From the Research
Bowel Retraining Plan
The bowel retraining plan after treatment of encopresis secondary to severe constipation in a child involves a combination of medical and behavioral approaches.
- The plan includes the use of laxatives to prevent retention, as well as a behavioral approach aimed at retraining the bowel 1.
- A simple behavioral approach can be adopted, which involves gaining the child's confidence, cooperation, and understanding, and involving both the family and school 1.
- The use of a negative reinforcement procedure, which involves having the child sit on the toilet three times a day for increasing time periods if no bowel movement occurs, has been shown to suppress soiling and lead to regular unprompted daily bowel movements 2.
- Enhanced toilet training (ETT) has been found to be somewhat more effective in treating childhood encopresis than either intensive medical therapy or anal sphincter biofeedback therapy 3.
- ETT involves a behavior management program that includes techniques such as scheduled toileting, positive reinforcement, and bowel movement tracking 3.
Key Components
The key components of a bowel retraining plan for encopresis include:
- Medical therapy to manage constipation and prevent retention 1, 3
- Behavioral therapy to retrain the bowel and improve toileting habits 1, 2, 3
- Increased fiber intake to promote regular bowel movements 4
- Laxatives and lubricants to help manage constipation and prevent soiling 1, 4
- Family and school involvement to support the child's treatment plan 1
Treatment Outcomes
Studies have shown that a combination of medical and behavioral therapies can be effective in treating encopresis, with significant improvements in bowel movement frequency, fecal soiling, and nutritional status 3, 4.
- One study found that 75% of children were able to remain free of soiling, and the remaining 25% had soiling episodes reduced to a frequency of less than once a week 4.
- Another study found that ETT resulted in statistically significant decreases in the daily frequency of soiling for the greatest number of children 3.