A Controversy inTreating Encopresis or Fecal Incontinence in Children: "Top Down" or "Bottom up?"

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Sooner or later frustrated parents find their way to the Soiling Solutions® website, http://www.soilingsolutions.com to finally free their children from fecal incontinence or encopresis. "Poop" is an extremely offensive body waste and disease carrying product causing great distress.

Psychologist Dr. Robert W. Collins reported on the history and theory behind the unique Soiling Solutions® approach in the Spring 2009 issue of "Digestive Health Matters". This is the quarterly publication of the International Foundation of Functional Gastrointestinal Disorders (http://www.iffgd.org).

The Soiling Solutions® approach uses the first treatment manual written for encopresis. It was introduced by Dr. Collins in 1998. It is controversial because it employs suppositories and enemas in a bowel retraining program. Many physicians and parents alike find this very distasteful. A majority of pediatricians now avoid even doing an adequate physical examination because of societal sensitivities about this area of the body.

Two earlier pediatric journal articles established the preferred "top down" use of oral stool softening agents in use today. The authors of those two articles referred to the use of "bottom up" suppositories and enemas as "anal assault." Their approach has been called the "soft" approach. Dr. Collins has reviewed evidence that this approach works in only 40-60 percent of cases, http://www.soilingsolutions.com/references.htm.

Orally ingested stool softeners are supposed to allow easier bowel movements. Dr. Collins argues that for too many children they only promote confused and ill-timed voiding signals because they have to work through the entire length of the GI tract. In addition, they frequently liquefy the stool so that there is even more stool leakage. Indeed, the children may only practice greater stool retention out of fear of accidents making success less likely and intensifying family conflict. This holding response can become so over learned that it has been demonstrated to occur under anesthesia. Thus, the standard pediatric protocol may even paradoxically cause a more resistant form of encopresis!

The Soiling Solutions® "bottom up priming" approach heightens voiding urge signals and assures a more immediate and successful voiding reflex with feelings of relief and lowered bowel pressure. The children delight in their success and success builds on success. Soiling accidents cease in 90% of children within two weeks, more success!

Over time and conditioning trials the children can more readily detect well-formed stools without the softening agents and can more reliably sit and release their stool without needing the suppository or enema primer. The Soiling Solutions® protocol is detailed in the step by step Clean Kid Manual allowing self-treatment using easily available and safe over-the-counter agents.

Another innovation of the Soiling Solutions protocol is that it provides a parents forum on the Internet where the parents, all using the same treatment manual, can advise and support one another. The forum is very active and even includes physicians and psychologists, who have discovered the Clean Kid Manual and are using it with their own children. Dr. Collins views it as a "clinical lab" and it has been instrumental in revising 4 editions of his manual. A number of those parents are willing to talk to the media and a list can be released upon request.

Dr. Collins does strongly recommend that parents inform their physicians of their intent to use the Clean Kid Manual. He provides free consults for physicians who contact him. Physicians should purchase their own copies to better support their patients. He does view his protocol as a default treatment approach when the standard "top down" approach fails.

About Soiling Solutions®:

Soiling Solutions® is registered internationally and it is a "doing business as" professional corporation registered in the state of Michigan. Robert W. Collins, PhD, PC is its founder and president. His biography is available at http://www.soilingsolutions.com/doctor.htm.

Robert W. Collins, PhD, President
Soiling Solutions®


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