Your baby’s bowel movements, what's normal and what is not

Is your child already potty-trained but still soils himself and is mostly constipated, has a hard stool and avoids using the toilet or goes for long periods without bowel movements?

Well, your child could be suffering from encopresis. Also called functional faecal incontinence or soiling, it is the repeated involuntary passing of stool when not on the toilet. Typically, it happens when compacted stool collects and fills up in the colon and rectum, causing leaking of liquid stool around the retained stool hence staining underwear and might be mistaken for diarrhoea.

Encopresis mostly affects up to four percent of children aged four, and it is more prevalent in boys. Its frequency decreases with older age. It is perhaps due to its low prevalence that there is little awareness about the disease. Most often it is mistaken for just constipation.

Your child’s age matters when considering the causes of constipation. In infants and toddlers, we think more of an organic cause as opposed to a functional cause. While it could be caused by emotional issues, constipation is the most common cause.

Changes in the child's life, such as diet, starting school, the divorce or separation of parents or the birth of a sibling can cause emotional stressors in your child and trigger encopresis.

Certain risk factors including using medications that may cause constipation such as cough suppressants, attention-deficit hyperactivity disorder, autism spectrum disorder, anxiety or depression may also cause encopresis.

Encopresis could also be a symptom of an underlying medical condition such as colonic inertia, where the child's colon doesn’t move stool as it should, missing nerve endings in the bowel or tear in the rectum.

Treatment of encopresis is unique to each child. It could include removal of any stool ball, taking stool softeners, laxatives or enemas to ensure regular, soft stools. Scheduled toilet sitting and eating a diet high in fibre and drinking plenty of water are other ways to manage encopresis.

Dr Ng’ang’a is a consultant paediatric gastroenterologist at Aga Khan University Hospital

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