or milk products?

Routinely review Chapter C-4: BHA/P Services and Common Interventions for how to prepare for and conduct interventions during appointments and for information on the levels of service available throughout Alaska.

Specifically, you may consider:

• Individual counseling focused on:
  • Determining if the soiling behavior is associated with disruptive behavior (LINK) and address these behaviors before toilette training.
  • Determine if soiling behaivor is associated with avoidance (e.g., uses soiling to avoid bed time).
    • Develop coping skills, and strategies to address the root cause (e.g., bed time routine).
  • Begin toilette training.
    • Modeling of proper bathroom behavior by the caregiver can be helpful if the child is extremely avoidant.
    • Schedule short, daily toilette sits to demonstrate positive bathroom time.
      • The client does not have to remove garments.
      • Insure client is comfortable and receiving positive attention from caregiver.
    • Establish incentives for successful bowel movements.

Be sure you are familiar with the information in Chapter B-5: Mandatory Reporting and Duty to Warn and Chapter B-8: Documentation and Billing. Report instances of the following, consistent with your organization's policies and procedures:

• Child abuse or neglect.
• Suicidal thoughts or plans.
• Intentions to cause harm or injury to the self or others.