Encopresis: Difficulty moving bowels (not constipation)

My four-year-old son has encopresis. He has been given mineral oil once a day -- under a doctor's direction -- for a long time. Once in a while, when I finish yet another bottle of oil, I'll wait and few days and see if he'll go on his own or will again begin "holding" his bowel movements. Usually, he'll go back to his old pattern after a time.

His doctor feels it is better to leave him on the mineral oil for a while longer because he believes the first painful bowel movement will land us back where we started. While he's taking the oil, he seems to have no fear of bowel movements and is very matter-of-fact about going to the bathroom.

Is long-term use of mineral oil harmful? And, in your opinion, is this the best form of treatment? I read that doctors' opinions vary on this subject. Also, someone whose child had a similar problem said that it was cured when his family became vegetarians. What's your opinion of this idea? My son is perfectly healthy except for this persistent problem.

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

You're correct when you state that doctors' opinions vary about treatment for encopresis. However, relatively new information has helped make treatment more consistent among physicians, and I will share these insights with you.

Encopresis is defined as repeated involuntary defecation into clothing. To understand the cause of this, it is best to start with how normal defecation takes place. As stool descends through the rectum, the stretch of the anal canal generates a signal to the brain telling us that we need to have a bowel movement. We then, through voluntary release of sphincters (muscles which hold in the stool), allow the passage of stool.

Children with encopresis have difficulty with this release mechanism. This is usually caused by the child either not stooling at all or incompletely stooling thus causing the rectum to become full of stool and stretching the muscles to the point that they are unable to contract enough to expel the stool. In addition, this over-streching of the muscles decreases the sensation the child feels about needing to stool. Thus, to treat encopresis two things must occur:

  1. The bowels must be regulated to allow easy passage of the stool. This may require initial evacuation of the stool by enemas. Then a diet rich in fiber is begun as well as stool softener/laxative or mineral oil is often added. In addition, a structured toileting program with a daily diary is needed to teach the child again the signals the brain receives about the need to stool.
  2. Second, and this is most important, understand and treat the reason for the child having problems with stooling. This means getting counseling for the child and parents in order to coordinate a team approach to the problem. Only too often, the child leaves the doctor's office with the doctor having given a prescription for laxatives and some rudimentary advice about the importance of sitting on the toilet without any follow-up.

I applaud you and your doctor for keeping in close contact about your son's problem. Your persistance and your doctor's guidance will speed the excellent outcome most children with encopresis experience. I agree with your doctor's long term use of mineral oil especially if it seems to be doing the trick. There are no harmful effects that I am aware of with the long-term use of mineral oil. As for the vegetarian diet, the cause of this diet improving the symptoms is the fact that it is high in fiber. You don't need to go to a full fledged vegetarian diet, however, I do encourage you add foods high in fiber both to your own and to your son's diet.

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