Encyclopedia of Diets - A Guide to Health and Nutrition

Medical approaches

Medical treatment of encopresis begins with dis-

impaction, or softening and removal of the mass of

fecal material in the lower colon. Disimpaction may be

accomplished by administering enemas or a series of

enemas; one or a series of suppositories; laxatives

taken by mouth; or a combination of these treatments.

Commonly used enemas include homemade soap-

and-water solutions and commercial saline prepara-

tions. Dulcolax (bisacodyl) and BabyLax are popular

brands of suppositories. Laxatives, which work by

increasing the amount ofwaterin the large intestine

to soften the impacted stool, include citrate of magne-

sia, Fleet Phospho-soda, Colyte, or GoLYTELY.

Other laxatives sometimes used are mineral oil and

senna, a plant native to the tropics that has been

used to treat constipation for over three thousand

years.

Following disimpaction, the child is given main-

tenance medications intended to produce soft stools

once or twice daily to prevent constipation from recur-

ring. They also help the child break the mental and

emotional connection between defecation and pain.

The child may be given glycerine or bisacodyl suppo-

sitories once or twice a day, or mineral oil, senna syrup

(Senokot), milk of magnesia, lactulose, or sorbitol

twice a day by mouth. Maintenance treatment typi-

cally takes several months.

Glucomannan, a complex sugar derived from the

roots of the Japanese konjac plant, is an effectivefiber

supplement for children that appears to be well toler-

ated and has fewer side effects than many laxatives.

Glucomannan is a water-soluble fiber that forms a gel-

like mass in the digestive tract and helps to push fecal

matter through the lower bowel more rapidly.

Psychological treatment

Psychological treatment is part of maintenance

therapy for encopresis because of the emotional stress

the condition causes the child and other family mem-

bers. In many cases the child has become depressed or

developed other behavioral problems as a result of

punishment, teasing, or social rejection related to epi-

sodes of soiling. Psychological treatment begins with

education; the doctor explains to the parents as well as

the child how encopresis develops, what causes it, and

why medications are used to treat it.

If the child’s encopresis is involuntary, behavioral

therapy is often used. This approach employs such

techniques as star charts and daily diaries to teach

the child to recognize the body’s internal cues. Some

doctors also recommend biofeedback for maintenance

therapy in encopresis.

If the child’s episodes of soiling are intentional

rather than involuntary, he or she will usually be

referred to a child psychiatrist for specialized evalua-

tion and treatment.

Function

The function of dietary treatment for encopresis is

as a form of maintenance therapy. The goal is to

prevent stool from building up in the child’s colon,

allow the colon to return to its normal shape and

muscular function, and to help the child have bowel

movements in the toilet at appropriate times.

Benefits

The benefit of dietary treatment for encopresis is

prevention of future episodes of constipation while

providing adequate nutrition for the child. Medica-

tions are used to clear impacted fecal material from

the colon and relieve discomfort associated with

defecation.

Precautions

Parents should follow the doctor’s advice about lax-

atives and enemas during maintenance treatment for

encopresis, as some of these products have side effects

or interact with other medications that the child may be

taking.

Risks

There are no reported adverse effects of dietary

treatment for encopresis.

Enemas and laxatives often produce side effects

including abdominal cramping, intestinal gas, nausea,

and vomiting. The child’s doctor may be able to

change the dosage or type of product for a child on

maintenance treatment. Lactulose should not be given

to patients with diabetes because it contains a form of

sugar, while sorbitol may reduce the effectiveness of

other medications. Mineral oil sometimes causes seep-

age into underwear and itching in the anal area. Senna

and citrate of magnesia may lead to electrolyte imbal-

ance if used in high doses over a long period of time.

Research and general acceptance

Disagreements regarding treatment for encopresis

focus on three subjects: whether enemas are preferable

to laxatives taken by mouth or whether enemas are

emotionally traumatic to the child; whether or not

adding fiber to the child’s diet is useful; and whether

Encopresis