I-SIT: Behavioral Management for Constipation and Encopresis

Important information:

Behavioral strategies can help children manage chronic constipation and soiling (encopresis). Using clear instructions, praise, and rewards can encourage positive toileting behaviors.

Patient instructions:

• Give clear instructions. Use direct, positive commands. Tell your child what to do, not what not to do. Avoid asking questions that give a choice when one is not needed.

  Effective examples: ✔ “Please sit on the toilet for 5 minutes.” ✔ “Take all of this medicine before dinner.” ✔ “Put your underwear in the sink.”

  Avoid: ✖ “Do you need to go to the bathroom?” ✖ “Are you ready to take your medicine?” ✖ “Don’t leave that there!”

• Use praise. Give immediate praise when your child follows instructions. Be specific about what they did well.

  Effective examples: ✔ “Thank you for sitting on the toilet right away!” ✔ “Great job taking your medicine on time.” ✔ “I’m proud of you for cleaning up on your own.”

  Avoid: ✖ “Thank you.” ✖ “Great job!” ✖ “Good! Why can’t you remember that?”

• Try a reward system. Give stickers or points immediately after a toilet sit.

  • Small rewards (an extra bedtime story) can be earned daily.

  • Larger rewards (a special outing) can be earned weekly.

    Example reward system:

     

    Sitting on the toilet = 1 sticker or point

     

     

    Sitting and pushing = 2 stickers or points

     

    Sitting, pushing, and having a bowel movement = 3 stickers or points

• Follow structured sit steps.

1. Get your child’s attention. Make eye contact before giving instructions.

2. Say, “You can earn a sticker/point if you sit on the toilet for X minutes. Please go sit on the toilet now.”

3. If your child follows the instruction, praise them and let them choose a sticker or point.

4. If they do not sit after your first instruction say, “If you do not sit now, you will not earn a sticker/point.”

5. Do not repeat the instruction again. If they do not sit at this time, do not give the reward.

6. Ignore complaints. If they resist or have a tantrum, stay calm and wait until the next scheduled toilet sit.

• Handle accidents calmly. Use a neutral tone. Say, “You had an accident. Let’s clean it up.” Do not punish your child. Instead, have them help with cleanup in an age-appropriate way, for example, placing soiled underwear in a designated spot. Keep post-accident baths short and without toys.

• Toileting talk tips: Keep toileting talk brief. Focus on positive behaviors. Praise your child for toilet sits and bowel movements in the toilet. Avoid giving extra attention to accidents.

   

   

  Using these strategies consistently can help your child develop better toileting habits.

Reviewed February 2025 by Kelly Rodriguez, PhD, Jennifer Webster, DO