Medical Treatment for Encopresis continued...
Medical professionals usually refer to emptying stool from the colon and rectum as evacuation or, in severe cases when the doctor needs to remove the stool manually, disimpaction. Evacuation can be accomplished in the following ways:
- Give an enema or series of enemas: An enema pushes fluid into the rectum. This softens the stool in the rectum and creates pressure within the rectum. This pressure gives the child a powerful urge to pass a bowel movement, and the stool is usually expelled rapidly. The fluid in most enemas is water. Something is usually added to keep the water from being absorbed by the intestinal lining. Widely used enemas include commercial sodium phosphate preparations (such as Fleet saline or Pedia-Lax enemas), slightly soapy water, and milk and molasses mixtures. Daily enemas for several days may be needed to completely evacuate the colon.
- Give a suppository or a series of suppositories: A suppository is a tablet or capsule that is inserted into the rectum. The suppository is made of a substance that may stimulate the rectum to contract and expel stool or it may soften the stool by drawing extra water from the body into the bowel. Popular stimulant suppositories include Dulcolax, Correctol, or Fleet Bisacodyl. Popular stool softening suppositories with glycerin are provided by Fleet or Pedia-Lax. Daily suppositories for several days may be needed to completely evacuate the colon.
- Give strong laxatives: Most laxatives work by increasing the amount of water in the large intestine. Some laxatives cause the lower intestine to secrete water and others work by decreasing the amount of water absorbed in the lower intestine. In either case, the end result is much more water in the lower intestine when using laxatives than when not using them. This large amount of water softens formed or hard stool in the intestine and produces diarrhea. Laxatives used for this purpose include magnesium citrate, GoLYTELY, and COLYTE products. Treatment for several days may be needed to completely evacuate the colon.
Establishing regular soft and painless bowel movements is mostly a matter of retraining the child to give up the habit of retaining stool. This is accomplished by giving laxatives every day to produce soft bowel movements. The laxative must be given in doses large enough to produce one or two soft bowel movements every day. The soft stool will be passed easily and painlessly, encouraging the child to have regular bowel movements rather than holding the stool in. See Medications for a list of commonly used laxatives. Remember that fecal retention and soiling go together. So, as long as the child has retained stool in the rectum, the soiling will persist.
The final step is working with the child to develop regular bowel habits. This step is just as critical as the first two steps and must not be abandoned just because the soiling has improved after the previous steps.
- Establish regular bathroom times: The child should sit on the toilet for 5-10 minutes after breakfast and again after dinner EVERY DAY. Some families must alter their daily routines to accomplish this, but it is a crucial step, particularly for school-aged children. Sitting on the toilet right after a meal takes advantage of the “gastrocolic reflex,” intestinal contractions that naturally occur after eating.
- Behavioral techniques: Offer age-appropriate positive reinforcement for developing regular toilet habits. For young children, a star or sticker chart can be helpful. For older children, earning privileges, such as extra television or video game time, may be useful.
- Training: Children may respond to teaching about the appropriate use of muscles and other physical responses during defecation. This helps them learn how to recognize the urge to have a bowel movement and to defecate effectively.
- Biofeedback: This technique has been used successfully to teach some children how to best use their abdominal, pelvic, and anal sphincter muscles, which they have so often used to retain stool.