Encopresis Experts – My Visit with Dr. Marc Levitt
by Robert W. Collins, PhD, PC
I had the very good fortune to meet with encopresis expert Dr. Marc Levitt on the morning of June 7, 2013. Dr. Levitt is the Director of the Colorectal Center at Cincinnati Children’s Hospital in Ohio. We had breakfast in the Hospital cafeteria where he shared the story of how and why they started up their own Bowel Management Clinic. Such a program would ordinarily be under the auspices of the Pediatric Gastroenterology Department in most institutions. Dr. Levitt’s partner of 21 years has been Dr. Pena, who is the former director and now the founding director of the Colorectal Center. Dr. Pena called attention to the fact that even after surgical corrections 25 percent of children continued soiling despite an excellent anatomic reconstruction. Their surgeries addressed Anorectal malformations, Hirschsprung’s patients, and Spina bifida. The poor results for ending soiling prompted the development of their own intensive week-long outpatient bowel management program described in my first blog post. They also accepted patients with chronic fecal soiling of a functional nature (encopresis or idiopathic constipation). Drs. Levitt and Pena developed a national and international reputation with their success and publications in leading medical journals. Their program has cared for children from all fifty of our United States and 88 countries! The published reports are how I originally became aware of their work. Dr. Levitt and I corresponded which eventually resulted in an invitation for my visit.
The main diagnostic test that is relied on by the Colorectal Center for the most relevant information is a contrast X-Ray using a soluble medium in place of the usual Barium enema. This test is a part of the outpatient program. Dr. Levitt is critical about the extended overuse of Miralax and other stool softeners because they soften the stool too much and do not provide sufficient substance for oral stimulant laxatives (Senna or its products like Ex-Lax) to push the stool mass through the colon. Their alternative is to substitute a soluble fiber in the form of Pectin or Citrucel for Miralax. Their program and instruction with a group of parents is an extremely powerful form of intervention that I have studied in my work with panic attack disorders. The peer support and much sought after goal of freedom from a very debilitating condition is a powerful force for change that might otherwise be resisted on an individual basis.
Dr. Levitt will probably blush here, but I was very impressed by his contacts with children and parents we met in the cafeteria and on his hospital rounds. He is very spontaneous and clearly enjoys the children as he meets them and their parents.
It is our hope that we can arrange for and participate in some interdisciplinary forums. As encopresis experts, we want to begin to influence current standard practices for encopresis that are overly reliant at present on Miralax. The cost of business as usual in this field is too great to ignore. Dr. Levitt discussed the possibilities of inadequately treated encopresis leading to damaged colons in teenagers requiring removal of about 1/3 of the colon and even more damage in adults extending to the whole colon. We hope to change the all too common fall back refrain of, “He/She will grow out of it!”.