The Clean Kid Treatment For Encopresis:

WARNING: A recent research report out of the Netherlands (see our scientific articles page) indicates that the rectum can become overly stretched and weakened from a megacolon such that the standard "top down" pediatric treatment may be rendered ineffective. In my opinion encopresis should not be allowed to continue indefinitely. Even children recovering under the standard pediatric approach may continue with distended rectums at 4 years follow up. The more aggressive Soiling Solutions protocol using suppositories and enemas with proper timing is well indicated at an earlier time to prevent this consequence. DrC.

This is a very focussed and text heavy page. Please click on the Home page tab above to get an overall view of this website and a letter to your physician.

This is a background page for the Clean Kid Manual to introduce you to the basics of encopresis. Our approach to encopresis is active, directive, and rational. This page will help you most directly to make a decision about ordering our step-by-step treatment manual for encopresis. It is not available in bookstores or libraries. This website is very extensive and frequently visited by professionals and parents alike who have been frustrated by an hereto lack of a coherent approach to treating encopresis. Take your time and explore the site. Mention it to your doctors, schools, and other parents. They may be just as frustrated as you have been! If you wish to examine the manual's table of contents and preface beforehand you may click here, CLEAN KID MANUAL-III.

Have these questions about encopresis been bothering you?

When should I have my child sit to void? For how long? Can't my child simply choose or "will" him/herself to go to the toilet versus going in his/her clothes? He/she is so smart; how can he/she have this stupid problem of encopresis? Is this a conscious choice by him/her that he/she should be held completely responsible for and punished? Why not? Why are the Doctors so vague about what to do? How long should I put up with the usual medical advice after no success for months or even years? Miralax and other laxatives or softeners just make the stools more liquid and difficult for my child to control his bowel movements; are there any alternatives? What is a "megacolon"? What causes the megacolon? The Doctors appear to assume that if the colon returns to normal size that everything will just automatically work right again, without any conditioning or training! Is that right? I just learned the name of this problem, why did my doctor take so long to share it with me? Why aren't the schools more understanding about encopresis? Why isn't my child the sweet kid that I know he/she truly is; is this problem a part of the answer? Is encopresis a medical or a psychological problem? Are there any special diets that will alleviate encopresis and lead to bowel control? Why aren't there more answers or practical approaches to handling encopresis? Why is my child in such denial and so secretive about encopresis? Why does my child "clamp up" when he/she feels bowel urges to go? Why does a "clean out" just result in him/her getting clogged up again? Which is more kind, years of accidents with the usual approaches or using suppositories and/or enemas for a brief time in a careful stepwise fashion to foster effective, accelerated learning on when and HOW to let go and void? Isn't the use of suppositories and enemas unnatural? What about dependency? Is the Clean Kid Manual worth ordering and why is it so different from prevailing advice?

You will find answers and many insights throughout this website that will help you to understand your child's problem in the "twilight zone" between medicine and behavioral science. Professionals and parents alike can exchange emails and phone calls with Dr. Collins by referring to the address block at the bottom of these website pages.

Here are some very critical observations that make the Soiling Solutions' protocol different:

1. An enlarged colon is NOT THE cause of encopresis. It is strictly secondary and a consequence of your child reflexively and repeatedly clamping up against his voiding urges (or "gastrocolic reflex"). This is called "anismus,” “stool hoarding,” "outlet obstruction," or, more recently, RAIR-Rectal Anal Inhibitory Reflex. His/her holding response is in some sense rational! Your child does not want to have an accident; they are actually trying to please you. Unfortunately, they are doomed to fail! This only makes you feel like a failure as a parent. Backing off and tolerating it is not an option either.

2. A variety of possible initial causes for fighting off the original gastrocolic reflex are cited in my manual. Once started this problem becomes very resistant to treatment by the ordinary means used by so many professionals and parents today. Some children poop just fine, but only in diapers, pull ups, or a towel that they bring to a parent to poop in! This remains "encopresis" as clothing is an inappropriate place to poop in. The parents and children think they have made great progress, but not so. These children, initially "hiders," become "diaper-dependent!" Later attempts to transition these children to the toilet stool frequently do not work and they fall back into category 1 just noted above. Sooner or later they have to be able to connect to pooping on the toilet stool to overcome the diagnosis of encopresis. This can only occur by pooping on the toilet by following the Soiling Solutions' protocol when the usual pediatric interventions fail.

3. Properly done (i.e., the Soiling Solutions protocol), the child can stop soiling within 2-3 weeks (and often sooner) with the appropriate timed use and fairness of brief sits, escalating to glycerin stick suppositories, and, finally, enemas if they are even needed. Enough is gotten out each day by using these “poop primers” that internal pressures are lowered and he learns to poop easier and easier as he begins to trust his voiding reflex while hanging his bottom out over the cold air and water of the toilet. He learns to recognize the proper signals that the “primers” naturally produce in a very timely fashion which just is not possible with any oral agents that take hours to act. Imagine seeing lightning followed by thunder over hours or even days later--our neurology/brain just won't make the connection! In my meetings with pediatricians throughout this country and parental reports from around the world they frequently see my approach as "too aggressive." But, is it? Maybe they are too passive and cavalier in dismissing legitimate parental concerns!

