Tips for Parents

Recognize that encopresis is a real problem. In my clinical work, I found that most parents first hoped that their child would simply outgrow the problem, but in time, they realized that encopresis was a true medical problem that required intervention and help. Even physicians can under-treat the problem, failing to identify the importance of both medical management and behavioral training. Be sure to pursue both parts of getting your child help: learn about the medications that are used to treat encopresis, but don’t forget to learn about the behaviors children with encopresis need to use to get better.

– Submitted by Frances Thorndike, Ph. D.

When your child sits on the toilet, check to make sure they are not tightly wrapping their legs around the toilet. Children with encopresis need to keep their legs resting loosely on the floor or a stool. Wrapping legs around a toilet seat makes it impossible to keep the external anal sphincter relaxed during defecation. And that needs to happen for the bowel movement or poop to be successfully pushed out.

– Submitted by Frances Thorndike, Ph. D.

Do your child’s legs reach the floor when they are sitting on the toilet?  If not, place a stool (or similar item) in front of the toilet so your child can easily rest his or her legs on its surface.  It’s hard for a child (or anyone for that matter) to keep the appropriate muscles relaxed when feet are dangling in the air.  Once the stool is in place, encourage your child to use this surface for gently resting their feet.

Many parents (and even some physicians) worry about giving children laxatives.  But most of these concerns are based on myths – not facts.  Nearly all laxatives work by keeping water in the stool, allowing these medicines to be used for a very long time without significant risk.  In the UcanPoopToo program, medications are discussed in detail, and there is no convincing evidence that any of the laxatives discussed in the program are harmful and will result in dependency.  Further, there is no good evidence that any of the laxatives described in the UCanPoopToo program lose their effectiveness over time.  Obviously, as children get older, larger amounts of laxative may be necessary, but increased dosage is usually the result of the stage of the problem and the age of the child – not dependency.  One of the greatest fears voiced about laxatives is parental worry that prolonged laxative use will result in colon cancer.  But there is absolutely no good data to suggest that using laxatives places children at increased risk for developing colon cancer later. What is clear is that not keeping children cleaned out with medication, enemas, and/or diet can lead to impaction and continued encopresis.  In the UCanPoopToo program, the Medication Core and Laxatives and Health Module provide additional information on the role of medicine and some of the common misconceptions about taking daily medicine.  Be sure to talk to your child’s physician about your worries about laxatives and get your all of your questions answered.  Although giving children medication can be anxiety-producing, getting answers to your questions can help you make the best choice for your child.  You may also want to read an excellent article from Dr. Muller-Lissner and colleagues in the 2005 issue of the American Journal of Gastroenterology titled, “Myths and Misconceptions about Chronic Constipation.”

This tip and the UCanPoopToo program are not a substitute for medical evaluation, advice, diagnosis, care or treatment. We recommend that you always seek the advice of a physician or other health care professional for all health-related matters. 

http://18.205.98.154/general-disclaimer-information

Encopresis: A Medical and Family Approach, an article recently written by Dr. Coehlo and published in Pediatric Nursing, has some excellent information for families struggling with encopresis.  According to the article, encopresis treatment works best when a “team” approach is used. The team should include the child, parents, teachers, and health professionals working together to develop a plan that is both feasible (able to be implemented) and supported by research.  The article also points out that even with the most effective treatments: 1) children with encopresis generally take up to six months to get fully better, and 2) relapses are common during times of change and transition. This is one of the reasons that ongoing support and monitoring are crucial.  The author stresses that positive outcomes take both dedication and time. As Dr. Coehlo poignantly notes, “children with encopresis need understanding, support, and encouragement to be successful at learning what to do to reach a milestone that many of us take for granted.”

Click this post and listen to an excerpt from our monthly Encopresis Expert online chat available to UCanPoopToo customers. Dr. Thorndike talks to parents about working with schools on a 504 plan.

Click below to listen!

Working with schools on a 504 plan.

