PEDIATRICIAN DR.PAUL Answers: Encopresis is the medical name for stool or fecal overflow or "soiling." Contrary to what we thought a decade or two ago, it is now believed that encopresis is usually a physical problem (a large amount of stool in the intestine), rather than psychological in origin.

I feel that encopresis, in most instances, is an "overflow" phenomenon in a child with long-standing fecal/stool retention, an extended form of constipation. I believe this is the case even in the absence of a history of constipation which includes hard stools and abdominal pain. The child's rectal control has been "numbed" so to speak, and he cannot feel the urge to defecate. The result is that stool "leaks," resulting in soiling, which obviously is embarrassing to the child. The approach to the problem is a simple one based on the following steps:

• Documentation of fecal overflow. Usually a simple abdominal X-ray will do.



• Very aggressive evacuation with a combination of oral/suppository/enema treatments. Note that this is the only circumstance in which we generally prescribe laxative-like medication for children, because as a general rule we do not use laxatives in constipated children who do not soil.



• Once evacuation is achieved, the next step is what I call a re-programming or re-training period. This is extremely important. The child should sit on the toilet on a daily basis, preferably after a meal, and at same time each day, for at least 15 minutes. During this time the child can read a book or play a game. Doing this repeatedly will create a routine and will re-train the intestine to empty itself daily. In this way the problem of fecal retention will not recur. Consistency is the key to success.



• Finally, a high fiber diet is always important. I recommend feeding your child brown/whole wheat bread, bran muffins, and lot of fruits. Drinking plenty of water is also very important. Avoiding junk food, like chips and chocolates, also helps.