Encopresis, also known as involuntary fecal soiling, is a common but distressing condition in children, often caused by chronic stool withholding. Many parents struggle to understand why their child deliberately avoids defecation, even when it causes discomfort and pain. Dr. Jovančević explains the mechanisms behind this issue and shares effective strategies to help children overcome encopresis.
Why do some children withhold stool?
In preschool and early school-age children, stool withholding can develop into a behavioral response triggered by emotional or psychological factors. A child may:
- Clench their legs, hop, or cry when feeling the urge to defecate.
- Associate painful defecation with discomfort, reinforcing their fear.
- Soil their underwear unintentionally due to prolonged withholding.
- Avoid food to prevent bowel movements.
This behavior can quickly turn into a vicious cycle: the longer the child withholds stool, the harder it becomes, making bowel movements even more painful. Parental pressure to use the toilet often backfires, reinforcing the child’s anxiety and resistance.
How does chronic stool withholding affect the body?
When defecation becomes irregular, faecal mass accumulates in the colon, causing it to expand. This leads to:
- Reduced colon motility, making it harder to push out stool.
- Constipation (obstipation) that worsens over time.
- Discomfort, bloating, and abdominal pain.
These physical consequences further reinforce emotional distress, making the child more reluctant to defecate.
Breaking the vicious cycle and what can Parents do?
1. Maintain a neutral emotional approach
Parents should adopt a calm and neutral response to the issue. Encopresis “feeds” on reactions, so neither frustration nor excessive encouragement is helpful. Avoid:
- Pressuring the child to use the toilet.
- Expressing disappointment or disgust.
- Comparing the child’s habits to those of peers.
2. Soften the stool and regulate bowel movements
To make defecation easier and less painful, parents should:
- Use stool softeners (such as lactose-based products) under medical guidance.
- Encourage a high-fiber diet rich in fruits, vegetables, and whole grains.
- Increase fluid intake to promote bowel regularity.
3. Create a stress-free bathroom routine
- Allow the child to sit on the toilet without pressure or expectations.
- Keep a consistent schedule to promote natural bowel habits.
- Ensure the bathroom environment is calm, private, and relaxed.
4. Avoid negative messaging
Statements such as:
“You don’t know when you need to go.”
“Doesn’t it bother you that you are dirty?”
These messages can harm the child’s self-esteem, increasing guilt and anxiety. Instead, focus on positive reinforcement and acknowledge the child’s small successes.
When to seek medical help
If encopresis persists despite dietary changes and behavioral adjustments, consult a pediatrician or child psychologist. In rare cases, chronic stool retention may indicate an underlying medical condition, such as:
- Neurological disorders
- Severe constipation (obstipation)
- Emotional trauma or anxiety disorders
Final thoughts
Encopresis is a complex issue that involves both physical and emotional factors. With patience, a non-judgmental approach, and appropriate dietary and behavioral interventions, most children can overcome encopresis successfully. If challenges persist, professional guidance can help create a personalized treatment plan.
Download LittleDot – Your Trusted Family Health Partner!
Easily manage your family’s health with our app. Track medical records, consult doctors, and stay one step ahead. Everything you need, right at your fingertips. Download now and try it for free!