4. Usage of “top down” laxatives very slowly through 30 or so feet of GI tract may only confuse urge sensations so that children are clamping up all the time and they cannot succeed! To borrow a phrase from the news, this is akin to the "fog of war". The children need a more effective and transparent voiding trigger to connect with for gaining true control. With oral agents they are going to fatigue, pass gas, or get distracted and “lose it” or “leak”! Make the stool softer as with Miralax and they are going to be even more likely to leak and have accidents! Paradoxical and frustrating isn’t it! If the usual approaches to encopresis don’t work, then maybe it is time to change! Why try innumerable variations of the top down approach with fiber, Miralax, mineral oil, lactulose, Milk of Magnesia, probiotics, etc. etc. forever and ever? Practicing failure only leads to more failure and demoralization. I have seen a definition of insanity as trying the same thing over and over again expecting a different result.

5. The use of suppositories and enemas in a rational, strategic program to end encopresis is not cruel. It is NOT a punishment paradigm. Rather it enhances awareness of bowel signals and establishs a proper voiding response. Allowing encopresis to continue may be crueler because of resulting family tensions and social ridicule. Success and the more immediate cessation of soiling are highly curative in helping everyone to forget a terrible and extended conflict. I actually believe that a more powerful bonding experience occurs with my approach to encopresis as both parties recognize how the much more focused, strategic struggle comes to a head with resultant success.

6. Suppositories and enemas are universally available off the shelf in many stores. If they were dangerous they would have stimulated headline news around the world and been removed from the market long ago. They are a legitimate option when used properly and not as mere repeated "clean out" agents with which they are commonly associated. Ignorant claims to the contrary are a disservice to suffering families.

7. Our method sets just the right times to sit for fewer and shorter times each day over the course of an hour or so over a much shorter period of the day, instead of exhausting and upsetting everyone. The usual practices of too many and too long sits throughout the day only exacerbate the problem and may even increase resistance because the urges often are not present or fade even as the child sits! Our method assures that the urges are present in a timely way with the child sitting in the bathroom for the sole purpose of having a bowel movement. Turning your bathroom into an entertainment center is not the answer! Why in heavens name would you distract your child from paying close attention to his body and its inherent voiding signals? He has to learn to use them to relax and GO ON THE STOOL! With our program he will and you won't need rewards! Pooping and the relief that results is a natural and powerful reward--plus all the happiness you will share!

8. You won't be alone! With a manual purchase you will be invited to join a free exclusive email forum with other parents using our manual-based treatment approach for support. Many successful parents remain for a time to help out newbies! See some of the parents' comments by clicking on the "User Comments" tab at the top of this page. There is also a paid consult option (see Program Highlights tab above or below in the footer) with Dr. Collins if you so desire. Many of you will not need that option!

CAUTION IN TREATING ENCOPRESIS: 

Proceeding without the guidance of my encopresis manual and a physician or myself is not recommended.  The ultimate medical specialist for treating encopresis is a Pediatric Gastroenterologist, but he may not adequately understand the neurological conditioning process.  I am not an MD/DO physician, but a doctoral-level Psychologist who is an expert in learning theory, which led to my treatment approach for encopresis.  Too many physicians and psychologists are not sufficiently aware of the learning process I am engaging with the Clean Kid approach. Some physicians actually believe that I am advocating for a repeated "clean out" process as they are doing with their oral laxative approach. The form of learning I advocate was described by Ivan Pavlov, in his acceptance speech for the Nobel Prize for Physiology and Medicine in 1904. He was a Gastroenterologist and is considered one of the founders of modern behavioral psychology! If your physician is "closed" to our approach, you may need to rely on our manual and services. A proposed letter for your physician is lower on the home page and will be inserted in your manual order. Check it out in the event you missed it! Do not alienate your physician, keep him or her available and in the background because more tests may be needed. Professionals are invited to click on the Professionals' Page for Encopresis using the hyperlink to it at the top of this page.  RWC

If you do order our manual you will qualify to join our exclusive forum for parents using the Clean Kid Manual to exchange ideas and insights about treatment at no charge. You will receive instructions inserted into the front of your manual for joining. RWC

For a more in-depth study about encopresis click on the hyperlinks below:

First International Conference on Encopresis  
Second International Conference on Encopresis (and Enuresis) 
Fourth Annual International Symposium on Functional Gastrointestinal Disorders  
University of Kansas Pediatric Functional GI Disorders Conference-Includes Encopresis-2002
     The Latest on Encopresis and Bedwetting Research from the Scientific Literature
Free Treatment Advice for Daytime Bladder Accidents
Excerpts--Clean Kid Manual for Encopresis
Professionals' Page for Encopresis 
Diet & Fiber for Encopresis
Testimonials Page
Megacolon
Dr Collins