Encopresis – what causes it?

It’s a condition in which children refuse to sit on the toilet to poop. Among others, a child may insist on pooping only in her diaper or clothes,  in various locations and positions, there can be partial or full soiling, and constipation that persists for some days.  

The model that Dr. Kushnir developed contends that the problem’s origin is powerful anxiety or a strongly-rooted habit. They take control of the child and prevent him from pooping in the toilet.



Encopresis Treatment Principles

Dr. Kushnir and his team have developed a series of innovative treatments, adapted to each specific problem. They are all behavioral treatments, aimed at providing a corrective experience and eradicating the paralyzing anxiety.

After hearing the details of the problem, we assemble a behavioral action-plan for the child and her family. Back at home, the parents put the plan into practice. In the vast majority of cases, a single meeting with the parents does the trick. Sometimes a more intensive plan is needed, with the parents being trained in detail, at the clinic. It’s followed by daily phone-training for several weeks.


Pooping only in a diaper

When this happens, the children usually no longer wear diapers in the daytime. They use the toilet completely independently but only to urinate. At night, some of them are dry, others are not. They don’t soil their clothes at all. When they need to poop, they ask for a diaper and that’s what they use. These kids are very anxious about sitting on the toilet, and use the diaper as a substitute toilet-bowl. Some of them are willing to sit on the toilet – they try to poop but can’t do it – while others refuse point-blank to go anywhere near the toilet. Usually they have two full poops each day.

With kids like these, we aim our treatment at ending their anxiety about pooping in the toilet. It’s based on a desensitizing behavioral approach…the child moderately and gradually stops depending on diapers. In these cases, it’s vital to encourage the child to keep using the diaper for pooping, because suddenly withholding diapers could lead to (missing??)


Full bowel movements in clothes

These cases are like pooping in a diaper, but with one difference – kids have a bowel movement in their clothes. Usually they have one or two full poops every day. Some do this only at home, others do it in nursery-school, public places, and other homes. And some ask to change their clothes immediately – while others don’t. There are children who agree to a change of clothes, while others refuse and even deny there’s poop in their clothes.


Partial, small, and frequent poops along the day

These cases resemble the other ones, but here many kids want to change their clothes as soon as they’ve pooped. Others are unconcerned by carrying on with soiled clothes. When people point out they should clean up and change their clothes, the kids deny everything. They refuse to continue the bowel movement on the toilet, and refuse to change their clothes. Tests and x-rays usually reveal that the child has been constipated for some time, causing great discomfort and affecting function. Another sign is a constantly swollen tummy.


Constipation lasting several days

Here, children do their best to totally avoid bowel movements. Because they hold it in, the constipation worsens and over time they do everything possible to retain keep the poo inside. It gets so uncomfortable that they may have to lie down without moving. Their discomfort ends some days later with a large, hard, and very painful bowel movement. Parents often need to seek emergency medical help.

Beating Sneaky Poo is a two-part article, first published in Australia in 1985, with a second edition following in 1988. Its first part is aimed at broadening parents’ knowledge on the subject, and the second tells the Snbeating-sneaky-pooeaky Poo story, that parents read to a child suffering constipation and fecal soiling. We suggest parents use it as a helpful tool in coping with this worrying problem. Sometimes just telling the story can resolve the problem. It’s well worth trying to apply the treatment method that the article proposes.