A child who passes stools into his underwear has a problem called encopresis or soiling. Some children have encopresis because they deliberately try to hold back stools. Stool-holding can lead to constipation, painful stools and even complete blockage (stool impaction). Children who have a stool impaction constantly leak or ooze stool in small amounts (encopresis). If the impaction persists for very long, the rectum and colon become stretched out of shape and are no longer able to squeeze out stool. Unblocking the child may require enemas. Keeping the child unblocked requires 3 to 6 months of laxatives or stool softeners. Stool holding is an important problem to recognize early and treat vigorously.
About 5% of children refuse to be toilet trained for stools (called bowel training resistance). They get into a tug of war with their parents around using the toilet. Some of these children decide to hold back stools so they won’t have to use the toilet. Other children start holding back after they pass a painful stool and never want to have that pain again (pain avoidance).
If your child is blocked up (impacted) with stool, he may need an enema to unblock him so that oral medicines can work. Enemas are generally not used under 2 years of age. Follow your healthcare provider's advice.
Warning: If you are using a phosphate enema (such as Fleet’s saline enema) it can have serious side effects if given in too high a dosage or given more than once per day. Follow the enema directions carefully.
Increase the dose gradually until your child is passing 1 or 2 soft BMs each day.
Because holding back stool hurts the body, there are some exceptions to not reminding your child:
If your child reaches the end of day 3 without passing a stool, also ground your child until he passes a big poop (at least the size of a banana). Remember that holding it back causes it to become larger and wider. After 4 or 5 days, it will become too wide to pass.
For children younger than 4, put them in a pullup at these times and encourage them to let go of their poop.
However, don't let your child wear diapers all day. Keep your child in loose-fitting underwear so that she has to decide each time she has an urge to pass a stool whether to use the toilet or to come to you for a diaper. To help her make the right choice, offer major incentives (for example, a trip to a favorite restaurant or toy store) for stools in the toilet. Offer minor incentives (for example, candy) for stools in the diaper. Staying in underwear also gives her an incentive to maintain bladder control and stay dry.
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