How constipation leads to incontinence
It all starts with one painful trip to the toilet: a crack, a hard stool, an unpleasant experience in someone else's toilet. The child remembers the pain and begins to restrain himself. The feces are retained, water is absorbed from it, the mass becomes even denser, and the next time it is even more painful. Over time, the rectum stretches, its wall ceases to adequately signal filling, and the continence muscles work worse. The liquid part of the contents flows around the tight plug and flows out. The child does not sense this in advance and discovers that the laundry is already soiled.
- Painful bowel movements and fear of the potty
- Consciously holding back stool
- Compaction of stool
- Rectal distension
- Decreased sensitivity to urge
- Leakage of liquid contents past the plug
Other causes and provoking factors
In addition to the constipation mechanism, encopresis without stool retention occurs, which is more often associated with emotional problems, anxiety, stress and sometimes with disruption of habits. Provoking factors include starting to attend kindergarten or school, where the child is embarrassed to use the toilet, the birth of a younger child, moving, conflicts in the family, too early and harsh potty training. Less commonly, there are organic causes behind the symptom: Hirschsprung's disease, spinal cord abnormalities, hypothyroidism, celiac disease. The doctor excludes them based on characteristic signs.
- Embarrassment to use the toilet in the garden or school
- Stress and family changes
- Hard potty training
- Lack of fiber and water, lack of exercise
- Hirschsprung's disease
- Neurological causes and spinal cord abnormalities
- Hypothyroidism and celiac disease
What not to do
The most common mistake is punishment, shame and public discussion of the problem. The child has no control over what is happening, and shame only strengthens control and closes the circle. You should not demand to sit on the potty until the result, threaten and compare with other children. You should also not use enemas on your own for a long time: they do not solve the problem of maintenance therapy and perpetuate fear. There is no need to sharply and for a long time limit food or prescribe adult laxatives to your child without a doctor. It is important to explain to the child in simple words what is happening to his intestines and that it can be treated.
- Don't punish or shame
- Do not discuss the problem in front of strangers
- Do not force sit on the potty until the result is achieved
- Do not use enemas on your own for a long time
- Do not give adult laxatives unless prescribed
- Explain the mechanism to your child in simple words
Survey
Most often, an inspection and a detailed conversation are sufficient. The doctor finds out how long the problem has been present, what is the frequency and consistency of stool, whether there have been painful episodes and cracks, how the child eats and drinks, what is the situation in the family and school. During the examination, the abdomen is assessed, where dense stool is often palpated, and the anus area is examined. Among the tests, a coprogram and a general blood test are prescribed; if underlying diseases are suspected, a study of the thyroid gland and celiac disease are prescribed. Instrumental studies are needed only for alarming signs.
- Detailed history collection and stool diary
- Examination of the abdomen and perianal area
- Coprogram
- General blood test
- Screening for celiac disease and hypothyroidism when indicated
- Ultrasound and special examinations of the intestines only in case of alarming signs
Treatment
The treatment is carried out in three stages and takes months, not days. The first stage is cleansing the intestines of accumulated masses according to a scheme selected by the doctor. The second is maintenance therapy with mild laxatives for a long time, so that the stool remains soft and the child stops being afraid. The third is the formation of a habit: regularly sitting on the toilet for 5-10 minutes after eating, comfortable support for your feet, a calm environment without a phone or rush. At the same time, the diet is adjusted: fiber, vegetables, fruits, sufficient drinking and movement. If anxiety is expressed, a psychologist is involved.
- Colon cleansing according to the prescribed scheme
- Long-term maintenance therapy with laxatives
- Regular sitting down after meals with foot support
- Adequate amounts of fiber and water
- Physical activity
- Reward for regularity, not results
- Working with a psychologist for anxiety and fear of the toilet