Constipation with Soiling (Encopresis)

Hilliard Pediatrics, Inc. - Dr. Tim Teller, MD


Introduction


Constipation with soiling or “encopresis” happens when someone has been constipated and held their bowel movements in their lower intestines over time, stretching the lower colon. This allows more bowel movement to build up. This further stretches where you hold the bowel movements. Over time this can cause someone to lose feeling for when it is time to have a bowel movement. This can allow looser or runny stool to run into the underwear, without the child knowing it is happening. This happens because our lower intestines will have some contractions occasionally and can push the bowel movement out in the underwear without your child knowing it. For many kids, the first thing you may notice is the smell of the bowel movement in their underwear. Please note: when I discuss this with your children, I will probably use the word “poop” for their bowel movements. When I was growing up, this was not an acceptable word around our house. So I was determined to not use that word as a pediatrician. However, I have found over the years, no matter whom I am talking to, that everyone knows what I mean when I say “poop”. And although there may be other words you use at home for this, when I use that word I know your child will understand what I mean.


What to Do:


The intestines can be cleaned out of the bowel movement and then kept cleaned out.

CLEAN OUT:

The initial “clean out” actually only takes a few days. Keeping things regular to prevent things from acting up again and keeping the underwear clean takes months. We are often very successful with a medication that is now available over the counter: Miralax powder. The powder is mixed into something to drink – juice, water, milk, etc. The typical dosing for this is 1 full capful in 8 ounces of juice twice a day for 3 to 5 days. Our goal is to soften the built-up stool (bowel movement) and have it flushed out of your child. This can be a “busy” process – your child may need to be in and out of the bathroom throughout the day, passing more loose (even diarrhea) bowel movements. It is not unusual for there to be some crampy pain. This pain can be off and on for the few days, but gets better quickly. After a couple of days of pain, running to the bathroom, and runny bowel movements, it can be tempting to stop the Miralax. Please do not stop until you have done this process for at least 3 days and all that is getting passed is loose bowel movements. If there are still some larger or harder bowel movements, you are not done yet. After the few days of this Clean Out, your child should quickly stop having accidents into their underwear. If the accidents are just a small amount of watery diarrhea, I would not worry. It may be best to do this Clean Out over a weekend, when you have enough time for it.

STAYING CLEANED OUT:

By the time this has gone on for a while, even if things are cleaned out and your child is no longer having accidents in their underwear, it will take months to keep the intestines relaxed so problems do not happen again. By keeping up with daily use of the Miralax powder, this allows your child to keep the bowel movements up on a regular basis. The dose is ½ capful (17 grams) in 8 ounces of juice once a day. You may have to “play with” or adjust this dose up or down. The goal is to have your child have at least one soft, comfortably passed bowel movement every day or every other day WITH NO ACCIDENTS. If your child starts having a harder bowel movement, so often they will put off having a bowel movement and set themselves up to have the accidents return. The Miralax is very safe to continue long-term (for months or years if needed). If everything is going well and your child has had no accidents for months, if you stop the Miralax and the accidents return after a while, we will recommend you either go back to daily Miralax powder or first do another clean out (as above).

Occasionally, these children may need the help of the Gastroenterologists at Nationwide Children’s Hospital. We will assist you with the referral to the specialist.

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