Is passing stool in pants unknowingly a psychological problem?

Question

Hi doctor,

My son is 8 years old. His weight is 55 lbs, and his height is 4.4 feet. He has had a problem with passing stool in his underwear for six to seven months now. He is doing this without knowing it. He suffered from the same kind of problem last year for three months, and it got cured. But, that medicine did not help this time. We discussed this with many doctors but did not get any solution. Would you please help us?

Answer 1

Hi,

Welcome to icliniq.com.

I saw the attached files and your child's history (attachment removed to protect patient identity). Your child has encopresis (involuntary fecal soiling), and probably he might also be having constipation. The standard treatment is dietary modification. I believe you know all as it has already been done. I have four concerns. The first one is to go for a thyroid profile check that is T3 (triiodothyronine), T4 (thyroxine), and TSH (thyroid-stimulating hormone) check. The second one, does the child have pain on defecation? Is the child developmentally normal? Have anyone checked the anal opening for any cracks or fissures? The third one, have you seen some behavior abnormality in your child, or is there any problem in the family? If so, you should also see a psychologist or psychotherapist.

The last is if everything fails, then you should go for an MRI (magnetic resonance imaging) spine to rule out if anything is wrong there.

Kindly revert with the answers to the above questions.

Answer 2

Hi,

Welcome back to icliniq.com.

Yes, it is a psychological condition. But, you also rule out other things such as constipation, as it also happens when a child is chronically constipated. If constipation improves, then this condition may also improve. Also, your child needs some psychotherapy.