| Q.
My
son is six years old and has been potty trained since 3. In
the last several weeks he has had many, many instances of poopy
underwear that he seems to have no control over. Someone mentioned
encopresis to me, and it sounds exactly like what he has.
He is a very picky eater so I suspect that may be the source of
much of his trouble. I’ve
supplemented with mineral oil and tried to cut out most dairy
for the first month. How much mineral oil do you think I
ought to give him, and are there any other things I can do?
A.
Encopresis
is defined as having a bowel movement in an inappropriate place
at an age when bowel movements have been controlled by the child.
This can include pooping in one's underwear by mistake or on purpose.
This can occur when constipation (or voluntary stool withholding)
leads to a hard mass of stool which partially obstructs the lower
intestine and "desensitizes" the child's ability to
stop the leaking of stool around that partial blockage.
It
can also occur as a defiant gesture indicating a larger underlying
emotional issue.
About
one out of a hundred five-year-old boys have this problem.
Mineral
oil is a common treatment because this non-absorbed oil lubricates
the intestines. By decreasing a child's ability to voluntarily
hold stool--sometimes for many days--easier passage of stool may
end the obstruction and the leakage. It might not be the
best long term solution, but it might solve the short term problem.
I
recommend another dairy free month, and/or cascara sagrada mixtures
from the health food stores in half the adult dose each day for
a month.
One
tablespoon of mineral oil twice/day for a week followed by one
tablespoon once/day for six weeks.
Keep
his diet very low in low fiber foods like meat and as high as
possible in grains, pasta, beans, fruits and veggies. He
has a partial obstruction of the lower intestine caused by his
withholding pattern and loose stool runs around it. He has
no control because that part of the intestine is desensitized.
A
child who constantly comes home from school with soiled (poopy)
underwear is frustrated, embarrassed and parents are tempted to
find some sort of punishment. Clearly, nothing could be
worse. Get good counseling to find the root of the problem
and look hard for dietary and emotional advice.
Herbal
laxatives and stool softeners can be used once the heart of the
matter is reached but enemas and suppositories focus on the "wrong
end" of the problem and should be avoided.
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