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6 Facts About Fecal Smearing That You Need To Know

“Code brown.” “Diaper digging.” “Paint the town brown.” Whatever you call fecal smearing, the question is: How do we extinguish this behavior? No one likes to talk about it, but fecal smearing, also called scatolia in medical literature, is surprisingly common among children and adults. It occurs most frequently among individuals with developmental delays or post-traumatic stress, which means that the person may not be able to verbalize the reason for the behavior.

1. Multiple Causes and Treatments

If you ask an occupational therapist, sensory integration strategies will be the recommended solution. A clothing manufacturer will suggest compression onesies and overalls to restrict access to feces. A psychologist will ask about a history of abuse leading to this behavior. A behavioral specialist will study antecedents to the behavior, the function of the behavior as well as the caregiver’s reaction.  A physician will look for medical causes. Sometimes one of these will be the right solution. But often, there are multiple causes and multiple approaches are needed. There are no simple answers for fecal smearing.  Understanding the causes and treatments is the first step to customizing a plan to resolve the issue.

2. Sensory Integration

Some families report that scatolia occurs during periods of understimulation, for example, while the individual is alone in a darkened bedroom at night with a case of insomnia.  If the person is deprived of appropriate sensory input, then frequent periods of supervised play with soft or sticky substances such as clay, shaving cream or bread dough can alleviate the need for handling feces.  Substances with a strong smell, such as essential oils, scented lotions, spices or cheese may satisfy the craving for odors.

3. Restrictive Clothing

[caption id="attachment_20764" align="aligncenter" width="602"] Jumpsuit from AdaptiveClothingShowroom.com[/caption] Restrictive clothing is often recommended as a preventive measure.  The main benefit is that it buys a few extra minutes for the caregiver to respond appropriately.  Some examples of restrictive clothing are:

• Overalls worn backwards
• Onesie pajamas worn with the zipper on the back
• One-piece compression underwear

The problem with restrictive clothing is that it makes independent toileting impossible, so it is really only a temporary measure while treatment is being pursued.

4. Psychological Reasons

Psychologists note that scatolia tends to occur in individuals with a history of obsessive-compulsive disorder, anxiety, schizophrenia, depression, bipolar disorder, ADD, autism or post-traumatic stress, especially trauma related to physical or sexual abuse.  Author Donna Williams, who has autism, points out that rectal digging and fecal smearing serve many real purposes that are often overlooked by caregivers and medical providers:

1. Provides a sense of control over one’s body and environment when other areas of life are out of control
2. Provides a sense of ownership over one’s actions
3. Expresses feelings of anger, frustration, helplessness and powerlessness
4. Prevents unwanted social interaction
5. May be associated with other comforting emotional experiences
6. May be part of a personal ritual that provides comfort
7. May be part of an obsession that is spiraling out of control

In each of these cases, care and attention must be given to the individual’s quality of life to make sure all needs are being met.  Inpatient psychiatric treatment may be needed for severe anxiety or OCD.

5. Behavioral Approach

Behavior is communication, and scatolia sends a strong message.  Social worker Jessica Wein recommends a functional behavioral analysis to understand the “ABCs” of the behavior: “A- Antecedent; what occurs directly before and/or leading up to the behavior (fecal smearing)? B- Behavior; the behavior itself C- Consequence; what occurs after the behavior including reactions of caretakers?” Parents report that a strong emotional reaction increases the frequency and messiness of scatolia.  Wein suggests that the caregivers react in an emotionally neutral manner with as few words as possible, then provide positive attention for desired behaviors.  Additionally, social stories and children’s books such as “Everyone Poops” by Taro Gomi can reinforce appropriate toilet behavior.

6. Medical Causes

It’s a good idea to consult with a physician to rule out possible medical causes for fecal smearing:

• Protozoal infections can cause rectal digging behavior.
• Pica, the ingestion of non-foods, may be caused by nutritional deficiencies.
• Encoporesis (the medical term for chronic constipation, impacted stool and soiling) causes abdominal discomfort that is relieved by rectal digging.
• Hemorrhoids are caused by straining to evacuate the bowels, and are the source of itching and pain around the anus, which leads to anal exploration and rectal digging.
• Rectal prolapse occurs when the rectum slips out of position, and can be caused by prolonged encoporesis or low muscle tone in the pelvic floor.  Symptoms include fecal incontinence and a sensation of incomplete bowel evacuation, which lead to fecal smearing behaviors.

All of these medical conditions are treatable. While you’re doing that extra load of laundry tonight, remember that you are not alone. Learning the facts about scatolia is the best way to prevent future incidents.