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Encopresis


Definition:

If a child over the age of 4 has been toilet trained and then passes stool and soils clothes again, this is called encopresis. The child may or may not be doing this on purpose.

Alternative Names:

Soiling; Incontinence - stool

Causes:

The child usually has constipation. The stool is hard, dry, and stuck in the colon (called fecal impaction). The child then passes only wet or almost liquid stool that passes around the hard stool. It may leak out during the day or night.

Other causes:

  • The child was not toilet trained
  • Toilet training began when the child was too young
  • The child has emotional problems, like oppositional defiant disorder
  • Conduct disorder

Whatever the cause, the child may feel shame, guilt, or lose self-esteem, and may hide signs of encopresis.

The risk for encopresis may increase with:

  • Being male
  • Chronic constipation
  • Low socioeconomic status
Symptoms:

  • Not able hold stool until at a toilet (bowel incontinence)
  • Passing stool in inappropriate places (as in the child's clothes)
  • Keeping bowel movements a secret
  • Constipation and hard stools
  • Sometimes passing a very large stool that almost blocks the toilet
Exams and Tests:

The doctor may feel the stool stuck in the child’s rectum (fecal impaction). An x-ray of the child’s belly may show impacted stool in the colon.

Treatment:

The goal:

  • Prevent constipation
  • Keep good bowel habits

It is best for parents to support rather than criticize or discourage the child

Treatments may include:

  • Laxatives or enemas to remove dry, hard stool.
  • Take stool softener.
  • Eat a diet high in fiber (fruits, vegetables, whole grains) and enough fluid to keep the stools soft and comfortable.
  • A short-term treatment of flavored mineral oil. This is only a short-term treatment because mineral oil interferes with the absorption of calcium and vitamin D.
  • A pediatric gastroenterologist can help when these treatments aren't enough. They may use biofeedback, or teach the parents and child about how to manage encopresis.
  • Psychotherapy can help the child deal with associated shame, guilt, or loss of self-esteem.
  • For encopresis without constipation, the child may need a psychiatric evaluation to find the cause.
Outlook (Prognosis):

Most children respond to treatment.

Possible Complications:

  • If encopresis is not treated, the child may have low self-esteem and problems making and keeping friends.
  • If encopresis is not corrected, the child may develop chronic constipation.
When to Contact a Medical Professional:

Call for an appointment with your health care provider if a child is over 4 years old and has encopresis.

Prevention:

Toilet train in a positive way when the child is the right age.

If your child shows signs of constipation, such as dry, hard, or infrequent stools, ask your doctor how to treat it.

References:

Feigelman S. Growth, development, and behavior. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 6.

Feldman MD. Encopresis. In: Ferri FF, ed. Ferri's Clinical Advisor 2009. 1st ed. Philadelphia, PA: Mosby Elsevier; 2009:section 1.


Review Date: 9/9/2013
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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