Usually, encopresis or psychological poop disorder happens in childhood, and it entails fecal incontinence. As a result, the child passes their stools in inappropriate places or soil themselves, creating stress for them and those around them.
Encopresis affects more males than females, and PsychCentral reports it’s seen in 4% of children aged 4 and 1.6% of those aged 10, showing that the condition can persist for years in some children.
Unfortunately, the condition can affect a child’s mental health because they may feel ashamed, resulting in them avoiding school, physical and social activities. As a result, these children have low self-esteem or even are subject to bullying, especially when they do not realize they’re about to soil themselves until it happens.
Causes of Psychological Poop Disorder
The symptoms of encopresis include:
- The child passes a stool anywhere else but never in a toilet.
- The soiling happens at least once a month and continues for at least three months.
- The child has already turned four or is at an equivalent level of development.
- Any medication does not cause the symptoms.
There are several causes for psychological poop disorder. Often, it is caused by painful bowel movements resulting from chronic constipation, leading to a child delaying going to the bathroom. The child tries to hold their bowel movement when they have the urge to go to the bathroom, and the desire goes away temporarily. These delays cause the stools to accrue and harden, making it even more difficult to go to the bathroom.
Some cases of psychological poop disorder are caused by overflow incontinence, causing leakage. With constipation and overflow incontinence, encopresis happens mainly during the day, and there is evidence of the underlying condition.
Sometimes the child may experience overflow incontinence, causing them to feel ashamed or embarrassed. This is when a liquid or softer stool passes through without the child noticing.
However, psychological poop disorder may also be deliberate where there is no constipation or overflow incontinence. In these cases, the soiling is sporadic, feces are often left in prominent places, and the behavior may coincide with conduct or defiant disorder. Common causes include stress, potty training difficulty, and fear of passing a stool.
Stress and Depression in Encopresis
Constipation, which leads to the non-intentional passage of feces, may often be caused by anxiety or other forms of psychopathology. However, physiological causes related to defecation or dehydration can also cause the condition.
In cases where the passing of feces is intentional, children may present features of another disorder. These often include oppositional defiant disorder or conduct disorder, characterized more generally by socially unacceptable behavior.
According to the DSM-5 (a diagnostic tool), painful elimination and some medications (including anticonvulsants or cough suppressants) may contribute to a child developing encopresis. In addition, psychological poop disorder is also more likely in inadequate toilet training and stress-related cases.
How can stress cause encopresis?
Scientists have discovered that the body has a second brain in the gut, which influences our behavior and mood. They have named this “backup brain” the enteric nervous system (ENS) since it processes our emotions and appears to contribute to the physical well-being of the gut and digestive system, including encopresis.
Is there a link between encopresis and depression?
According to Fredric Neuman, M.D., in this article on depression in Psychology Today, depression manifests itself differently in children and teens than in adults. They often have regressive behavior since they cannot express their feelings and why they don’t want to go to school or elsewhere.
Therefore, encopresis can be a contributing factor or a symptom of depression in these age groups. Parents must watch their children for any signs of age and developmentally inappropriate behavior, especially sudden changes in bowel habits, constipation, soiling, or bed wetting.
Treatment Options for Psychological Poop Disorder
Depending on the type of encopresis, there are treatment options.
Treating Encopresis Caused by Constipation
Before deciding on any of the treatment options for encopresis, getting a physical examination is crucial to make the correct diagnosis. The doctor might even need to remove a severely impacted stool. After that, a combined medical and behavioral therapy treatment often results in the most successful treatment option.
A physician or pediatric gastroenterologist will treat the symptoms of constipation with measures like enemas, laxatives, stool softeners, and other techniques. In addition, they encourage the parent to place the child on a high-fiber diet and to include plenty of liquids and physical activity.
Parents must reduce the child’s intake of foods that cause constipation, like dairy and bananas. In addition, doctors encourage parents to maintain the program of laxative use and the scheduled toilet times for at least a few months.
At the same time, the child also sees a medical health professional to help them cope with their condition’s adverse psychological effects, including feeling ashamed and embarrassed.
Behavioral and Physical Therapy
If the child deliberately soils themselves, displaying the feces in a prominent place, then a trained therapist must see if the condition is related to another mental health issue.
Behavioral treatment therapy can help encourage healthy bowel movements. The child is encouraged to defecate on the toilet with a reward system to promote appropriate behavior. Parents are encouraged to create a program for when the child will empty their bowels—for example, sitting on the toilet when they’re more likely to move their bowels, usually after a meal.
Keeping a log helps parents to find a routine that fits their child best. Therapists warn parents that they should never punish a child if they soil themselves because it can undo their work and worsen the problem.
During behavioral therapy, the therapist emphasizes that the condition is not the child’s fault. Behavioral therapy may also include educating the child and their family on the cause of constipation and typical defecation behavior.
Sometimes physical therapy is used to help the child improve their pelvic muscle awareness and better control their bowel movements. During physical therapy, a child will learn about the best pasture to help make stool movements easier, breathing exercises, isolating the pelvic floor, toilet relaxation exercises, and body awareness.
In rare cases, medication or behavioral interventions may not help children with psychological poop disorder, requiring surgery.
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