A Message to Parents of Children with Soiling and Encopresis: setting realistic expectations

It is gen­er­al­ly hard for par­ents to under­stand and accept the behav­ioral com­po­nents of with­hold­ing and soiling/encopresis.

Over and over again, I am told: “ He can’t feel the poop”, “She didn’t know she had an acci­dent”, “She doesn’t mind sit­ting in poop”, “He does not even smell it”. All of these state­ments may be true. Chil­dren who have had this con­di­tion for a long time may lose the urge or the feel­ing to go. They may be desen­si­tized after all this time to the feel and smell of stool in under­wear. Even so, chil­dren who with­hold stool and soil stool have land­ed in this predica­ment because of behav­ior. The behav­ior must be addressed along with the use of lax­a­tives to com­bat the withholding.

“My child only wants to please”, ” He is a love­ly sweet boy”. “This is her only issue”.

Agreed!!  Your child is a dar­ling, lov­ing child who cares very much about pleas­ing and being loved by you. He wants to be accept­ed by friends and mas­ter toi­let train­ing, a most impor­tant mile­stone of childhood.

By def­i­n­i­tion, chil­dren who with­hold are oppo­si­tion­al. Some amount of oppo­si­tion­al behav­ior is entire­ly nor­mal in child­hood. Fre­quent­ly, chil­dren with enco­pre­sis behave well in school and fol­low the rules and expec­ta­tions of teach­ers.   Oppo­si­tion­al behav­ior is reserved for the house and espe­cial­ly direct­ed at moth­ers. Sor­ry Mom…it comes with the territory.

Chil­dren who with­hold and soil stool need expert help to over­come this prob­lem. This con­di­tion is too chal­leng­ing and will not respond to rewards, anger, prized gifts, trips to Dis­ney World, etc. Though the med­ica­tions are ‘over the counter’, tri­al and error with­out pro­fes­sion­al guid­ance, results in one step for­ward and three steps back­wards, fre­quent set­backs and lack of effec­tive resolution.

Key to suc­cess­ful toi­let train­ing for stool requires behav­ioral change along with ade­quate lax­a­tive administration.

To over­come with­hold­ing behav­ior and soil­ing, your child requires lax­a­tives for what­ev­er peri­od of time is deemed nec­es­sary. The lax­a­tive will give your child an unde­ni­able urge to have a bow­el move­ment. I use most­ly sen­na, a safe, nat­ur­al veg­etable lax­a­tive. Regard­less of how respon­sive a child is to the lax­a­tive, it will take a long time to change behav­ior that has caused the prob­lem in the first place. Thus, in addi­tion to lax­a­tives, I will guide you toward estab­lish­ing appro­pri­ate behav­ioral mod­i­fi­ca­tions for your child.

For your part, your expec­ta­tions must be real­is­tic. Many of you have lived with this con­di­tion for a long time and your chil­dren will not be cured overnight. How­ev­er, the encopresis/soiling can be well man­aged and your child acci­dent free and com­plete­ly func­tion­al. Dur­ing main­te­nance, it is com­mon for chil­dren, at times, to put up resis­tance and for with­hold­ing to recur.  For this rea­son, it is vital for you to be men­tored by an expe­ri­enced and com­mit­ted pro­fes­sion­al. Try­ing to do this on your own, fol­low­ing lay sug­ges­tions, invari­ably results in frus­tra­tion and delayed success.

Par­ent­ing a child with soiling/encopresis requires that you be firm and con­sis­tent, with­out feel­ings of guilt. Nev­er apol­o­gize for expect­ing your child to learn nor­mal toi­let­ing behav­ior. Just as a teacher does not apol­o­gize for expect­ing your child to arrive at school on time, to sit and lis­ten dur­ing sto­ry hour or to clean up her mark­ers, you should nev­er apol­o­gize for being a good par­ent.  To best help your child, I will coun­sel you and, togeth­er, we will estab­lish appro­pri­ate guide­lines and expectations.

Par­ents, under­stand that treat­ing enco­pre­sis is a process. Your child will not give up this behav­ior will­ing­ly or hap­pi­ly. Even after long and joy­ous acci­dent free peri­ods of time, your child may sur­prise you by try­ing to with­hold. We teach par­ents to be on the look­out for cues to with­hold­ing and to con­tact us to make adjust­ments. In my pro­gram, you will become a keen observ­er of your child and ulti­mate­ly empow­ered to man­age your child’s prob­lems with occa­sion­al advice from us.

Wish­ing all of your chil­dren a won­der­ful, hap­py and suc­cess­ful school year!

Doc­tor Daum