Withholding and Encopresis: The What, the Why, and How to Effectively Overcome Them
Once your child finished potty training, you probably breathed a sigh of relief. Now, however, new problems have popped up, like your child refusing to poop or having poop accidents. What’s going on?
If this happens to you and your child, you’re probably frustrated. We get it! In this article, we’ll demystify withholding and encopresis (the medical term for poop accidents). Once you understand what’s happening, you can start working with your child to overcome these issues.
It All Starts With Withholding
We’ve all done it — had the urge to use the bathroom and held it until there was a better time to go. Once kids have been through potty training and have learned how to hold it, they make this decision, too.
There are a lot of reasons kids end up withholding poop. For example, they’re:
● Playing with friends and don’t want to miss out on what’s happening.
● Afraid to poop. If they’ve had a painful poop in the past, they don’t want that to happen again, so they’ll withhold to keep from hurting.
● Scared of the toilet. Maybe they're afraid they’ll fall in (or maybe they’ve fallen in the past and are scared of it happening again). Or, the toilet seat isn’t comfortable.
● Fearful of using the bathroom in places other than home or are afraid someone will walk in on them.
While there are various reasons for withholding poop, once this happens repeatedly, your body learns to withhold it rather than have a bowel movement. Technically, the pelvic floor muscles learn to stay clenched and hold the poop in rather than allowing it to move out of the body.
As the body holds onto the poop, the rectum — where poop is stored until it moves out of the body through the anus — starts to stretch out. Usually, once your child has a bowel movement, their rectum will return to its normal size. However, when their rectum is stretched over and over, it loses the ability to return to its original size. That’s when withholding turns into encopresis.
What Is Encopresis?
The encopresis definition is when stool repeatedly passes into clothing. To our clients, encopresis means:
Leaking stool
Pooping in their underwear
Skid marks in their underwear
Finding poop in their underwear and your child may not be aware it’s there
Usually, encopresis is seen in children four years and older who have completed potty training. However, we’ve had clients in their teens and even in college with encopresis.
Encopresis develops because as your child withholds poop, more and more poop is compacted in the rectum. The poop in the rectum dries out and gets hard, making it difficult and painful to pass. As the body makes fresh poop, it is softer than the old poop that has been sitting in the rectum. This fresh poop seeps around the dried poop held in their rectum. This seepage is what appears in the child’s underwear.
As the rectum adapts to holding more poop, it stretches out. Ever picked up an old bathing suit or clothing with elastic in it, stretched it out, and heard crackling because the elastic has broken down? A similar thing happens with your child’s rectum.
As the rectum stretches repeatedly, it loses its elasticity. Then, the nerves on the rectum stop communicating to your child’s brain that they need to poop.
Photo Credit George D Ferry, Up to Date 2011
Children going through this DO NOT want to poop their pants. It often happens without them being aware it’s happening until they see their underwear. They may not want to talk to you about it because of fear and shame.
Encopresis is not your child’s or your fault. It’s how your child’s body adapts to poop being held in their rectum. Normally, a young child produces about one-half to one cup of poop each day.
Annette has a great video showing what happens when your child holds onto poop. You can also show it to your kids, so they understand what’s happening.
Encopresis Treatments
The good news is that encopresis can be treated, and normal bowel function can return. The earlier it’s addressed, the easier it is to recover from.
We recommend addressing withholding first. Talking with your child can help you learn why they are holding on to their poop. Then, you can work with them to get them to poop regularly. For example:
● If the toilet or toilet seat is uncomfortable, look for ways to make it more comfortable — maybe add a padded toilet seat.
● If they’re having FOMO (fear of missing out), talk with them about how it becomes easier and quicker to go when they go consistently, so they’ll be less likely to miss something.
● If they’ve had painful poops, you can explain that does happen sometimes, but not every time. If your child is constipated, work with them to address their constipation.
If withholding has advanced into encopresis, then professional help is your best bet. We’ve worked with many children and parents on encopresis and have had great outcomes.
We recommend working with a pediatric pelvic floor specialist (like Annette) and a pediatric dietitian who is an expert in helping kids with constipation, encopresis, and enuresis (like Jessica).
With our clients, we start usually start by:
● Addressing any constipation issues
● Learning about your child’s withholding
● Developing a doable plan for you both.
Treating encopresis takes a few months to over a year, depending on how long your child has had it. We know you can do it, and we’re here to help.
Want Help?
The experts at Constipation Gurus have a Constipation Solution Package that can take you from not knowing what to do to help your child to having an actionable plan you’re confident you and your child can do.
You get a 45-minute session with both Jessica, our dietitian, and Annette, our pediatric pelvic floor specialist. In this session, we’ll talk through the issues your child is having and develop a plan to get recovery started.
You also get to choose whether to have one or two 30-minute follow-up sessions where you can check in and get more support for you and your child.
Our Poop Boot Camp is included in the Constipation Solution Package. So, you’ll have additional information on treating your child’s constipation, encopresis, and withholding. As a part of Poop Boot Camp, you’ll become a member of our Facebook group with other parents dealing with the same issues as you and your child. It’s a safe place to talk about what’s going on with others who get it.
Already purchase the Poop Boot Camp? No problem! Send us an email and we’ll credit the cost of the course toward the price of a package.
