Toilet Training Resistance - Encopresis without Constipation

Definition

• A child who refuses to be toilet trained. He passes stools into his underwear or pull-up. The medical term for this is encopresis.
• This handout discusses children who have this problem but are not constipated.

Causes

• The most common cause of chronic soiling is resistance to using the toilet. This is called bowel training resistance. Many of these children refuse to even sit on the toilet. They may sit on the toilet only if the parent requires it. But, they don't release the stool until after they get off.
• Bowel training is usually accomplished in 2 to 3 months. Healthy children over 3 who aren't using the toilet after 3 months have toilet training resistance. About 5% of children refuse to be bowel trained.
• The most common cause of toilet training resistance is a strong-willed child. In addition, they have been reminded or lectured too much. Most children have been forced to sit on the toilet against their will. A few have been punished for not cooperating. Many parents make these mistakes. This can be common if you have a child with a difficult temperament.
• Most children under 6 with encopresis are simply engaged in a power struggle with you. More practice, such as you used in toilet training, will not help. Instead, your child now needs to take full responsibility. He will need some incentives to spark his interest.
• Sometimes, encopresis begins all of a sudden in a toilet trained child. When this happens, the cause is usually a new stress. The stress may be a physical illness such as severe diarrhea. It can also be an emotional upset such as going to a new school. These children usually regain bowel control when the stress is reduced or gone.
• If your child starts holding back stools and becomes constipated, medicines will be needed.