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October 2015

Poop in Your Child's Underwear: Encopresis or Not Wiping?

The treatment of encopresis requires parents to keep track of poop accidents so that they can appropriately add or change the laxative or other treatment their child may be on (see the “Weekly Laxative and Stool Record” in my book, The Ins and Outs of Poop).

When I ask parents to describe the size and consistency of their child’s accidents, they will sometimes say, “I’m not sure if it’s an accident or if he/she just didn’t wipe, or wipe completely.” This is an important distinction because changes in laxatives or their doses is often based on the frequency, size and appearance of a child’s accidents.  If a parent doesn't know or is just guessing whether a child had an accident, the data they are using to make this decision is problematic.

Generally, poor or no wiping results in a brown stain or a thin smear. Anything more than a stain or thin smear is defined as an accident.

(One caution, however, about loose or liquid-like stools. These are sometimes mislabeled as accidents caused by constipation when they are not. As described in detail in my book, too much of a laxative (e.g. Miralax) can cause incontinence.)

13 Year Old with Encopresis Cries While Reading "The Ins and Outs of Poop"

I recently received a request for a telephone consultation from the mother of a 13 year old girl who had been withholding her poop for eleven years. She said that her doctors had recommended Miralax, ultra sounds, x-rays, therapy and even a barium enema when her daughter was only 4 years old, which, she said, "was horrible beyond belief and probably made everything worse".

Because she had not yet read my book, I suggested that she do so before we talked by phone. Shortly thereafter she sent me the following email:

Dear Dr. Tom,

Just to let you know that my 13-year old daughter wept like I haven't seen her weep as we read your book together and we read about kids who were like her, who are great achievers and great kids, but who have greatly struggled with functional constipation. When she read that a girl had actually recovered, she just started sobbing. There it was, a possibility she had never heard of... she has felt so alone. We all have because most people aren't willing to talk about this, so, we haven't known that this was a problem others were facing.

There has been so much shame. Doctors have mostly just sent us away telling us to feed her more prunes or giving us sheets on normal constipation which we knew somehow was very different. There has been much trauma and loss of trust with the medical world over the fact that doctors couldn't hear us, for example, when we told them that she was able to hold in an enema for 13 minutes as a four year old.

It has been a week and we are all supporting my daughter in going to the bathroom every day with Miralax.  We are going to continue for 6 months with her going every day and see how this goes and contact you again if we need guidance along the way.