Encopresis

Elimination disorders have been treated successfully with biofeedback for years using conventional measurements of peripheral physiology. The pelvic floor muscle system is trained for better control. In such a method, it is not entirely clear just what is being trained. If function is deficient, are the muscles intrinsically too weak or is there a deficiency in regulatory control? Even clinical success in these conditions doesn't quite tell us the answer.

When we do Neurofeedback / EEG Biofeedback for these conditions, matters are less ambiguous. If we are indeed solving the problem, then it must be through our influence on central nervous system regulation. As it happens, we do solve the problem in the vast majority of cases, which means that the problem should really be reappraised as involving a deficit in central regulation rather than a deficiency in the muscles themselves.

It is fortunate that this should be the case because it goes without saying that children are mortified when they are equipped with anal sensors, etc. for conventional biofeedback. It is nice to be able to avoid all that discussion and embarrassment by just training the brain instead.

There is another issue that is probably at work in many of these cases. The dyscontrol is often episodic. There is no steady-state deficiency of any kind, either in the muscle system or in the control electronics. But episodically the child may lose control because of a seizure-like event in the brain. If that event does not rise to the level of actually causing a seizure, it is unlikely to be recognized. The result is inappropriate treatment.

Fortuitously, EEG biofeedback is once again the remedy of choice to help with the sub-clinical seizure activity (called paroxysmal activity). Training the brain toward greater stability can cause these phenomena to disappear, whereas most of the conventional treatments won't.

There is also a big-picture issue here that must be discussed. We often see encopresis in children who have been abused or traumatized in some way. As we already know from our work collectively, trauma is profoundly disruptive of brain function, even giving rise to paroxysmal or sub-clinical seizure-like activity. If a trauma history could be at issue in a particular case, it is the trauma that should be the organizing principle of therapy, not the encopresis. Here we have yet another rationale for beginning by training the brain.