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People who would like more information about treatment for children with defecation problems can call the University of Iowa Encopresis Clinic at 319-384-7888.

Release: Jan. 5, 2000

UI pediatric clinic helps children with constipation, soiling

IOWA CITY, Iowa -- It's something that gives many parents cause for concern: a child's problem with constipation or soiling even after toilet training. Acute constipation affects nearly one-third of all children at some time during childhood. A smaller number of youngsters have chronic constipation or constipation accompanied by stool soiling. Rarely are constipation or stool soiling signs of serious underlying disease that may require surgery.

Even when not potentially life-threatening, defecation problems, particularly soiling, can cause both physical and social problems such as low self-esteem for children, said Vera Loening-Baucke, M.D., professor of pediatrics and director of a special University of Iowa Health Care pediatric clinic that offers children and their families help with these sensitive problems.

The UI Encopresis Clinic, established by Loening-Baucke nearly 20 years ago, focuses on treating encopresis -- fecal incontinence in the presence of constipation -- and provides comprehensive treatment for other pediatric constipation and defecation problems.

Loening-Baucke said many parents have trouble determining that children who soil themselves may also be constipated. A hard stool may be stuck in the bowel, and loose stool leaks out around it, she explained. Usually, the constipation has an unknown but not serious cause.

"It's important to recognize that children are not intentionally soiling even though it may appear that way," Loening-Baucke said. "Children simply don't have the control. Successful treatment involves parent-child cooperation to get results."

Parents should be aware that treatments are available, she emphasized, noting how trying it can be for parents to have to clean up a child's messes and how socially trying it can be for an older child to soil.

Decreased physical activity and diets low in fiber are often contributing factors to constipation, Loening-Baucke said. Common first steps for treatment are increasing fiber and fluids, and parents' insisting on toilet sitting. Prescribing laxatives may also be helpful. However, especially for older children, it may take a while to resolve problems.

"Many years of problems can't be solved overnight," Loening-Baucke said. "It takes time to help patients retrain their bowels, sometimes months, sometimes years."

Once more serious conditions are ruled out, Loening-Baucke may recommend a dietary change such as switching to a new type of formula for an infant who is not breastfeeding, or behavioral changes such as having a child routinely spend five minutes on the toilet after a meal in addition to taking laxatives.

Constipated patients fall into three general groups: infants and toddlers who cry or scream during bowel movements; children ages 4 and older who still have toilet-training problems or frequent and/or large messes (once or more a week); and older children and teens who have stool soiling or chronic abdominal pain.

The clinic also sees newborn infants or older children who are suspected of having serious problems such as Hirschsprung disease or birth defects that cause defecation problems. Approximately one in 5,000 children has Hirschsprung disease in which a lack of nerve cells in the bowel makes it tight and spastic and prevents normal defecation. Over time, severe constipation in patients with this condition can lead to an inflamed or perforated bowel, or even death. However, when detected, surgical treatment can help lead to healthy bowel functioning.

Better detection methods, such as anorectal manometry (which measures anal and rectal pressure and decreases in anal pressure during rectal distention) and special radiographs, are making many bowel conditions easier to diagnose and treat in the first weeks or months of infancy, Loening-Baucke said. She recently published a paper on diagnosing delayed stooling in newborns.

A UI faculty member since 1975, Loening-Baucke also trains medical students, residents and nurses on how to help families deal with and receive treatment for their children for soiling and constipation problems. She is known nationally and internationally for her research in childhood constipation and soiling. Loening-Baucke recently spent a year as a Fulbright Senior Scholar at the Charite-Hospital in Berlin, extending her studies into gastrointestinal tract diseases and leading to international cooperation between the UI and the Humboldt University of Berlin.

As with all medical conditions, parents whose children have bowel problems should talk with their pediatrician or family physician.

People who would like more information about treatment for children with defecation problems can also call the UI Encopresis Clinic at 319-384-7888.

University of Iowa Health Care describes the partnership between the UI College of Medicine and the UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide.