Encopresis is defined as the unintentional passage of stool, or fecal incontinence. In children, stool leakage is only considered to be encopresis when the child is over the age of four and has previously been potty trained. However, as I have recently found, encopresis can occur in toddlers who have never potty trained. Getting a diagnosis for encopresis in a child under the age of four is very difficult.
When my second son was a newborn he would cry while having bowel movements. This concerned me greatly, but his pediatrician examined him and found no physical problems. It seemed that the sensation of a bowel movement was unpleasant to him. This didn’t change over time. As he moved into toddlerhood he began to withhold stools. His bowel movements would only be complete about once or twice per week. He’d shake and cry while trying to hold back stools that his body wanted to force out. It was heartwrenching to watch. We tried relaxation and calming techniques. We made sure he wasn’t experiencing constipation due to an improper diet. There was no sign of encopresis at this point. I spoke with his pediatrician and was assured that he’d eventually grow out of the stress that this natural bodily function was causing. We were warned to not push potty training and since I firmly believed in child led potty training this was our plan from the beginning.
At his two year well visit, he was checked again to be sure that nothing was physically wrong but I had noticed that sometimes he would hold stools for a week and I was concerned. Still, he had no signs of constipation so there was no worry. At around 27 months he begin to defecate in small amounts which I had no clue was considered to be encopresis. I changed diaper after diaper and noticed that the smell had changed. After his younger brother was born a few months later, my son held his bowel movements for three weeks. During this time he leaked fecal matter constantly. Since he had always eventually let the movement happen I didn’t start to really worry until about two weeks into his holding. At that time I made an appointment with his pediatrician. The day before the appointment, after three weeks of not have a completed bowel movement, he finally passed a huge mass. This was another sign of encopresis that I did not know about.
Unfortunately, because he had defecated the day before seeing the doctor, there were no signs of encopresis for his pediatrician to see. He went undiagnosed once again. I was left with a warning to bring him in for prescription laxatives if he went that long again without a movement. However, because the pediatrician did not realize he was leaking, he did not realize that he was truly experiencing encopresis. I finally made some headway with my internet searching on the subject and found a few other moms who had toddlers with encopresis.
After a few more months of my son experiencing fecal incontinence and using glycerin suppositories to help him, I took him back to the pediatrician armed with my information on encopresis and the pediatrician agreed that his symptoms pointed directly to encopresis. He prescribed a laxative to keep my son’s stool soft enough that he cannot withhold them. This has helped and since beginning the laxative he has not experienced fecal incontinence.
This is just the beginning of a long journey. My son held his stools so effectively that he lost the urge to defecate and has to regain the control necessary to produce bowel movements. He will likely have problems with encopresis for years to come and the problem may become worse when he finally begins to potty train. The key will be proper nutrition and a relaxed schedule to allow him time in the bathroom to take care of business. A low stress lifestyle will also be important. The biggest hurdle, that of a diagnosis for a child his age, has been overcome and we are on our way to better times.