Encopresis can turn into an incredibly stressful ordeal for the whole family, as well as a physically and emotionally painful one for your toddler. It's my strong opinion that a few simple and health approaches can be taken to stop it in its very early stages. I'm a mom who experienced the beginnings of bowel withholding and avoidance when my daughter was about to turn two. Since I've never been one to go blindly with the flock on medications, I felt I had no choice but to do my due diligence and study like a med student to help her through it as intelligently, and naturally, as possible.
I respect medicine and doctors, within reason, but also feel that we live in a time that alerts us to be more educated about all these new chemicals available for us to put in our bodies. Furthermore, it's one thing to choose it for yourself, and another to give it to your child. There are so many medicines out there now with such frightening hazards, a parent cannot help but think, "Exactly what is this, and how safe is it?" Even if a product claims to work naturally, or call itself "all natural," one has to pay close attention to what they're doing.
That said, let it be known that I am not a doctor or health care practitioner, so this article is not to be construed as such professional advice, and it is for informational purposes only. This is our personal experience and opinion surrounding the beginnings of Encopresis, which we very successfully stopped, completely, in less than six months, physically and emotionally. The purpose here is to encourage parents to look into working with the body (and mind) naturally rather than trying to take a seemingly easy way out with a drug or medication that might only mask over the problem for a while, (or cause another problem). It should be understood that it is a parent's responsibility to investigate and weigh any options they might choose for their child, preferably with the guidance of a like-minded doctor or health care practitioner.
I won't venture into defining Encopresis, because if you've arrived here, you already know what it is. It's not just bowel accidents (fecal soiling) - in my opinion, that more accurately describes what it turns into, if given the chance. So it would be fair to take a look into how a child ends up with soiling issues, and to know how to stop those conditions so Encopresis doesn't develop in the first place.
What Encopresis doesn't always define is the real "why," perhaps because it is unknown, or there could be varying reasons for different cases. For example, there are general physical reasons for constipation... Many professionals will say that there are physical reasons for fecal soiling too. Of course there are, (a stretched colon perhaps) but let's look at those reasons and find the origin of the problem. In our experience, the early stages displayed as many psychological as physical reasons. If this is not addressed right away, the child will hold onto bowels for days, repeatedly, and eventually the colon will stretch, and be unable to naturally detect (or hold in) a bowel at all. Then you have Encopresis to struggle with.
Our child had always had a mild case of constipation, which persisted until we finally decreased her dairy intake to almost nothing. Our doctor's advice to add more milk was in sharp contrast... But to this day, we still wonder if constipation was actually the first sign of what was to come.
During the time when our daughter was consuming the doctor-recommended amount of dairy, she had a bowel that was painful, and it left quite a psychological impression on her. She was almost two years old, and in her world view, she decided she didn't want to do that again - heaven's no. Besides, it seriously interrupted play time, and she was too busy to allow any fun-wrecking pain into her day. And so it began. She figured out how to hold it in, of course, with no mature knowledge of the consequences. Note that her reasons were both psychological and physical - it hurt and it interrupted unpleasantly - and both reasons were quite natural too, especially for a young human. Even adults want to avoid pain and having their fun interrupted! Multiply that by about ten million for some toddlers.
Physical fact: When a bowel is held in for days, the colon accommodates - it stretches. Over time, the stretched colon may lose its natural ability to sense when a normal-sized bowel is present due to the colon being larger, thereby undermining the sensations that would normally send the body signals to eliminate. Psychological fact: The longer a bowel is held in, the larger it gets, causing painful bowels, rectal fissures, possible bleeding, pain, resulting in less incentive to eliminate regularly, thereby causing more withholding. This apparently leads to an inability to hold a bowel in at will, causing soiling, and full blown Encopresis. According to many parents of children with encopresis, they cannot get their child to have a bowel, and when a bowel does occur, it's in the wrong place and time, and not under the child's control. Both parent and child experience enormous stress for the social inconvenience, and often, the child is reprimanded or ridiculed in one way or another, by somebody, and this does nothing to change the results.
From my perspective, it just makes sense to: first and foremost, address healing the fissures to avoid pain, restore tone to the colon, be attentive to diet by learning what can help and what can hinder, while offering age appropriate psychological coaching to encourage and educate the child. Trust me, a child's soiling or holding problem is not due to a body's lack of Miralax, and I want to emphasize working with the body.
Polyethylene glycol 3350, or PEG, seems fine for adult relief, or a cleanse before a colonoscopy, but it's made for adult temporary use, not long-term use for children. When I say long-term, I'm talking about a year, which our pediatrician suggested. PEG is in the same family as antifreeze (ethylene glycol) but of course it is NOT antifreeze. Still, that's disturbingly close enough for me; and any discerning parent might hesitate after simply finding out more or reading the label. Even its own label doesn't recommend it for anyone under age 17, so I'm perplexed by pediatricians prescribing it, with very little else for advice or guidance. The number 3350 is the molecular size/weight, which is supposed to be too large to be absorbed by the body, (which is why the FDA approves it as "safe") but what if leaky gut syndrome, or a bowel obstruction or blockage exists, and this chemical finds its way into your child's system?
