Q. My son is six years old and has been potty trained since 3.  In the last several weeks he has had many, many instances of poopy underwear that he seems to have no control over.  Someone mentioned encopresis to me, and it sounds exactly like what he has.  He is a very picky eater so I suspect that may be the source of much of his trouble.

I’ve supplemented with mineral oil and tried to cut out most dairy for the first month.  How much mineral oil do you think I ought to give him, and are there any other things I can do?

A. Encopresis is defined as having a bowel movement in an inappropriate place at an age when bowel movements have been controlled by the child.  This can include pooping in one’s underwear by mistake or on purpose.  This can occur when constipation (or voluntary stool withholding) leads to a hard mass of stool which partially obstructs the lower intestine and “desensitizes” the child’s ability to stop the leaking of stool around that partial blockage.

It can also occur as a defiant gesture indicating a larger underlying emotional issue.

About one out of a hundred five-year-old boys have this problem.

Mineral oil is a common treatment because this non-absorbed oil lubricates the intestines.  By decreasing a child’s ability to voluntarily hold stool–sometimes for many days–easier passage of stool may end the obstruction and the leakage.  It might not be the best long term solution, but it might solve the short term problem.

I recommend another dairy free month, and/or cascara sagrada mixtures from the health food stores in half the adult dose each day for a month.

One tablespoon of mineral oil twice/day for a week followed by one tablespoon once/day for six weeks.

Keep his diet very low in low fiber foods like meat and as high as possible in grains, pasta, beans, fruits and veggies.  He has a partial obstruction of the lower intestine caused by his withholding pattern and loose stool runs around it.  He has no control because that part of the intestine is desensitized.

A child who constantly comes home from school with soiled (poopy) underwear is frustrated, embarrassed and parents are tempted to find some sort of punishment.  Clearly, nothing could be worse.  Get good counseling to find the root of the problem and look hard for dietary and emotional advice.

Herbal laxatives and stool softeners can be used once the heart of the matter is reached but enemas and suppositories focus on the “wrong end” of the problem and should be avoided.