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Resolving Encopresis in Children

Nothing is impossible, the word itself says "I'm possible" - Audrey Hepburn

I pride myself on doing the best I can for each and every one of my clients.

But I have to say, the younger ones find me really pulling out all the stops, and going that extra mile on their behalf.

Our responsibility to our young people is great and the burden is heavy. Yet society continues to let them and their parents down by not providing the kind of psychological information to help them manage anxiety and maintain emotional well-being.


One of my youngest clients, Sally aged just seven, was a little girl with a big problem, encopresis.

In a pre-session phone call, mum reported that Sally had become increasingly incontinent over a period of three years, first singly and then doubly. She had sought out helped to resolve the problem.

School counselling had revealed no traumas or significant family problems. The GP had suggested, if things did not improve, surgery might provide a solution.

Growing more and more concerned, mum had even sought out the services of a hypnotherapist who had suggested it was all about control. Sally was attention seeking, should be put back into nappies and sent her room after an accident. Needless to say that didn’t help.

First impressions make a big impression and I will never forget the day when I opened my front door to a nervous mother tightly clutching the hand of a little girl who was tiny, pretty and very frightened.


As I had no previous knowledge of encopresis in children, I had done my homework about the condition and discovered several things.

No one is certain how it starts, but it might be something as simple as cystitis or a painful stool which makes the child want to avoid going to the toilet. Accidents then begin to occur as the child becomes increasingly desensitised to the signals for emptying.

The child feels shame, parents grow anxious and, before long, you have a negative cycle and an unhelpful, embedded pattern of behaviour.

When I train psychotherapists and therapeutic coaches, I encourage them to ask three essential questions when making their case notes.

  1. What is the essence of the problem?
  2. What is the essence of the solution?
  3. What is the focus for the work?

I approached this first session with an apparent confidence which belied my underlying concerns.  I was riding a hunch that this was not a physical condition but simply a pattern that needed interrupting.

Over four sessions, I worked firstly with mum and daughter together and then Sally on her own to establish several interventions.

I explained what I had learned from my research about how these problems can start and suggested that we would begin to work together to retrain and re-sensitize both bladder and bowel by encouraging 5 min of sitting on the toilet 10 min after mealtimes, three times a day, with a star chart and reward for just trying rather than for results.

I suggested that mum and the whole family deal with any accidents with as little fuss as possible, leaving soap, towels and clean underwear where Sally could access them on her own if necessary.

I talked about when the situation got better rather than if and continually reinforced positive expectation of success and a good outcome. I suggested that mum really notice all the positives and, in the event of accidents not to show her own anxiety as Sally would notice and it would not help.

Twinkle twinkle little star

When I worked with Sally on her own, I asked her to imagine she had a little butterfly inside her tummy that would flutter and tickle to let her know when she wanted to go for a wee and asked Sally what little animal in her tummy might give clear signal that she wanted to do a poo?

Sally thought for a while and suggested a fluffy kitten that would meow. We did some drawings and colouring around the idea of the butterfly and kitten playing happily together in Sally’s tummy and, by the time she came for her next session, I had made her an old fashioned tin can and string telephone.

Sally was curious as I asked her whether she had good hearing? She said she did and I asked her if she would be able to hear the kitten in her tummy even if it meowed very quietly. Sally was certain she could and that the kitten would sing the nursery rhyme twinkle twinkle little star, every time she needed the toilet.

I was certainly grateful there were no spectators as, with Sally holding onto one end of the telephone, I stretched the string around the corner and into my conservatory as I began to sing the nursery rhyme.

I popped my head around the corner and asked Sally if she had heard. ‘Yes’ said Sally brightly, ‘but you got it wrong, the kitting meows the tune, it doesn’t sing the words, which found me meowing twinkle, twinkle little star into a tin can in my conservatory as Sally giggled with her ear to the ‘receiver’….. but the point was made.

Just a few weeks after seeing them for the first time, the situation was now almost fully resolved with only occasional accidents which were becoming fewer and fewer.

I was very pleased to have been able to help mother, daughter and a whole family who had become very anxious around an unsettling situation.

But a part of me remains concerned about what could have happened to Sally if things had continued as they were.

We must teach good mind management skills

Parents, children and teachers would all benefit from a simple understanding of the mechanism of emotional hijacking and of good mind and emotional management skills which are actually easy to learn.

These are all part of the Fusion Therapeutic Coaching Diploma, Distance Learning Skills Certificate and the new Fusion Breakthrough Programme.

Frances Masters

Frances Masters is a BACP accredited psychotherapist with over 30,000 client hours of experience. Follow her @fusioncoachuk, or visit The Integrated Coaching Academy for details about up coming training.