Matt smelled so bad that the staff at the group home refused to work with him. Matt didn¹t seem to care though. He acted as if there was nothing wrong and made jokes, that usually involved bodily noises, and laughed when someone told him he "smelled!" Matt has a problem, experienced by many children, called encopresis. This is a clinical term for children over the age of four, who regularly has stool or bowel movement "accidents."

In some cases, children with encopresis void their feces into unusual ares like their bedrooms or dresser drawers or hide soiled underclothes under the bed, closet, or trash. The result of these types of behaviors is ridicule and ostracism by family and friends. Even professionals, like the staff in Matt¹s group home, find it difficult to tolerate. Children, like Matt, are often punished for their encopretic behaviors, often out of anger and frustration over the "disgusting" situation. Most children with this disorder also experience shame and embarrassment. Even Matt, who made light of his problem, finally admitted that he felt bad about his actions. He confessed that he often did these things on purpose, to push people away whenever he started feeling too close to them. It was a fool-proof plan until he begin some serious work on his abuse issues in therapy. Not all children with encopresis are abused. And many children do not do this voluntarily. Sometimes, there is a medical problem behind the disorder.

When children experience constant constipation, the stool can become large, hard, and dry. This creates a lot of pain that causes young children to avoid going to the toilet, creating more pain and difficulties. Over time, if the colon (large intestine) and rectum become stretched, the muscles and nerves will not signal the need to have a bowel movement. This leads to stool accidents.

Parents should be concerned that their child has encopresis if the child has accidents at times other than during an illness, the child has a poor appetite and complains of stomach pains or cramps, complains of pain when toileting, or has a large mass that resembles an upside down U starting on one side of the abdomen and moving to the other side. If untreated, encopresis can result in "megacolon" or stretched out colon, bleeding from the rectum, and urinary tract infections, not to mention more frequent, chronic stool accidents. Medically, encopresis is treated with regular toileting schedules, diet, and exercise. Children with this problem need a lot of positive support and encouragement to overcome the pain and shame that accompanies this disorder.

They must eat a diet high in fiber and drink lots of liquids. And, they must exercise on a regular basis. If parents suspect that their child is encopretic, that they make an appointment with a physician and comply with all of the physicians requests for tests and treatments. Family members may need support and education on this disorder as well. Parents must be encouraged not to use coercive or rigid toilet training practices. And entire families may be engaging in a vicious cycle of hostility and dependency. For example, a child¹s encopresis may anger a parent, who reacts in a critical or hostile manner, whereby the child punishes his or her parents for their anger by soiling again. In order to break this cycle and foster more positive treatment of the disorder, parents and children may need to work with a professional together.

Seeing a professional is essential if the encopredic child has been abused or traumatized. They will need a caring, tolerant professional who can address the emotional issues underlying the disorder. Children who experience strong feelings of fear or hostility may channel these uncomfortable emotions into acts of encopresis. In addition, children with poor impulse control do not take responsibility of their hygiene (e.g., wiping after a bowel movement) or toileting practices. To help them understand these emotional issues, Matt¹s group home got a referral to their community mental health clinic. A clinical psychologist tested Matt for possible Attention Deficit Hyperactive Disorder, impulse-control disorder, depression, and other emotional problems. The psychologist was able to determine that the encopresis was due to feelings of traumatization and rejection by his biological parents. It later became apparent that Matt had been the victim of physical and sexual abuse by his father. Matt¹s surface behavoirs, of joking and lack of care, were cover ups for the constant feelings of vulnerability and anger he felt inside. His encopresis kept people away that might hurt him and it made him unattractive to potential sexual abusers. The psychologist used play therapy techniques and provided an atmosphere of unconditional positive regard and genuine concern that allowed Matt to trust the psychologist enough to work on his underlying emotional issues and talk about his history of abuse and neglect. Matt eventually learned to communicate his feelings of fear and anger to the group home staff without having an "accident."

Eventually, Matt stopped being encopredic and was able to return to a reasonably normal life. Encopresis is a serious disorder that have various medical and emotional causes. In addition, it can dramatically affect a child¹s self-esteem. It also affect parents and caregivers who are must confront their own feelings of frustration and anger when dealing with the problem. Overcoming encopresis is not easy but it is also not impossible. It requires that everyone involved with the problem (parents, caregivers, and professionals) work together in a positive, affirming manner to help the child. With insight, patience, and perseverance, children can, and do, overcome encopresis.

References: Axline, Virginia M. (1969). Play Therapy. Ballantine Books, New York. Jongsma, Arthur E., Peterson, L. Mark, and McInnis, William (2000). The Child Psychotherapy Treatment Planner. John Wiley & Sons, Inc., New York. UHS Care Bulletin. YOUR CHILD AND ENCOPRESIS. Susan Poulton, RNC, ARNP, CNS II, Jeanne Torrens, RN, MSN, CNS II