Encopresis | Treatments

At Boston Children's Hospital, we consider you and your child integral parts of the care team and not simply recipients of care. You and your care team will work together to customize a plan of care for your child.

With treatment, your child will eventually have regular bowel movements and avoid the constipation that can lead to encopresis.

How is encopresis treated?

Treatment for encopresis may include:

  • using laxatives to help your child pass the impacted stool
  • using medication to keep your child's bowel movements soft so the stool will pass easily
  • having your child sit on the toilet for five to ten minutes after breakfast and dinner

About prescribed enemas:

  • Prescribed enemas help remove the impacted stool. An enema is a liquid that is placed in your child's rectum and helps loosen the hard, dry stool.
  • Enemas are prescribed when medically indicated and both the child and parents are comfortable.
  • We offer other treatments, but sometimes enemas with other medications are the easiest and most efficacious.
  • Do not give your child an enema without the approval of her physician.

What happens after the impacted stool is passed?

After your child passes the stool, it's important to develop a good routine to ensure that stool does not get backed up again. Because your child's intestine and rectum will remain stretched (they go back to normal after about six months), your child may still have problems with leakage.

To reduce the number of accidental bowel movements or fecal soilings, have your child sit on the toilet two to three times a day for five-to-10 minutes, preferably shortly after a meal.

Ten minutes? That's a long time. What are some ways to keep my child entertained?

It's very important to make this time pleasant, so that your child doesn't see it as a punishment. Here are a few ideas to make toilet time fun:

  • Have some special toys that your child gets to play with while sitting on the toilet.
  • Tell stories or sing songs with your child.
  • Read your child's favorite book.
  • Let your child play a video game.
  • Begin a sticker chart or come up with some small prizes to reward your child for sitting on the toilet.

It's also important to remember that each time your child sits on the toilet, she will become more comfortable with it. So make sure to praise your child for sitting on the toilet — even if she doesn't have a bowel movement.

What can we do to make sure my child doesn't get constipated again?

Often, making changes in your child's diet will help her constipation. Consider the following suggestions:

  • adding more fruits and vegetables to your child’s diet
  • adding more whole-grain cereals and breads (check the nutritional labels on food packages for foods that have more fiber)
  • encouraging your child to drink more fluids, especially water
  • limiting fast foods and junk foods that are usually high in fats and sugars; instead offer more well-balanced meals and snacks
  • limiting whole milk to 16 ounces a day for the child over 2 (but not eliminating milk altogether; children need the calcium and Vitamin D in milk to help their bones grow strong)
  • serving your child meals on a regular schedule
  • serving breakfast early so your child does not have to rush off and miss the opportunity to have a bowel movement
  • increasing the amount of exercise your child gets
  • if a child has a limited diet/sensory aversion, a fiber supplement can be helpful — these come in chewable tablets, a powder that you can mix in a drink and a gummy variety

What if my child's encopresis is caused by toilet refusal?

We usually see children and their parents individually at first and most children quickly master using the toilet without anxiety. For those who have trouble, we have developed Toilet School, an educational program for both parents and children to help them with difficult toilet training.

Toilet School is a six-week program in which six kids — mostly 4-, 5- and 6-year-olds — come to class once a week for an hour to an hour and a half. Parents attend a separate class where they learn behavioral techniques designed to help their children master toilet use.

By graduation time in the sixth week, about 60 percent of the kids have successfully had a bowel movement on the toilet. The ones who haven't get follow-up visits until they're successful.

Encopresis follow-up care

A schedule of follow-up care will be determined by your child's physician and other members of your care team. The main purpose of these follow-up appointments is to make sure that your child is not getting constipated again.