Very Early Signs of the Twilight Zone for Holding in Children: To Treat or Not to Treat?

The Twilight Zone in Understanding the Early Onset of Encopresis and “To Treat or Not to Treat”?

I have noted in the last two blog entries that the most common onset of encopresis occurs during toilet training and upon entry to school. Somewhat arbitrarily, encopresis can only be diagnosed at 4 years of age according to diagnostic criteria. However, there are a number of children that begin holding much earlier than for any of these occasions. This can often be associated with hard and overly large stools that are difficult or painful to pass, but not always. Some kids just find bowel elimination to be resisted for whatever reasons which may remain forever in the twilight zone of understanding. The simple behavioral fact is that it happens and is not to be denied because reality is reality.  Now humans, being humans, will start up offering all manner of possible reasons. I do not expect to authoritatively pronounce explanations here.  All I can do is offer some considerations for parents and physicians in addressing this problem.

Some Considerations for To Treat or Not to Treat If You Find Yourself in the Twilight Zone:

  1. Will this lead to an enlarged colon compromising future efforts at toilet training? Yes, it can enlarge the colon. The longer it remains enlarged, the less sensitive and weaker the colon will become. It will sabotage toilet training, especially for poo!
  2. Will this deepen a holding habit and lead to dysnergia? Dysnergia is a condition of confusion in coordinating voiding urge signals and the coordination of the muscles themselves that permit successful elimination. Yes, this is very likely and the longer it exists the more difficult it will be to reverse holding.
  3. Do you intervene with stool softeners to actually promote stool leakage to avoid dysnergia? Yes, it is worth a trial if it is effective until toilet training time. Unfortunately there are children who can successfully hold even liquefied stool. Also, constant leakage can promote rashes and infections which really is to be avoided because more pain will reinforce the holding.
  4. Can suppositories and enemas be employed in very difficult cases on a more routine, even daily basis to avoid the aforesaid complications or produce even newer ones? I think, yes. Many Soiling Solutions parents wish they had intervened more effectively much earlier with the signs of holding.
  5. The physician and parent will have to collaborate on the best path forward, To Treat or Not to Treat?

Readers are invited to offer their own comments: