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Children's Health

Large bm`s in six year old

08/24/2000

Question:

My six year old son has very large bowel movements, probably 3-4 inches in diameter. So large that they can not be flushed without stopping up the toilet. I am sure this is caused by him holding it in. He has been having bm`s in his pants, which he says are "accidents". He is highly praised when he goes to the toilet, and we let him know our disappointment when he goes in his pants, but this has not helped. We now take away a privilege when he goes in his pants, nothing seems to help. My question is: Is his colon elasticity damaged from this witholding bm`s and will his bm`s always be this large? I have thought about giving him a laxative short term (1 week), so he can not hold them, but will this really make a difference? If his colon is stretched, will it ever regain the elasticity?

Answer:

Large bowel movements are caused by inadequate fiber in the diet and going to the bathroom too infrequently. This problem can frequently lead to loss of bowel control and stooling in the underwear. This is called encopresis. It should be managed by a health care provider who is knowlegeable in its treatment.

Encopresis is a disorder that needs to be addressed on many levels. The child`s stool must be made soft enough to pass without pain, or a large diameter. This is accomplished by increasing the fiber in the diet, but also frequently requires the addition of medication until the bagged out and poorly functioning colon can regain some of its lost tone. You are correct that the colon loses its elasticity. This repair may take a year or more.

Sitting on the toilet after every meal is the second step to helping overcome this problem. Children sometimes need a reward system to encourage this and keep it from becoming a battle. A sticker chart, with a goal prize after a certain number of stickers is a tool many parents find helpful.

The third component to treatment is the family team approach. It is important to NEVER punish a child for soiling, since this leads to other emotional problems, and poor self esteem. It is unlikely that your son has not figured out that stool in his pants is a problem. Now you can give him the tools to address the problem so that it can be fixed. The family should work as a team on this problem, not against each other. Praise with successful toileting is helpful, but he should not be ostracized for his soiling problem. Encopresis may be a result of parents forcing potty training before the child is ready, and so the child holds the stool rather than using the toilet appropriately. I tell parents to never discontinue the pull ups or diapers until the child is regularly stooling in the toilet. It is a mistake many parents later regret, when encopresis develops.

The last component of treatment is rebuilding self esteem if that has been damaged. Children with this disorder are often teased mercilessly at school. Some cities have support groups for children and their families for this disorder. I recommend you speak with your health care provider to find resources if your son`s self esteem has already been affected, he seems angry, withdrawn, doesn`t have close friends, or is not performing up to his potential at school. Good luck with this very difficult and frustrating experience!

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Response by:

Caroline Mueller, MD
Assistant Professor
College of Medicine
University of Cincinnati