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September 2019

Encopresis Treatment and Exercise

Parents of young children being treated for encopresis sometimes think it strange that their child likes to runs around before pooping. One parent said, "My son often needs to run up and down the hallways to make a bowel movement." In fact, there is nothing strange or unusual about this at all. As I say in my book, The Ins and Outs of Poop:

"Exercise is important (especially when treating encopresis!) because it directly affects the movement of stool. Our large intestine works better when we are active. Children (and adults) frequently experience the urge to poop either during exercise or shortly thereafter. Children who are physically active are less likely to become constipated than those who are not." (page 50)

Exercise helps constipation by decreasing the time it takes food to move through the large intestine thereby decreasing the amount of water the large intestine absorbs from stool. Aerobic exercise, like running, is especially helpful because, by speeding up breathing and heart rate, it helps stimulate intestinal peristalsis.

Therefore, provided that your child's laxative and liquid intake is sufficient to make his stool softer than normal ( applesauce or pudding), you might want to encourage your child to run around for a few minutes before sitting to try to poop. 



Teaching constipated children to "push" using games and toys

The treatment of functional constipation often involves teaching and encouraging children to "push" in order to help their poop come out.  As I reported in a previous post, one mother found that teaching her son to push resulted in his first real bowel movement She couldn't believe she hadn't tried that sooner.

So how do you teach and encourage a child to push? In kid-friendly terms, the act of pushing is like trying to blow air through a straw that is blocked on one end so that no air can pass through. Pushing causes the diaphragm to move in a way that puts downward pressure on the rectum and its contents. In the second edition of my book, The Ins and Outs of Poop, I advise parents to teach their preschool or older age child to push by doing the following while sitting on the toilet:

  1. "Breathe in a little and hold it."
  2. "Pull in your belly button a little and hold it in or push out your belly button a little bit and hold it out."
  3. "Try to push your belly button down and out through your poop chute."
  4. "Push for three to five seconds, then let the air out and relax." 

For young preschoolers and older toddlers I advise parents to approach teaching how to push as if it were a game.  Games give a child the opportunity to have fun practicing the components of pushing before they have to deal with the added stress of having to do it while sitting on the toilet to poop. For example:

The Belly Button Game: While either standing or sitting in the bathroom (or in any other room in the house), a parent first demonstrates what it looks like when they move their own belly button in and out and then challenge their child to see how many times they and their child can move their belly buttons in and out together at the same time. Vary it up with how slowly or how quickly the child can move their belly button in and out.

Using toys that encourage partially obstructed exhalation can also be helpful. Partially obstructed exhalation also causes the diaphragm to put downward pressure on the rectum and its contents but less so than breath-holding. To help children recognize the feel of "pushing the belly button down" while sitting on the toilet, toys such as pinwheels or New Year's Eve party favors like "blowouts" or horns are excellent. The objective is to encourage blowing out or exhaling as long as possible without straining. "Blowouts" that make a funny sound when fully extended are ideal.

To maintain interest in "playing" with these toys I recommend that children only be allowed to use them when sitting on the toilet.

Join in and have fun!!