Click this post and listen to an excerpt from our monthly Encopresis Expert online chat available to UCanPoopToo customers. Dr. Thorndike talks to parents about how to help children catch up on school work they miss while going to the bathroom.

Click below to listen!

How to help children catch up on school work they miss while going to the bathroom.

Effective treatment of encopresis relies on first successfully emptying or cleaning out the child’s colon.  As explained in more detail in the UCanPoopToo Medication Core, children can be cleaned out with enemas or medicines.  If you do not believe your child is cleaned out after following the steps highlighted in the Medication Core, you should talk to your doctor.  Once your child’s colon is cleaned out, taking regular daily medicine can help ensure that your child has soft, formed poops at least once a day.  If your child is still having accidents after an earlier clean out, he or she may need to get cleaned out again before then adjusting the regular medicine dose.  It is quite possible your child got constipated or backed up again.  Changing the regular medicine dose alone is typically not enough if the child is already backed up.  So, if your child has started the UCanPoopToo program but is still having accidents, revisiting the Medication Core may help.  Read the material carefully to determine whether additional Clean Outs may be needed.

Click this post and listen to an excerpt from our monthly Encopresis Expert online chat available to UCanPoopToo customers. Dr. Thorndike talks to parents about some of the difficulties that can arise while on vacation, and some things you can try to help.

Click below to listen!

Difficulties that can arise while on vacation and tips to help them.

If you have been dealing with encopresis for a long time and are feeling fed up, don’t give up yet! Encopresis can be difficult to treat. Even pediatricians and family care physicians think so. In fact, in a recent survey by Dr. Philichi and Dr. Yuwono (Click here for more information), primary care physicians reported feeling confident that they could help their patients with constipation (73% of the doctors estimated a 75%-100% success rate when managing constipation). But, when asked about helping their patients beat encopresis, only 19% of doctors estimated a greater than 80% success rate with encopresis patients. What does this mean? It can be hard for primary care doctors to treat it alone.

Our research has shown that kids benefit from a combined medical and behavioral approach to managing the problem (Click here for more information). UCanPoopToo combines the expertise of clinicians and researchers from multiple disciplines, including pediatric gastroenterology, behavioral medicine, psychology, and online health interventions. We all came together to extend the support and care families receive through their primary care or pediatric physician. Whether through UCanPoopToo or another option, consider combining medical advice with behavioral modification, ongoing daily symptom monitoring, and corresponding adjustments in the child’s treatment regimen based on that monitoring. As you know well, it can take a lot of work to beat this problem. But it is beatable with the right combination of tools and strategies.

Dear Dr. Steve:

Our 8 yr old son can be accident free with daily fiber, but then his stools are soooo large that he routinely needs to plunge or the toilet needs to be snaked. Where is the happy medium?

Signed, G

Hi G,

Our website, www.ucanpooptoo.com, includes general information about the signs and causes of encopresis, including the exceptionally large stools you describe. A recently published survey indicated pediatric care providers are likely to instruct families with constipation to increase fiber, eliminate constipating foods, and reduce dairy from their children’s diet. However, the North American Society for Pediatric Gastroenterologists (NASPGHAN) guideline proposes a well-balanced diet for children with encopresis.

You are welcome to contact us if you have other questions about the UCanPoopToo program. Although we cannot give you personal support, advice or recommendations, we can provide you with general information that you may find helpful.

Take care,

Dr. Steve

Hear Dr. Thorndike exchange information with UCanPoopToo parents and caregivers about how to talk and listen to kids with encopresis.

Click to listen!

1. How can I get my child to talk about encopresis?
   
2. What do other parents say to their children about encopresis?
   
3. How do I get my child to sit down and do UCanPoopToo with me?
   
4. My child is convinced that he is the only one with a problem. What do I say?
   
5. My child wants to have a sleepover, how do I talk about the issues encopresis could pose?
   
6. How do I convince my child to take daily medication?
   

Nurse Shelly Dean provided information regarding the role of a healthy diet as it relates to encopresis and constipation.

Click to listen!

