Encopresis- Kristen Barry

Kristen Barry
TE 803 Section 9

Special Education Fact Sheet Assignment
Encopresis


Special need Special Need: Encopresis
Characteristics • Defined as: “The soiling of underwear with stool by children who are past the age of toilet training,” (Borowitz, Vargas, 2005).
• Symptoms
o Constipation
• Child develops constipation when bowel movements are painful, and they therefore withhold stool
o Painful bowel movements causing the child to retain stool
o Children with encopresis often do not have an urge to pass a bowel movement, and are unaware when they have a bowel movement
o Stretched out colon causing the passage of large bowel movements
o Soiling often occurs during the day, while child is awake and active
o May develop incoordination of muscles used to pass bowel movements, and sphincter may contract rather than relax during bowel movements
o Embarrassment, shame
o Low self-esteem
• Who is commonly affected
o Considered a medical condition if child is past the age of 4-years-old
o Effects 1-2% of children in the United States
o 80% of children in the United States affected are male
• Treatments
o Keep a complete record of child’s medication use and bowel movements
o Medications given will commonly serve to:
• Empty the colon of stool
• Establish regular soft and painless bowel movements
• Maintain regular bowel habits
o Common Medical Treatments
• Enema: Fluid (usually water) pushed into the rectum that creates pressure, and causes the colon to evacuate of stool
• Suppository: One or a series of capsules or tablets inserted into the rectum that causes it to contract and release stool
• Laxatives: When administered, greatly increases the amount of water in the large intestines, causing stool in the lower intestines to soften and dispel
o Working with the child to establish regular bowel movements by:
• Setting regular bathroom times
• Positive reinforcement when developing appropriate bathroom behaviors
• Teaching children about appropriate use of muscles and physical responses during a bowel movement
o Using natural laxatives like fruit juices and prunes to stimulate regular, painless bowel movements
Misconceptions • Misconceptions
o The child is doing the stool inappropriately on purpose, and is acting out
o The child’s parents are lazy and “did not try hard enough” to toilet train their child
o The child willingly chooses not to use a toilet, and is lazy
o Giving students a laxative will make them dependent on it to have a bowel movement
o Laxatives will lose their effectiveness over time

These misconceptions could negatively affect the teaching and learning of children with encopresis. If a teacher or caregiver believes and communicates to the child that they are lazy, or soiling their undergarments on purpose, this could result in shame and diminished self-esteem. This consequently will translate to decreased confidence in schoolwork, and lack of trust in teachers. Therefore, the student will become withdrawn in school, and may suffer academically. It is important for teachers and caregivers to be supportive and encouraging to children with encopresis in order stimulate strong self confidence, which will promote the child to be more successful in school.

If caregivers believe that their child will become dependent on laxatives, or laxatives will lose effectiveness, they may refrain from providing their child with a kind of laxative or treatment to soften stool. If such treatments are not implemented, it will be more difficult for a child with encopresis to have painless, and regular bowel movements. Therefore, the cycle of encopresis will most likely continue. This will hinder the student’s learning in school because they will distracted by teasing from peers, discomfort from having stool in their underpants, and low self-esteem effecting academic performance in school.
Resources • Borowitz, Stephen & Vargas, Jorge. (September 2005). “Encopresis.” Emedicinehealth. Retrieved 9 March 2012. http://www.emedicinehealth.com/encopresis/page15_em.htm
• Kaneshiro, Neil. (2012). “Encopresis.” A.D.A.M. Medical Encyclopedia. Retrieved 9 March 2012. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002537/
• Owens-Stively, Judith. (1987). “Self-Esteem and Compliance in Encopretic Children.” Child Psychiatry and Human Development. Retrieved 9 March 2012. http://www.springerlink.com/content/v451wt6236705672/
• International Foundation for Functional Gastrointestinal Disorders http://www.iffgd.org/
Curricular Modification(s) In my classroom, there is a student with encopresis. My mentor teacher and I created a bathroom schedule for this child. The schedule had the student go to the bathroom every hour, and immediately after eating breakfast and lunch. Every time he used the bathroom, either she or I would go into the bathroom when he was done to see what kind of a movement he had in the bathroom. We would document the time and kind of bathroom use. If the student had a bowel movement, we would reward him with a small piece of candy.

There was not a huge modification in the daily routine at school. We simply had to allow time for this child to go to the bathroom every hour, check what he did in the bathroom and document. One of the most powerful things we did was outside of the school day routine. My mentor teacher and I worked closely with this student’s mother and a nurse associated with Detroit Public Schools. We had to do our best to keep track of the student’s bathroom schedule at home, and ensure his mother was on board. Unfortunately, she did not consistently give him his medication or track his bathroom schedule. Most of the toilet training was done at school. The nurse had instructed the mother on what she could do at home, and to take the student out of diapers.

Another situation we had to prepare for was if the student had an accident. His mother was supposed to send in extra underwear but she never did. My mentor teacher went to the store and bought him some underwear to have at school. The student only had an accident twice and now consistently goes to the bathroom in the toilet.
Accommodations The most effective accommodation was to have a set bathroom schedule for the student so he or she knows when to go to the bathroom, and also to help establish a regular bathroom schedule. By having the student on a regular schedule, the child will start to recognize the physical sensations and cues that indicate he or she needs to use the bathroom. It provides the child with a greater probability of successfully using the toilet, which in turn increases self-esteem and confidence.

Additionally, a signal can be used to indicate to the teacher when the child needs to use the bathroom. In my classroom, the student with encopresis uses the sign language signal that means bathroom. This way, he can discreetly give me the signal, and I can silently nod telling him to use the restroom.