A Series of Accidents ~ Encopresis

Charlie sat in his room, crying. He didn’t know whether to call for his mother or to try and sort out the accident himself. This was the seventh time it had happened in two weeks. He didn’t want to make his mother angry. He didn’t know why it kept happening and felt extremely guilty, ashamed and frustrated.

Just then, he heard his mother’s footsteps coming up the staircase. He tried to move, but he also didn’t want to make more of a mess. ‘Charlie! What are you doing? Shall we go and play…’ Charlie’s mother’s face dropped as she entered the room and saw Charlie had soiled his clothes again. ‘Oh Charlie dear, not again…’ she sighed. ‘Is everything okay, son? You do know when you need the toilet don’t you?’ she asked.

Charlie hugged his mother and started crying. ‘I don’t know what’s happening mum, I just don’t know!’

‘Oh, my dear, it’s okay. Let’s get you clean, change your clothes and book an appointment with the Doctor. I’m sure he can help us. Don’t worry!’ she answered and smiled, trying to hide the worry in her voice.

Charlie smiled back, and knew everything would be okay. He had the best mum!

At the doctors, Charlie became very anxious and didn’t know how to explain the situation to the doctor. He didn’t want him to pity him, and just hope that he could help and had answers to solve the problem and stop the accident from re-occurring. His name was called out and he was called into the doctor’s room. ‘Hello Charlie. Hello Mrs Taylor. Nice to see you both today. How can I help you?’

Charlie remained silent. His mother looked at him and gave him a hug. ‘Well doctor, young Charlie here has a problem. In the past two weeks, he has soiled his clothes seven times and it’s making him very upset. I was reading online and I know some mothers think it’s the way of their child misbehaving but I know my Charlie. He gets so upset by it, I don’t think he realises when it happens,’ explained Mrs Taylor.

‘Charlie do you mind if I have a quick look at your tummy?’ asked the doctor. Charlie lied down on the bed whilst the doctor pressed down on his stomach. ‘It’s very hard, Charlie, are you in any pain?’ asked the doctor.

‘No,’ Charlie quietly replied.

‘Well, Mrs Taylor, what Charlie has is encopresis. This is the medical term for a toilet-trained child soiling their clothes. I’m glad you’ve come to see me, we can help him. The tummy feels slightly hard which is suggestive of faecal impaction. I’m going to arrange an X-ray to see how much stool is in Charlie’s bowels and to see whether it has caused his bowels to enlarge. According to how much distension we can see, I will prescribe Charlie with some laxatives to get rid of the hard stool that is retained in his bowel’, explained the doctor.

‘Oh, I see,’ responded Mrs Taylor, ‘why does this happen?’

‘Most children in whom this happens are severely constipated. They ignore the urge to go to the toilet and ‘hold on’ to avoid the pain of passing stools. This causes faecal impaction, which is where large, solid stool becomes stuck in their back passage. This stool causes the surrounding muscle to stretch and weaken, which subsequently causes watery stools to leak out from this blockage. It can also be common in children who do not have enough fibre and fluids in their diet’, continued the doctor.

‘Fibre? Is that fruit and vegetable, mummy?’ asked Charlie.

‘Yes, my dear. That is why I tell you to eat your entire broccoli and have an apple a day!’ smiled Mrs Taylor.

‘Yes, Charlie. It is really important for you to eat at least five pieces of fruit and vegetable a day and to also go to the toilet whenever you need to go,’ carried on the doctor.

‘I know,’ blushed Charlie.

‘Mrs Taylor you have been really supportive. At this time, children need the support of their parents to help them feel less anxious. Your encouragement will help Charlie feel less stressed about going to the toilet. You should also try to keep a diary of Charlie’s bowel movements and hopefully incorporating more fibre into his diet will help resolve the issue. Try also for him to drink plenty of water. When the X-ray results return, I will prescribe a laxative for Charlie, which is a sachet of powder that dissolves in water and he just needs to drink this once a day. This will help to get rid of the hard stool, stimulating it to go back to normal. Is that okay, Charlie?’ asked the doctor, smiling.

‘Thank you doctor,’ Charlie replied. He was finally relaxed. He had found the answer to his problem and he felt very fortunate to have such a carrying and supportive mother.

Shrinal Kotecha

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