Encopresis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
There is a 3-pronged approach to the treatment of encopresis associated with constipation:
- Cleaning out
- Using stool softening agents
- Scheduled sitting times, typically after meals
The initial clean-out is achieved with enemas, laxatives, or both. Following that, enemas and laxatives are used daily to keep the stools soft and allow the stretched bowel to return to its normal size.
Next, the child must be taught to use the toilet regularly to retrain his/her body. It is recommended that a child be required to sit on the toilet at a regular time each day and 'try' to go for 10-15 minutes, usually soon (or immediately) after eating. Children are more likely to be able to expel a bowel movement right after eating. It is thought that creating a regular schedule of bathroom time will allow the child to achieve a proper elimination pattern.
Dietary changes are an important management element. Recommended changes to the diet in the case of constipation-caused encopresis include:
- Reduction in the intake of constipating foods such as dairy, peanuts, cooked carrots, and bananas;
- Increase in high-fibre foods such as bran, whole wheat products, and fruits and vegetables; and
- Higher intake of liquids, such as juices, although an increased risk of diabetes and/or tooth decay has been attributed to excess intake of sweetened juices.
Unless there are immediate, satisfactory results from the above, some practitioners recommend keeping the child on a program of daily laxative use with a laxative recently made available to the public as a generic medicine. Use of laxatives, however, often results in unexpected and/or uncontrollable bowel movements for the child, wherein the child cannot "avoid" soiling. Other practitioners recommend that the child be kept on a regular program of simple, water-based enemas, which can be scheduled for appropriate times when the child is comfortably at home or in other private quarters. One benefit of the enema therapy is that it keeps the child from any attempts at "parent control" by preventing the child from withholding stool. An enema usually results in a fairly timely expulsion at a time and place more convenient to family members.
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