1. Can encopresis be treated by diet alone?
   
2. What are some suggestions for helping children to take Miralax?
   
3. Does dairy contribute to constipation?
   
4. What is fiber’s role as it relates to constipation?
   
5. Is there any time that I need to worry about the color of my child’s poop?
   

Encopresis Expert and one of the developers of the UCanPoopToo program, Dr. Frances Thorndike, talked with parents about how to help their kids take ownership over their behaviors (like sitting on the toilet, taking medicine), so there is less of a struggle between parents and kids. Listen to these audio excerpts of some of the questions that were asked.

Click to listen!

1. Rewarding your child for good bathroom behaviors / Finding the right reward.
   
2. How to get your child to sit on the toilet.
   
3. How to get your child to provide accurate information about bathroom habits at school.
   
4. Ways to stay positive while dealing with Encopresis.
   

Our encopresis expert Nurse Shelly Dean recently provided information regarding the myths and realities of laxative use.

Click to listen!

1. Myths and realities of Miralax use
   
2. How long should a child stay on a laxative regimen?
   
3. Can diet alone help constipation and encopresis?
   
4. How fiber works
   
5. Routines for laxative use
   

Please note that these encopresis expert tips are to provide general education regarding laxative use.  It is important to consult with a physician prior to the start of any medication use.  These tips are not meant as a substitute for medical evaluation, advice, diagnosis, care or treatment.

In this month’s chat, Encopresis Expert and pediatric gastroenterologist, Dr. Stephen Borowitz, talked with parents about the role of medication in managing encopresis. These chats are exclusively available to all UCanPoopToo subscribers. Listen to these audio excerpts of some of the questions that were asked.

Click to listen!

1. Are Laxatives addictive?
   
2. When should I give my child laxatives so he doesn’t have an accident at school?
   
3. After the accidents stop, how long should a parent wait before cutting back on medication?
   

Dr. Lee Ritterband, one of the creators of the UCanPoopToo program, answers questions from parents and caregivers regarding the origins of encopresis and other current issues related to handling a child’s encopresis.

Click to listen!

1. My child has encopresis and I am worried that his siblings will have encopresis, as well.  Should I be concerned?
   
2. My child has had success with laxatives however is still having accidents.  Is this behavioral in nature or is it an issue of overlow?
   
3. I think my daughter is doing this on purpose.  How could she be having so many accidents?
   
4. My 9 year old son was previously potty trained, however has now been having accidents since second grade.  What happened to set him back?
   
5. Do you see children who refuse to use the toilet for pooping even though they regularly go for peeing?
   

Encopresis Expert Nurse Shelly Dean talked with parents about using laxatives as part of the UCanPoopToo program for encopresis.  Listen to these audio excerpts of some of the questions that were asked.

Click to listen!

1. Why is MiraLAX used most frequently?
   
2. Can I use Milk of Magnesia or X-LAX for cleanouts?
   
3. Are there any long term effects of using laxatives?
   
4. My child was prescribed MiraLAX and Senna. Is that too much laxative?
   

Hear Nurse Shelly Dean provide expert responses to questions from parents and nurses regarding how to effectively work together and with the school to help children with encopresis.

Click to listen!

1. As a school nurse, how can I most effectively help a child who has encopresis and is experiencing pain and other issues?
   
2. What are some general tips for talking with school nurses?
   
3. As a parent, how can I best explain to teachers that encopresis is not my child’s fault?
   
4. How do I get my child to talk with the school nurse and/or other adults about her encopresis when needed?
   
5. How do I help the school best understand my child’s situation?
   
6. How do parents and school nurses best collaborate in the care of encopresis for children?
   

Click this post and listen to the special entire live discussion from our monthly Encopresis Expert online chat normally available exclusively to UCanPoopToo customers. Dr. Thorndike talks to parents about working with schools to help children with Encopresis.

Click below to listen!

