The Ins and Outs of Poop: A Guide to Treating Childhood Constipation

ENCOPRESIS? STOOL WITHHOLDING? POOP ACCIDENTS? This book is the revised and expanded 2nd edition of The Ins and Outs of Poop: A Guide to Treating Childhood Constipation. It is a how-to book for parents and a treatment guide for pediatric healthcare specialists. This edition contains all of the information contained in the first edition plus new and updated information on important topics related to prevention, early diagnosis and the treatment of functional constipation. These topics include: functional constipation in the first 24 months of life, how toilet training can cause encopresis, how to manage encopresis in the classroom and how temperament-related behavior problems can cause functional constipation. It also includes a self-study Parent-Child Interaction Training (PCIT) course which teaches parents how to “treat” such behavioral problems. Functional constipation (encopresis) is an increasingly common condition that can cause children aged 6 months and older to withhold stool following a painful bowel movement. Occasional or mild constipation is very common in children. However, more than 20% of children who have occasional constipation go on to develop a more severe type of constipation known as functional constipation or encopresis. Functional constipation occurs when children do not sense the need to defecate. Some of these children accidentally soil in their underwear, which causes them embarrassment. Functional constipation is not a disease but it does cause serious physical and emotional problems which can be prevented by knowing what to do when a child develops occasional constipation. Because functional constipation can persist for months or years, treatment can be stressful for everyone involved, including healthcare providers. To treat functional constipation, parents and providers work together as a treatment team over an extended period of time to manage and resolve the problem. There are six steps required to effectively treat functional constipation: 1. Educate the family 2. Empty the rectum 3. End withholding 4. Shrink the rectum 5. Withdraw laxatives 6. Remain vigilant. Each step is explained in detail along with the tools needed for successful implementation, such as forms for data collection and instruction in the use of laxatives and incentives. There are many stories written by parents describing specific aspects of their child's treatment. The book is written in a light-hearted fashion and uses cartoon-like illustrations to highlight key points. It emphasizes the very good news that with comprehensive care, functional constipation can be dramatically improved.

"I commend Dr. DuHamel on publishing a great reference book for parents and medical professionals alike.  In this second edition, the artwork and descriptions, useful citations from pertinent scientific literature, and new information (e.g., treating constipation in infants and toddlers) make this book a uniquely valuable resource. I will continue to endorse and highly recommend this book to families seeking care for children with chronic constipation."
                                             -- Uma Pisharody, MD, FAAP, Pediatric Gastroenterologist