Bowel Movement Resistance

When a child soils himself without evidence of constipation, this is called nonretentive encopresis. This type of encopresis accounts for between 5-20% of all cases. This condition is characterized by soiling with daily bowel movements that appear normal in size and consistency.

Is He Ready?

It is rare to find a physical cause for nonretentive encopresis. On medical examination, everything appears to be in order and there are no signs of constipation. Part of the medical workup should include developmental and behavioral assessments in order to establish that the child is ready to stop soiling himself. Such assessment also helps to identify any personal barriers to your child's success.

Successful correction of nonretentive encopresis involves making sure your child can have soft, comfortable bowel movements as well as dealing with toilet resistant behavior.

Parents will be advised to schedule times when their child will sit on the potty each day. Should your child have a bowel movement during the time he is seated on the potty, he may be given a small prize as an incentive. These issues should be discussed between the parents and the child's physician.

The Boys Have It

Encopresis affects between 1-3 percent of all children, with more boys affected than girls. Encopresis sometimes goes unnoticed until a physician asks a direct question about your child's toileting habits. Some 80-95% of encopresis cases have as their cause fecal constipation and retention. The other 20% of those children with this condition may be divided into some four subgroups:

1)    Failure to succeed at bowel training

2)    Fear of having a movement in a potty or toilet

3)    The child's effort to manipulate his own environment

4)    Irritable bowel syndrome.

Once the cause of the child's resistance is identified, it may be addressed with a variety of techniques. For example, if it is determined that the problem is related to the need to learn a skill such as opening the bathroom door, undressing, sitting down on the toilet, wiping, then the parent can address these issues as they arise.

If, however, it is deemed that the child is rebelling, the physician may choose to refer the family to a pediatric psychologist, who will be familiar with helping children find the ability to comply with behavioral norms. There is a fear that in the absence of active intervention, the stress level within the parent-child relationship will grow out of bounds and increase the risk of abuse.