Encopresis is the repeated passage of feces into inappropriate place, eg clothing or floor, whether involuntary or intentional. In Western cultures bowel control is established by most children by their fourth birthday. Physical problems are often present and need to be treated.
In this article I will restrict the discussion to children without physical problems and in whom it can be assumed that the origin of the encopresis is emotional problems.
If a child has never obtained bowel control it indicates a fixation in development – in other words the child’s development is not proceeding normally. Emotional factors are interfering with the child’s normal emotional development (in other word the child is acting in a way typical of younger children). If the child did obtain bowel control, but lost it later it points to regression – meaning that the child has reverted to earlier/younger ways of functioning. Regression in children is normally a reaction to stress. External stress can be caused by separated from his mother or when a new baby is born or if there is an onset of conflict within the family. Internal stress can also lead to regression. In children with internal stress the cause might not be that clear and careful thought has to be given to the child’s emotional development thus far and factors that can be influencing the child.
In young children there is a close link between body and mind. Therefore children often show physical reactions when they experience emotional stress. In children of 4 years and older encopresis is often a sign of emotional problems. Children need to find ways to express their feelings without bodily symptoms. If, for instance, a mother cannot tolerate her child expressing anger verbally or behaviorally (eg tantrums) the child may revert to soiling as a way of expressing anger. Some parents struggle to bear their children’s emotions of sadness and/or anger because it causes the parent too much pain. These children can express their feelings through deliberate soiling.
Toddlers often experience conflict between a wish to please their mothers and gain the mother’s love and approval or demonstrating their independence. Children can experience conflict between a wish to please the mother and a wish to do what is pleasurable to the child (eg passage of feces where the child want to and not where the parent wants the child to pass the feces). The young child can experience feces as a gift to the mother or as a weapon against her depending on his feelings towards her. At times children soil or retain feces in an active effort to get the mother’s attention and to indicate to her that he/she is still helpless and needs the mother’s care. When parents are overly indulgent they may negatively influence the development of the child’s ego and toilet training. Children do need some structure and encouragement to adhere to societal norms.
Between the ages of about 12 months and three years children find pleasure in bowel movements. When children feel deprived of love and affection the pleasure found in soiling or retention can be used in a self-soothing way to find comfort in the absence of receiving enough love and comfort from parents.
If your child has this symptom the first step is to make sure that there is no physical problem. In the absence of physical problems the above mentioned possible emotional factors need to be considered.
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