Editing Encopresis (section)

==Treatment==
Many [[pediatricians]]{{weasel-inline |date=March 2025}} will recommend the following three-pronged approach to the treatment of encopresis associated with constipation:
# Cleaning out
# Using stool-softening agents
# Scheduled sitting times, typically after meals

The initial clean-out is achieved with enemas, laxatives, or both. The predominant approach today is the use of oral stool softeners like [[Movicol]], [[Miralax]], [[lactulose]], [[mineral oil]], etc. Following that, enemas and laxatives are used daily to keep the stools soft and allow the stretched bowel to return to its normal size.

The child must be taught to use the toilet regularly to retrain his/her body.{{citation needed |date=March 2025}} It is usually recommended{{weasel-inline |date=March 2025}} that a child be required to sit on the toilet at a regular time each day and "try to go" for 10–15 minutes (timed toileting), usually soon (or immediately) after eating. Children are more likely to be able to expel a bowel movement right after eating (due to the [[gastrocolic reflex]]). It is thought that creating a regular schedule of bathroom time will allow the child to achieve a proper elimination pattern. Repeated voiding success on the toilet itself helps it become a releasor stimulus for successful bowel movements.

Alternatively, when this method fails for six months or longer, a more aggressive approach may be undertaken using [[suppository|suppositories]] and enemas in a carefully programmed way to overcome the reflexive holding response and to allow the proper voiding reflex to take over. Failure to establish a normal bowel habit can result in [[Megacolon|permanent stretching of the colon]]. Certainly, allowing this problem to continue for years with constant assurances that the child "will grow out of it" should be avoided.

Dietary changes are an important management element. Recommended changes to the diet in the case of constipation-caused encopresis include:{{citation needed |date=March 2025}}
# Reduction in the intake of constipating foods such as dairy, peanuts, cooked carrots, and bananas
# Increase in high-fiber foods such as bran, whole wheat products, fruits, and vegetables
# Higher intake of water and liquids, such as juices, although an increased risk of tooth decay has been attributed to excess intake of sweetened juices
# Limit drinks with caffeine, including cola drinks and tea
# Provide well-balanced meals and snacks, and limit fast foods/junk foods that are high in fats and sugars
# Limit whole milk to {{convert|500|mL|USfloz|0|abbr=on}} a day for the child over two years of age, but do not eliminate milk because children need calcium for bone growth and strength.{{citation needed|date=April 2018}}<!-- 500 mL per day seems like a lot of milk. Isn't that more milk than what is consumed by most children? This item is also redundant with the first item, which includes reduction in dairy intake. -->

The standard behavioral treatment for functional encopresis, which has been shown to be highly effective, is a motivational system such as a [[contingency management]] system.<ref name="Patrick C">Patrick C. Friman, Kristi L. Hofstadter and Kevin M. Jones (2006): [https://psycnet.apa.org/record/2014-52016-005 A Biobehavioral Approach to the Treatment of Functional Encopresis in Children.] ''Journal of Early and Intensive Behavior Intervention (JEIBI) 3 (3)'',  page 263–272. {{doi|10.1037/h0100340}}</ref> In addition to this basic component, seven or eight other behavioral treatment components can be added to increase effectiveness.<ref name="Patrick C" />