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Functional Constipation/Encopresis

Treatment and Prevention

Functional constipation or encopresis??
Functional constipation frequently causes children to become stool incontinent or to soil or defecate in their clothing. A medical term for stool incontinence is encopresis. However, even though encopresis is just one symptom of functional constipation, many pediatric healthcare providers and parents have come to use this term in place of functional constipation. I prefer to use the term functional constipation.

What is functional constipation??
Functional constipation follows a fairly predictable course. It usually begins with an uncomfortable or painful bowel movement which can occur as early as the first few months of life. Following one or more painful bowel movements, a child begins to withhold stool to avoid pain whenever he or she feels the need to poop.Initially, the decision to withhold is voluntary but as uncomfortable bowel movements continue, withholding becomes what psychologists call a conditioned avoidance response. It is no longer intentional because it happens automatically. In other words, the act of withholding develops into a habit which continues even after bowel movements no longer hurt. Withholding causes stool to be retained in the rectum. Think of the rectum as a round muscle with an empty space in the center, like a small balloon. As the rectum stretches to accommodate increasing amounts of stool, it periodically contracts in an effort to expel the excess stool. These repeated contractions cause the walls of the rectum to get thicker and stronger. As the rectum gets stronger, however, it also becomes less sensitive and less adept at signaling the need to poop. This often leads to stool incontinence. Moreover, once the rectum is stretched, it remains stretched for a long time even after the excess stool has been removed. While the onset of functional constipation can occur quickly, breaking the habit of withholding and giving the rectum sufficient time to shrink back to its normal size can take many months or years.

How do you treat functional constipation/encopresis?
Over the past 35 years I have successfully treated many children with these disorders, beginning in the Encopresis Clinic at Children's Hospital in Seattle and, subsequently, here at ABCD. My approach to treatment incorporates those strategies which clinical practice and research has found to be most effective. There are six steps which must be followed to effectively manage functional constipation: educate the family, empty the rectum, end withholding, shrink the rectum, withdraw laxatives, and remain vigilant. Each of these steps and their implementation is explained in more detail in my book,

The Ins and Outs of Poop: A Guide to Treating Childhood Constipation.

For more information about functional constipation and its treatment go to:

How to prevent functional constipation/encopresis
The key to preventing functional constipation is to know when a child develops occasional constipation. Most of the time pooping is easy but when occasional constipation occurs it stops being easy. If a parent is unaware that their child is constipated or does not manage it properly, occasional constipation can quickly become functional constipation.

It is my hope that my book, Softy the poop: Helping Families Talk About Poop will help prevent severe childhood constipation by educating children and parents and by facilitating healthy parent-child conversations about poop.

Return to Providers: Thomas DuHamel, Ph.D.

155 NE 100th St., Suite 306 Seattle WA 98125 206.361.6884    
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