Views from Above and Below:
A psychologist may diagnose and treat encopresis under their scope of practice. A physician should rule out the presence of physical causes for the presence of fecal soiling in children over age four years. The physician may proceed with treatment typically using top down oral medications on a maintenance basis following a clean out of a colon that is overfilled with feces. Most psychologists may follow a similar course and work on compliance and emotional issues.
The Much Neglected Role of Specifically Training and Connecting the Voiding Response with Toilet Sits:
My approach is quite unique and not understood by many physicians and psychologists because I use a learning theory-based approach based on the special properties of bottom up medications. The reasons are really very simple:
- Oral medications have a delayed effect of 6-10 hours in promoting evacuation at the end of the very long gastroenterological (GI) tract. Bottom medications have a much more pronounced and immediate effect in promoting voiding urges recognition and evacuation by the child.
- This allows a much superior pairing or connection of urges with the bathroom, sitting, and successfully having a bowel movement. This is severely compromised for the oral medications that may promote many more confusing and vague sensations over the course of their action. In fact, it is likely that such confused stimuli and holding tendencies will promote a reinforcement of holding rather than releasing when sitting in the bathroom!
- Biomechanically the use of bottom medications are more likely to adequately empty the colon sufficiently each day that the child is safe form soiling for the next 24 hours and allow it to return to a more normal condition and size. This should enable better urge recognition over time by the child along with the reinforcement of the stimulus-response connection.
- The principles here are based on the work of a Nobel Prize winner (1904), Ivan Pavlov, MD, who studied the conditioning of salivation in dogs at the top of the GI tract. I have basically done the same thing at the bottom of the GI tract.
- Repeated case studies have demonstrated the power of my approach in a subject as his own control design.
- A treatment comparisons study demonstrating the power of Pavlovian conditioning for a related disorder, bedwetting or nocturnal enuresis, was performed and published by myself in my doctoral dissertation at Indiana University’s now renamed Department of Psychological and Brain Sciences. It was later published in a professional journal and widely reported in over 100 citations in other journal articles and book chapters.
The Role of the Brain:
A medical specialty emphasis on a given organ system often leads to a too narrow focus on that lower system. I have attempted to bring attention back to the integration of the GI tract with the highest organ, the brain.