Overcoming Encopresis

1. Encopresis is (usually) pooping in the pants. At first glance, most people would see the solution to this problem as learning to “hold it back” more successfully. But the most important thing to realize is that clamping with the muscles that hold back pooping is not the solution – in fact, doing this too much is central in causing the problem.

2. Encopresis almost always happens along with constipation. A bunch of hard stool stretches the wall of the rectum and makes it not sensitive enough to produce the usual reflexes that make us want to poop. So stool tends to leak out involuntarily at random times.

3. The solution to encopresis is not to “hold it in,” but to “get it out,” as frequently as possible. That is: the more poops go into the toilet, the closer you are to the solution.

4. If poop gets held back inside us, it gradually gets harder and harder. Then it can be painful to get out. That can make someone want to avoid pooping. So that’s a vicious cycle. So along with frequent poops the other big goal is soft poops.

5. Having lots of fiber in the diet helps to let the poops be soft and frequent. Supplementing the diet with Metamucil or another product containing psyllium is one way of helping the poop be soft and frequent. Starting with one teaspoon each day of psyllium in a large glass of water or juice, and gradually increasing the dose of psyllium until the poops are once or twice or more daily, and soft but not runny, is one approach to this. There is no problem with using psyllium over a long period of time. Other doctors like Miralax (polyethylene glycol) as a way of accomplishing the same thing. Prune juice is another possibility for keeping poops soft and frequent.

6. If there is a lot of hard stool clogging up the intestine, a “clean out” is often useful – trying to get all that hard stool out. There are various approaches to this, including enemas, mineral oil, and other methods. The goal is to get un-constipated. It’s good to do this on a week end rather than a school day, because it’s very possible to overshoot and for the person to have to poop many times. This can be good for cleaning out the bowel, but not pleasant to do while at school.

7. It’s important that the person with encopresis not be punished or shamed for soiling the pants, because this tends to bring out more of the “hold it back” strategy. Being asked to cooperate with a rational strategy of cleaning up is fine. The more cleaning up can be done with an unemotional, reasonable, cooperative relationship between people, the sooner will be the day when such cleaning up is no longer necessary.

8. The person with encopresis should strive to pay attention to any urges to poop, or any feelings that it’s possible to poop, and act on these feelings as high a fraction of the time as possible.

9. It’s good to have an understanding with school folks or camp staff or anyone else that the person is allowed to go and poop whenever they have the urge, without having to wait till the end of class or without being suspected of avoidance of work. The longer you have to wait after noticing an urge, the more chance there is that the urge may go away. Answering that urge with a poop in the toilet is what solves encopresis.

10. The plan of trying to have soft poops and frequent poops is a long-term goal. If one thinks that the problem is solved after a while of not soiling, and stops doing the things mentioned above, the problem is likely to come back. So keep at it for a long time!