Parents of children with encopresis are often instructed to do "clean outs" with their children, to the point of having orange, watery stools. My concern is that such a thing could fall into the overdose category. Some of the risks listed for PEG overdose are: blood in stools, rectal bleeding, coma and death. Some parents have suspected (and reported) what they feel to be neurological consequences like tics, twitches and behavioral changes in their children as a result of long-term and/or large doses of PEG. Additionally, if you use it to clean out your child to this degree, should it not mention the importance of replacing electrolytes? Dehydration can be quite serious, affecting many things that are important for neurological functioning. The product label may not mention this probably because the manufacturers didn't make it for that use, and don't want to be held accountable if it is used in that way.
Who really wants to take these chances with their child? It's worth it to investigate Aloe Mucilaginous Polysaccharides, simple saline enemas, dietary changes and psychological coaching complete with a "poop attempt" schedule, chart and reward stickers. It may take a little time and effort, but anything worthwhile does, and this is parenthood - guidance is what you're here for. Your child's colon will be toned, healthy and able to eliminate a bowel regularly very soon. Furthermore, emotional trauma will be avoided if you and the child confront this head on. Show them how you can offer a gentle, natural, calm approach.
The Top Five Most Important Approaches
1. Let's talk about enemas. You may dread the thought of giving your child an enema, as much as your child will protest the first few times, but the good news is that they are gentle saline, not an internally ingested mask over the symptoms (that won't really address the core of the problem). Enemas stimulate the bowel to come out, with little chance of resisting it, while teaching your child's colon this sensation. It's non-irritating, and the body doesn't come to rely on it, as it might for something like PEG or laxatives. You may prefer a gelatin suppository for making it easier on yourself, but in our experience, we found gelatin a little irritating in comparison to saline, and sometimes suppositories didn't work, whereas an enema worked every time.
If your child goes a full day or two without a bowel, wait no longer. An enema will help avoid a larger bowel later and preserve the tone of the colon by not allowing it to stretch with a pile up. After a few times, you'll get better at giving them and your child better at receiving them. Be sure to purchase a child's enema with a flexible, small tip, and follow the instructions. Only a small amount of fluid is needed - less than half a bottle worked just fine for us. Suggestion for comfort: let the enema sit in a warm glass of water for about 5 minutes to make it closer to body temperature.
Psychological consideration: never "threaten" an enema, and don't talk about it unless it's actually time to give one. You don't want this perceived as punishment, or negative in any way. If they have gone 24-48 hours with no bowel, and the day is almost done, an enema can be given after a warm relaxing bath before bed. Explain to them that it's just water to make the poop come out easy, and use comforting tones and words. It's possible that it will be quite a fuss the first few times as you and your child learn to do this, but it will get easier. Keep trying to encourage relaxation, for yourself and your child! Remember, you will not have to do this forever... you're only helping to train your child's colon for a period of time.
2. Aloe mucilaginous polysaccharides (AMP). This is only the healing part of the aloe plant, and it's even safe for infants, with no toxic overdose level. Drinking pure aloe juice, for example, could be quite irritating to the intestinal tract, whereas AMP is a long-chain polysaccharide, extracting only the healing properties of aloe. There are many educational websites that can explain this in detail and teach you about the endless benefits, but the importance of AMP here is healing painful fissures, helping to soften the stool a little, supporting regularity, and making bowels feel more slippery on the way out. Pain MUST be removed from this process or your child won't be open to relaxing and making a healthy emotional adjustment.
There are many quality makers of AMP to choose from. The price of one bottle may seem high at first, but it's nothing compared to doctor visits, OTC meds, and continued problems. Realize that a bottle of AMP will last the better part of a year. Not only is it extremely beneficial, it's incredibly low maintenance compared to other options. It may be the only bottle you'll ever need to purchase, unless you love it so much and wish to maintain it. One capsule a day, opened up and mixed in juice before breakfast is all that's needed for a 20-40 pound child, for example. You may offer two a day if it's really needed, but try one a day first.
In this case, it's important to order AMP with an L-glutamine base rather than a soy lecithin base, as many companies offer these two options. L-Glutamine has several perks, but the one you'd be most interested in is supporting tonal integrity of the intestines and colon. Each capsule typically has about 275 mg of L-glutamine, so keep in mind that you don't want a very small child to have more than that unless advised by a professional.
