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Soiling; Incontinence - stool
The goal is to prevent constipation and encourage good bowel habits. Laxatives, and sometimes enemas, are used to remove fecal impaction. A stool softener is often prescribed.
A diet high in fiber, including fruits, vegetables, whole grain products, and adequate fluid intake will promote the passage of softer stools and minimize the discomfort associated with bowel movements. Another way to treat this problem is to give flavored mineral oil to the child in sufficient quantity for the oil to leak from the rectum. This is an excellent short-term treatment, but it must be avoided long-term because of interference with calcium and vitamin D absorption.
Parents should be supportive and refrain from criticism or discouragement. Pediatric gastroenterologists often provide education to the parents and child and use biofeedback for the child to treat the more difficult cases. Psychotherapy can help the child deal with associated shame, guilt, or loss of self-esteem. For encopresis in the absence of constipation, psychiatric evaluation may help determine the underlying cause.
Most children respond to treatment.
The child may suffer from low self-esteem and peer disapproval related to this problem. If routine bowel habits are not developed, the child may suffer from chronic constipation.
Call for an appointment with your health care provider if this behavior is noted in a child over 4 years old.
Feigelman S. Growth, Development, and Behavior. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 6.
Feldman MD. Encopresis. In: Ferri FF, ed. Ferri’s Clinical Advisor 2009. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2009:section 1.
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