Encopresis Expert: Working With Schools (Part 1)

Encopresis Expert: Working With Schools (Part 2)

Parents often ask excellent questions of our encopresis experts and we find the responses are helpful to many families.  One parent recently needed help with the following:

Question

My child says he doesn’t feel the poop coming out and that’s why he has continued to have accidents.  Can this be true?

Encopresis Expert Response

Encopresis occurs after a child has a hard, painful poop, or more than likely several hard and painful poops.  The pain causes the child to tighten the muscles that are used to have a poop, instead of relaxing them.  This is not intentional or on purpose, but is the body’s response to the pain that it felt.  As time goes on and the withholding has become natural to the child, stool gets backed up in the colon and the child becomes very full of the stool.  As a result, there can be loose stool that leaks around that retained stool that the child cannot feel.  This in turn will likely cause soiling accidents of which the child may be unaware.

Thank you to this parent for her recent question for our encopresis experts!

Question

My 9 year old is really struggling.  He works so hard with his regimen of laxatives and participation in the daily routines we have established.  He has regular toileting twice a day at home and once at school after lunch.  He participates in daily exercises that are recommended by the program.  Yet, he still has to wear pull ups at school and has frequent accidents throughout the day.  I am sure the other children are aware of this at times; sometimes I can smell it when he comes home.  How can I help him?  He is going to be in middle school next year.

Response

Living with encopresis can be frustrating and difficult for children and their parents, especially knowing how hard it already is to fit into social circles with other children.  When they have suffered for years with encopresis and are still struggling to manage the accidents, it is often a good idea to talk with a pediatrician, pediatric gastroenterologist, and/or a behavioral therapist.  There may be options or aspects of treatment that have not yet been explored.

Keeping the colon cleaned out and keeping poop moving through the colon as quickly as possible are two very important pieces to managing encopresis.  If your son is following a good routine but continues to have frequent accidents, it may mean he has the wrong laxative regimen.   Sometimes it is necessary for children with frequent soiling to have clean out regimens with enemas or Miralax either weekly or perhaps more often for a certain period of time.

Making sure the school is working with your son and he is participating in the process, taking ownership of situations at school as well as at home are very important.  Allowing him access to the nurse and a private bathroom are also important.  This can help with communication as the nurse can assist in understanding your son’s progress and whether things like additional toileting times during the school day are necessary.  Privacy and access will also make changing pull ups easier when necessary, which in turn will minimize or eliminate odor, help cleanliness and prevent skin breakdown.

Thanks to this parent for his recent question to our encopresis experts regarding laxatives.

Question:  Are laxatives addictive?

Encopresis Expert Response:  As with any use of medications for treatment, it is important to consult with a physician prior to the start of laxatives for cleanout and/or treatment.  This tip is not a substitute for medical evaluation, advice, diagnosis, care or treatment.

Many studies have been done over time, as indicated in the research for constipation, that show the use of laxatives to be effective and safe.  It is important to treat constipation and encopresis with enough laxatives to clean out the colon and keep poop soft and keep the child using the bathroom regularly and without accidents.  This is safe and not addictive, but is necessary for a long period of time in order to break the pain and retention cycle.

Parents often ask excellent questions of our encopresis experts and we find the responses are helpful to many families.  One mom recently needed help with the following:

Question:  My son (just turned 7) becomes very uncooperative when it is suggested that it is time to sit and try. We have continually tried to tell him the importance of trying, yet he refuses only to have an accident shortly after. HELP

Encopresis Expert Answer:  Many parents in our program have expressed the very same frustrations and feelings you are describing.  Encopresis can be very difficult to manage and time consuming to treat, especially when it feels like you are the only one trying to solve the problem!  The behavior you describe is actually quite common in encopresis, where the child does not want to sit and try (or may not want to take medications, or any of the other helpful behaviors needed to end encopresis).  We generally recommend parents work with the child to develop some kind of reward system to reward the child for participating in the needed (and clearly identified) behaviors.  Children typically do best when they know exactly what is expected of them (i.e.,sit 3 times a day at this time), and what they can earn in exchange.  Involving the child in picking the reward can really help.