For Professionals Dealing with Encopresis


Psychologists have adopted the work of a Gastroenterologist, who won the Fourth Nobel Prize for Physiology and Medicine in 1904, much more thoroughly than have medical professionals. Dr. Ivan Pavlov studied the front end of the GI tract for salivation and I’ve focused on the opposite end. Earlier, I performed and published the first significant double-blind, active placebo study of the bedwetting alarm. This eventually led me to focus on the much more culturally and medically distressing condition of encopresis.

Medical professionals came to view the use of suppositories and enemas for encopresis as limited to “clean outs” or for emergency purposes only. This bias was introduced out of the Boston Children’s Hospital by D. Levine in publications from 1976 and 1982 in Pediatrics and Pediatric Clinics of North America. These referred to the use of suppositories and enemas as “anal assault”. Subsequently, two-thirds to three-quarters of general pediatricians no longer conduct digital examinations for their patients with encopresis.  Undoubtedly, this reluctance has been reinforced by our cultural inhibitions surrounding this very private sexual area of our bodies that involves a very offensive body product.  I have heard of strong parental negative reactions to physicians approaching this area of the body by parents and, of course, the child.  Children would also resist shots or eye drops, but this area engenders much stronger reactions. Request an Exam Copy for internal office use only.


The Soiling Solutions® (SS) protocol relies heavily on reconnecting the stimuli associated with voiding (sitting on the toilet stool, interoceptive voiding cues, etc.) to trigger the voiding response mechanism. The holding response is naturally prepotent and buys us time to get to the toilet. However, it can become so dominant that it blocks the voiding response that should take over. Worse, it can lead to dysnergia, a condition that sabotages relaxation and successful complete bowel movements.  Psychological professionals recognize that this can become so automatic and overlearned that it cannot be verbalized or instructed away. The suppository and enema “primers” (UCSs) in the SS® protocol assure successful voiding. Through a programmed conditioning process, the powerful enema primer gives way to the relatively mild inert glycerin suppository, and, finally, to the child’s own weakened internal triggering cues. Pavlov described this transition as a serial fractional anticipatory cue response (transl. from the Russian). This sequence eventually comes under conscious control. The child’s feeling of massive “relief” with voiding and social reinforcement accompanied by parental/child insights are usually sufficient to sustain a coordinated voiding habit.

Parents have found the book, “Sneaky Poo” to be very helpful in externalizing the issue toward the Encopresis monster or “sneaky poo,” rather than one another. The SS Parent Forums, consisting mainly of mothers, provide technical and emotional support that has proven to be very important to successful treatment. Request an Exam Copy for internal office use only.