Encopresis (fecal soiling)
The psychologist for a 10-year-old boy reports that this young man’s extreme acting- out behaviors have been stabilized with medication and therapy. A new symptom has arisen: encopresis. The psychologist notes that the young man used to verbalize to his mom when he needed to make a bowel movement but now does not seem to know it is happening or try to communicate this. Incidents are happening primarily in the morning. Any suggestions? Could bowel control or lack of sensation be a side effect of medication?
Bowel activity can always be potentially related to medications. However, encopresis is usually a behavioral issue. It starts with conscious withholding of stool, which in turn stretches the bowel and decreases the sensation of knowing when the body wants to have a bowel movement. Stool becomes impacted, and some liquid will seep around the impaction and leak out. Treatment involves retraining the bowel following a clean-out. The clean-out usually consists of a Fleet enema for three days, oral administration of mineral oil and a stool softener for months until the problem is corrected, scheduled sitting times for bowel movements, and lots of positive reinforcement. Based on what you described, it doesn’t necessarily sound like encopresis. It sounds like accidents. This too could be behavioral. I would strongly recommend that this all be discussed with the child’s pediatrician.
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