A Childhood Condition

By David Andrewsy

You've just finished washing your child's underwear for the third time today and you anticipate you'll have to do it again, at least one more time, before the day is over. You don't understand why he's still soiling at 4 years old and your anger and frustration are beginning to get the best of you and him - it's a good thing the appointment with the specialist is only days away. Well, you're not alone. Your child is only one of nearly 300 treated for encopresis, in Nova Scotia alone, each year. There are many more who may never receive the treatment they need.

Many families, all over the world, suffer from dealing with a childhood condition known as encopresis. Defined as: " The depositing of formed or semi-formed stool in a child's underwear, or other inappropriate place, after the age of four years ", encopresis has been diagnosed as early as three years of age. This condition, which often accompanies constipation in the child, has many devastating effects, both on the child him/herself and the other family members, as well as friends. In most cases, encopresis can be treated but the lack of availability of information and the shortage of treatment facilities make it difficult for the family to access what they need. The taboos of our advanced society also make it very hard to find solutions.

The first step in treating encopresis is in having the condition diagnosed properly. This can be the most difficult step as it means finding the appropriate physician, which can lead to delays in getting appointments and often means coping with it as best the family can until seeing the physician. A pediatric gastroenterologist is the best source of information on this condition and is the only person who has been trained to diagnose and treat it. While many family doctors may try to help families who have children experiencing the symptoms, most tend to tell the parents that their child will "outgrow it" and "not to worry". This is the most frustrating situation imaginable because the family may have been trying to understand and cope with it for a period of years. While many children do outgrow the condition, others do not. If proper treatment is started early enough the usual outcome is, at least, a distinct reduction in the frequency of soiling and, at best, a complete cure.

Treating encopresis effectively means that the parents must have all the patience possible and need to encourage the child to do their best with the treatment plan. The child's role is even more difficult in that he/she must learn to take responsibility for their cleanliness and follow the plan to the best of their ability. In most cases of encopresis, the child can neither smell the odor of the feces when they have soiled nor feel the sensation of the need to go to the bathroom or even the process of the feces coming out. Some of this appears to be caused by the normal situation of not being able to detect odors which we constantly live with, while the sensations of actually soiling may not be present because of nerve damage (or underdeveloped nerves) in the sphincter muscles, for any number of reasons. Therefore the child doesn't really understand what the "fuss is about when they have soiled. Getting the child to follow the plan is usually the more difficult chore and requires the most diligence and patience by all parties involved.

Encopresis may also lead to psychological difficulties for the child which may require treatment. These children are often shunned by their peers and even by family members. It's common for families to have curtailed visits, especially overnight, to other extended family members and friends. The family will also try to keep it a secret which is very hard to do under the circumstances, and this will have caused a lot of social problems which need to be addressed. Encopresis has caused child abuse, both physical and mental, and has also resulted in children being diagnosed with learning disabilities, which they don't have, by doctors who haven't done their research. Some children have even been institutionalized because of improper diagnosis. It has caused families to break up and will continue to do so until it becomes recognised for what it is - a medical condition like any other. With the proper education and more effective research and treatments for this condition, it may yet become a thing of the past and allow our children to be able to lead more normal lives.

Education is the key to battling this condition and it needs to start with both the parents and the child. Doctors and nurses need to be educated as well because they may not have even heard of the condition so they won't be able to help until they do. While a statistical estimate (that three percent of the population of North America suffers from encopresis) exists, it is, more likely, a much higher percentage. Many treatment methods have been tried but few have a success rate of more than sixty percent and so, not a great deal of research is ongoing. The most successful plan available dates from the nineteen forties but is still the best way to do something constructive. It consists of re-toileting the child using a schedule that must be adhered to, coupled with the use of a laxative or enema or other such bowel aid, to help loosen the stool, prevent constipation and facilitate painless bowel movements. Such a program (which is available on the internet) has helped many families and children who must deal with this condition on a daily basis.

While encopresis is difficult to treat, it isn't an impossible task. Parents and children need support and understanding in order to combat this condition. Every major community should establish a support group but government agencies don't appear to be as concerned as the families involved. Summer camps for encopretic children would go a long way in re-establishing their social skills and they wouldn't need to pretend in such an environment. In closing, I would like to point out that encopresis is not a problem that can or should be ignored - by anyone. These children are our future and we owe it to them to provide what they need - love, understanding and the will to do what's right for them. They expect nothing less.