Defecation

Vomiting usually occurs in the underwear, occasionally also in living rooms. In contrast to enuresis, defecation usually occurs during the day. It often occurs together with enuresis and/or other behavioural problems. It can also be associated with faecal smearing. Defecation is often caused by children holding back their stools for long periods of time, thus triggering constipation with hard stools. As the bowel movement is often painful as a result, it continues to be held back and only small amounts of stool are passed. At some point, the child can no longer control the retention and defecation begins.

Around 2% of six-year-old children are affected. Among 7- to 8-year-olds, the figure is around 1.5%. Boys are affected three times as often as girls. In 10- to 12-year-old children, around 1.3% of boys and 0.3% of girls still defecate. In contrast to enuresis, there is no familial clustering of enuresis.

Special forms of defecation are toilet refusal syndrome (stool only in the nappy, urine in the toilet) and toilet phobia (toilet is avoided for stool and urine).

An interdisciplinary (paediatric/child psychiatric) assessment is essential in order to rule out organic causes and to identify psychosocial conditions and accompanying circumstances. In the case of chronic constipation, bowel evacuation is necessary beforehand and, in addition, stool regulation with medication during further treatment.

This is followed by so-called toilet training: no nappies, at least 3 times a day, sitting on the toilet for at least 10 minutes.

Parents should keep a record of excretions (toilet, underwear) and consistently prevent restraint manoeuvres. If the child has defecated, he/she should be sent to the toilet immediately (without any affect/scolding/reproach), after which he/she should change his/her clothes, clean his/her pants independently and put them in the laundry. In the evening, parents and child should always look at the daily log (toilet visits, frequency of defecation). Parents should praise their child for any progress (e.g. going to the toilet without having to be sent or defecating less frequently). A reward plan can also support the training: This involves the child receiving rewards for previously agreed target behaviours (e.g. for every time they sit on the toilet, for excreting in the toilet, for clean pants).