She's a Pooper.

My 8yr old daughter has been wetting or pooping in her pants and hiding them from us. It used to be occasionally, now it is multiple times during the week. When asked why, she says she is only allowed to go to the bathroom at school during certain times. She also has other behaviors, which are very concerning. This evening she peed in a small cup instead of going to the bathroom (located right outside her bedroom) because she did not want to disturb me. We have tried taking privileges away and spankings, but it has not fixed the problem. I am at my hits end and would appreciate any suggestions you might have.

Thank you ~T.


Hi T.,

Your daughter has what is called an elimination disorder. Elimination disorders occur in children who have problems going to the bathroom -- both defecating and urinating. Although it is not uncommon for young children to have occasional "accidents," there may be a problem if this behavior occurs repeatedly for longer than 3 months, particularly in children older than 5 years.

There are two types of elimination disorders, encopresis and enuresis. Encopresis is the repeated passing of feces into places other than the toilet, such as in underwear or on the floor. This behavior may or may not be done on purpose. Enuresis is the repeated passing of urine in places other than the toilet. Enuresis that occurs at night, or bed-wetting, is the most common type of elimination disorder. As with encopresis, this behavior may or may not be done on purpose.

In addition to the behavior of releasing waste in improper places, a child with encopresis may have other symptoms, including loss of appetite, abdominal pain, loose stools, scratching or rubbing the anal area due to irritation from watery stools, decreased interest in physical activity, withdrawal from friends and family, and secretive behavior associated with bowel movements.

A child with encopresis is at risk for emotional and social problems related to the condition. They may develop self-esteem problems, become depressed, do poorly in school and refuse to socialize with other children, including not wanting to go to parties or to attend events requiring them to stay overnight. Teasing by friends and scolding by family members can add to the child's self-esteem problems and contribute to the child's social isolation. If the child does not develop good bowel habits, he or she may suffer from chronic constipation.

Encopresis is fairly common, even though many cases are not reported due to the child's and/or the parents' embarrassment. It is estimated that anywhere from 1.5% to 10% of children have encopresis. It is more common in boys than in girls.

Encopresis tends to get better as the child gets older, although the problem can come and go for years. The best results occur when all educational, behavioral and emotional issues are addressed. A child may still have an occasional accident until he or she regains muscle tone and control over his or her bowel movements.

If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. The doctor may use certain tests -- such as X-rays -- to rule out other possible causes for the constipation, such as a disorder of the intestines. If no physical disorder is found, the doctor will base his or her diagnosis on the child's symptoms and current bowel habits.

The most common cause of encopresis is chronic constipation, the inability to release stools from the bowel. This may occur for several reasons, including stress, not drinking enough water and pain caused by a sore in or near the anus.

When a child is constipated, a large mass of feces develops, which stretches the rectum. This stretching dulls the nerve endings in the rectum, and the child may not feel the need to go to the bathroom or know that waste is coming out. The mass of feces also can become impacted -- too large or too hard to pass without pain. Eventually, the muscles that keep stool in the rectum can no longer hold it back. Although the large, hard mass of feces cannot pass, loose or liquid stool may leak around the impacted mass and onto the child's clothing.

Factors that may contribute to constipation include a diet low in fiber, lack of exercise, fear or reluctance to use unfamiliar bathrooms (e.g., public restrooms), not taking the time to use the bathroom, changes in bathroom routines (e.g., scheduled bathroom breaks at school).

Another possible cause of encopresis is a physical problem related to the intestine's ability to move stool. The child also may develop encopresis because of fear or frustration related to toilet training. Stressful events in the child's life, such as a family illness or the arrival of a new sibling, may contribute to the disorder. In some cases, the child simply refuses to use the toilet.

Although it may not be possible to prevent encopresis, getting treatment as soon as symptoms appear may help reduce the frustration and distress, as well as the potential complications related to the disorder. In addition, being positive and patient with a child during toilet training may help prevent any fear or negative feelings about using the toilet.

Treatment often begins by clearing any feces that has become impacted in the colon, also called the large intestine. The next step is to try to keep the child's bowel movements soft and easy to pass. In most cases, this can be accomplished by changing the child's diet, using scheduled trips to the bathroom and encouraging or rewarding positive changes in the child's bathroom habits. In more severe cases, the doctor may recommend using stool softeners or laxatives to help reduce constipation. Psychotherapy (a type of counseling) may be used to help the child cope with the shame, guilt or loss of self-esteem associated with the disorder.


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