Most children achieve bowel control and are potty trained by age three. Most children have no more trouble, beyond occasional accidents or diarrhea, after that. Some children will begin to poop in their pants again, and the problem can get out of control. Yelling, shaming, pleading and restrictions don't work. The child says he didn't feel it come out and seems unaware of the mess and the smell. The medical term for such soiling is encopresis. It commonly affects children four to twelve years old.
Medical Management of Encopresis
Your child's pediatrician can offer opinions ranging from rare neurological disorders to sexual abuse, and of course these should be ruled out. Doctors believe most cases of encopresis are due to the child withholding stool; either as a result of issues around toilet-training or because a stool was once painful to pass and they fear a repeat of that experience. However, doctors admit that no amount of reasoning seems to correct the problem. Another type of child with encopresis may be categorized as too impatient to sit on the toilet long enough to have normal bowel movements. They are too eager to play and simply don't have time to poop. Soiling is thought to be the result of severe constipation; liquid stools leak out and soft stools escape. An enema and laxatives are recommended to clear constipation and then a regimen of regular visits to the toilet with rewards for successes is implemented. Doctors warn it may take a long time of consistent scheduling, along with the patience to ignore slip ups, to resolve encopresis.
Dietary Management of Encopresis
Sue Dengate, author of Fed Up and The Failsafe Cookbook, coined the term "sneaky poos" to describe encopresis in children due to an overload of dietary chemicals. If the child is constipated and irritable, the likely cause is amines, chemicals found naturally in meat, milk, bananas, avocados, grapes, plums, cheese, and chocolate.
But the chemical most responsible for sneaky poos is salicylate. Aspirin and ibuprofen, food colors, flavor enhancers, preservatives and artificial antioxidants contain salicylates. So do fruits that are picked early and shipped long distances, or are sold out of season. Concentrated salicylate foods include ketchup, pizza sauce, and fruit juices. Amines and salicylates build up over time until overload occurs. It is difficult or impossible to avoid them in any form, but feeding children a low chemical diet should result in noticeable improvement.
Some children also react to dietary milk proteins (casein) and gluten (wheat, barley and rye). A gluten-free/casein-free (GF/CF) diet will remedy encopresis for this population. Behavior problems often also "magically" disappear when children are fed low chemical and/or GF/CF diets.
Parents benefit from understanding that the child is not able to control sneaky poos; compassion, not punishment, is the only reasonable approach to this problem. Both medical and dietary methods require consistency and dedication. Over time, the medical method results in less soiling but a dietary approach is more likely to treat the cause of the problem.
References:
Warren P. Silberstein, M.D., Fecal Soiling, 1997 http://www.mindspring.com/~drwarren/encopres.htm
Sue Dengate, Fed Up, Random House Australia, 2008
Food Intolerance Network, http://www.fedupwithfoodadditives.info/
Mary Earhart - Mary Earhart, RN, BSN, is a Licensed Midwife. She has written articles for professional journals and grants for non-profit agencies as ...
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