3. Probiotics, or friendly bacteria, are a must. There is no toxic overdose level on these either. Like AMP, the worst that might happen is diarrhea. I think everyone should make probiotics a part of their health maintenance, especially if antibiotics have ever been taken. It is paramount to offer probiotics in your child's diet if they have had difficult bowels. There are many brands and ways to offer these to your child, but yogurt is NOT the favored choice in this situation. Yogurt is dairy, and doesn't offer a full spectrum of probiotic strains anyway. Probiotics help your child's immunity by supporting healthy flora in the intestines, which helps digestion and nutrient absorption. They can also help make bowels more slippery so they come out easier.
4. Dietary changes. I know this can be a challenge with a toddler coming into their own, realizing that they can choose or refuse foods, so here are some things you can do without them noticing too much or changing things too radically. Reducing or eliminating dairy is probably the single most beneficial change of all, and a toddler can forget about it quickly enough, especially if they feel better. Do make sure there are other sources of calcium and vitamin D for your child - milk is actually NOT the best source. Slip a little prune juice in with other juices a couple of times a day. Pear juice worked for us as well. Cut your child's constipating peanut butter 50/50 with almond butter (unless of course there is any suspected allergy to almonds). Go easy on the bananas; they contain lots of supportive nutrients, but the iron they contain can sometimes constipate. Adding a little magnesium (like Baby Calm) to juice once a day can also make stools softer. A few drops of slippery elm does exactly what you imagine it might do - makes the bowel more slippery. In the unlikely event that all of these small adjustments don't change anything, consider a gluten-free diet. It's involved, and a little tedious, but it always results in great physical and mental health if properly done.
5. Psychological coaching must not be overlooked. There are many resources available to help. Some reputable guides for soiling can be purchased online, but try these other suggestions before investing. Add books about "pooping" to your child's library, including: Everyone Poops, The Long Journey of Mister Poop, Where's The Poop?, It Hurts When I Poop!, and Clouds and Clocks (if your child is already soiling). Set a schedule that you think works with your child's natural rhythm and let them know "It's time to sit for 10 minutes to try to poop," and give them one of the books to look at, or sit and read to them. For toddlers, potty training videos, like Potty Power, can go along with the rest of the encouragement, building confidence and making them feel like they're part of a community of sorts.
Tape a decorative "poop chart" to the bathroom wall and discuss what the reward should be when the chart is filled. They earn a sticker for each fearless bowel movement until the chart is filled. If your child shows anxiety or fear at the prospect of going through with a bowel movement, it's important to sit with them in the bathroom and talk about it, show understanding, support, and relay some of your own experiences in short simple sentences; be reassuring and calm. Sometimes a hug, or just talking about the creative poop chart is a nice distraction from their anxiety. Make eye contact, suggest slow, deep breathing and teach them about relaxing all the muscles. It's amazing what a toddler can do in this arena. We used to tell our little one that she had to relax her butt or "the door won't open" and she loved that! We even drew pictures of poop with personality, and talked about how they wanted to get out because they had lots of things to do. It was all very humorous, and it worked psychologically because it turned something she feared into something she thought was quite funny.
Of course you want to praise each bowel, consistently, and tell them how perfect it is and how proud you are that they did it without being too afraid. Never lose your patience, even secretly, as a child is often as intuitive as a person can get, and they can feel Mom or Dad's stress, frustration or impatience. Check your own feelings, and establish in your own mind that this will not last longer than a few months. Your time and attention, as well as your child's health and happiness, will be well worth it later.
I feel passionate about helping children with the most natural and gentle solutions possible, and I hope you will study these options and make the healthiest choice for your child before turning too quickly to the so-called "quick fixes," or over the counter options that don't exactly work with nature. My primary concern is toxicity that could lead to other problems in a child's wellness, and then encountering a doctor who says that problem and the medicine are unrelated... and the child ends up on yet another chemical, and another, and another.
I do respect doctors, but the above example can happen. It's still important to have a medical professional you trust, especially if things take a turn in a serious direction that you are not educated enough to handle. Just remember that they are human too; it's got to be hard for them to keep up with every little detail about every chemical, its risks, and millions of details about so many patients, or healthier options. They would have to go to school for at least two or more years just to learn about the tremendous array of natural options. They are given information that is aligned with their training, and they recommend and prescribe. Most of the time, all is well, but sometimes a parent has to work outside of the box. Regardless, it's always advisable to have a productive relationship with your child's doctor in case they have a need. Let your child's pediatrician know if you're uncomfortable with a medicine, tell them why, and ask them what they think about an approach you'd rather take instead. That way they can continue to advise you medically when needed, and your success may even open their eyes to something that they can use to help another child.
I hope this article has offered information about gentle solutions as well as a realization that, for some children, this issue begins simply as a normal reaction to learning all about poop! And of course, as a parent, you have the responsibility of guiding them to a healthy perception of it. A challenge like this is likely only one of many more to come, so every effort to be the best parent now adds up.
