Encopresis - Traditional Treatment

Traditional Treatment

Many pediatricians will recommend the following three-pronged approach to the treatment of encopresis associated with constipation:

1. cleaning out
2. using stool softening agents
3. scheduled sitting times, typically after meals.

The initial clean-out is achieved with enemas, laxatives, or both. The predominant approach today is the use of oral stool softeners like Movicol, Miralax, Lactulose, mineral oil, etc. Following that, enemas and laxatives are used daily to keep the stools soft and allow the stretched bowel to return to its normal size.

The child must be taught to use the toilet regularly to retrain his/her body. It is usually recommended that a child be required to sit on the toilet at a regular time each day and 'try' to go for 10–15 minutes, usually soon (or immediately) after eating. Children are more likely to be able to expel a bowel movement right after eating. It is thought that creating a regular schedule of bathroom time will allow the child to achieve a proper elimination pattern. Repeated voiding success on the toilet itself helps it to become a releasor stimulus for successful bowel movements.

Alternatively, when this method fails for six months or longer, a more aggressive approach may be undertaken using suppositories and enemas in a carefully programmed way to overcome the reflexive holding response and to allow the proper voiding reflex to take over. Failure to establish a normal bowel habit can result in permanent stretching of the colon. Certainly, allowing this problem to continue for years with constant assurances that the child "will grow out of it" should be avoided.

Dietary changes are an important management element. Recommended changes to the diet in the case of constipation-caused encopresis include:

1. reduction in the intake of constipating foods such as dairy, peanuts, cooked carrots, and bananas
2. increase in high-fiber foods such as bran, whole wheat products, fruits, and vegetables
3. higher intake of water and liquids, such as juices, although an increased risk of diabetes and/or tooth decay has been attributed to excess intake of sweetened juices
4. limit drinks with caffeine, such as cola drinks and tea
5. provide well-balanced meals and snacks, and limit fast foods/junk foods that are high in fats and sugars
6. limit whole milk to 16 ounces a day for the child over 2 years of age, but do not completely eliminate milk because children need calcium for bone growth and strength.

The standard behavioral treatment for functional encopresis, which has been shown to be highly effective is a motivational system such as a contingency management system In addition to this basic component, seven or eight other behavioral treatment components can be added to increase effectiveness.