Encopresis and Enuresis in Stress Disordered Children
W.E.Krill, Jr. L.P.C.
Children with stress disorders (Acute Stress or Post Traumatic Stress) often suffer from encopresis or enuresis, or both. Encopresis is typically a consistent soiling of feces in the clothing, despite previously known toilet learning. This sometimes is just a small amount, or it can be large amounts of feces. In some children with a stress disorder, they may also “play with” the feces, smearing themselves or the environment with feces. Encopresis may be accompanied enuresis, or wetting. The wetting may occur both at night and during the daytime in otherwise toilet competent children. Some children simply wet the bed or themselves, while others may void in inappropriate place when a toilet is readily available.
The reasons for both problems can be multi layered. There may be more than one source for any particular child’s toileting issues. Some children may have not had adequate toilet learning or scheduling, and may have a physical disruption of the normal bowel process due to consistent withholding of feces. The child may have begun to withhold due to having a painful bowel movement, or from having gotten into trouble with an adult when they had a genuine accident. In essence, they may have developed a poor bowel habit. In addition, a child may have experienced emotional and physical regression following a single, very frightening trauma. In this case, the toileting problem may resolve itself once the child begins to feel secure again.
The effect of losing control of one’s bladder and bowels when deeply frightened is well documented. A child who has been repeatedly frightened may develop an automatic, uncontrollable elimination whenever they begin to be frightened about anything , and by anyone , not just the perpetrator of their traumatic abuse. They may even have the effect when they have had an intrusive memory or nightmare about their original trauma. This effect is not just due to a muscular release, but also likely due to intense chemical changes in the child’s body when they are frightened.
In other cases, there may be the additional layer of the child’s anger. All cultural myths to the contrary, children do not have much control over the adults in their lives. When a child becomes very angry at an adult, they have few options to “get back” at the adult. In most cases, these children do not have adequate learning in how to positively express negative emotions. They also do not have good role models on how to express anger. Nothing quite strikes back at an adult that the child is angry at than soiling themselves and smearing the results on the walls.
Still yet another possibility for the behaviors is that the child has used them as a defense against sexual abuse. Again, the feces and urine may be a very effective way for the child to keep a sexual perpetrator away.
Untangling the source(s) for the behaviors is thus not an easy task, and it takes time, close observations and tracking of behaviors, and above all, patience. It is important for those treating stress disordered children with encopretic and enuretic problems to understand that the child is not engaging in the behaviors to get you angry per-se. The behaviors are a reactivity to old history and traumatic events in their lives.
In most cases, all of the “practical” advice that is given on these issues, while it may ease the problem, does not solve it. The real solution lies in helping the child to gain improved, age appropriate ego strength and a healthy level of differentiation. In doing this, the child is able to adequately face and process the horrible traumas that they have endured, and in turn, find more positive and effective ways to express their pain, fear, and anger.