Encopresis

Encopresis (en-ko-PREE-sis) is the repeated passing of stool into clothing in a child who has already been toilet trained. The passing of stool usually cannot be controlled. Encopresis typically happens when impacted stool collects in the colon and rectum. The colon becomes too full and liquid stool leaks around the retained stool, staining underwear. Eventually, stool retention can cause stretching, also called distention, of the bowels and loss of control over bowel movements. Encopresis is sometimes called fecal incontinence or soiling.

Encopresis usually happens after age 4, when a child has already learned to use a toilet. In most cases, soiling is a symptom of long-standing constipation. Rarely, it happens without constipation. In these cases, emotional issues may be the cause.

Encopresis can be frustrating for parents — and embarrassing for the child. However, with patience and positive reinforcement, treatment is usually successful.

Symptoms of encopresis may include:

• Leakage of stool or liquid stool on underwear, which can be mistaken for diarrhea.
• Constipation with dry, hard stool.
• Passage of large stool that clogs or almost clogs the toilet.
• Avoidance of bowel movements.
• Long periods of time between bowel movements.
• Lack of appetite.
• Belly pain.
• Problems with daytime wetting or bedwetting, called enuresis.
• Repeated bladder infections, typically in girls.

Call your child's healthcare team if your child is already toilet trained and starts experiencing one or more of the symptoms listed above.

There are several causes of encopresis, including constipation and emotional issues.

Constipation

Most cases of encopresis are the result of long-lasting constipation. In constipation, the child's stool is hard, dry and may be painful to pass. As a result, the child avoids going to the toilet — making the problem worse.

The longer the stool remains in the colon, the more difficult it is for the child to push stool out. The colon stretches, ultimately affecting the nerves that signal when it's time to go to the toilet. When the colon becomes too full, soft or liquid stool may leak out around the retained stool or loss of control over bowel movements may occur.

Some causes of constipation include:

• Withholding stool due to fear of using the toilet (especially when away from home) or because passing stool is painful.
• Not wanting to interrupt play or other activities.
• Eating too little fiber.
• Not drinking enough fluids.
• Drinking too much cow's milk or, rarely, an intolerance to cow's milk — though research results conflict on these issues.

Emotional issues

Emotional stress may trigger encopresis. A child may experience stress from:

• Premature, difficult or conflict-filled toilet training.
• Changes in the child's life, such as dietary changes, toilet training, starting school or schedule changes.
• Emotional stressors, for example, the divorce of a parent or the birth of a sibling.

Encopresis is more common in boys than in girls. These risk factors may increase the chances of having encopresis:

• Using medicines that may cause constipation, such as cough suppressants.
• Attention-deficit/hyperactivity disorder (ADHD).
• Autism spectrum disorder.
• Anxiety or depression.

A child who has encopresis may experience a range of emotions, including embarrassment, frustration, shame and anger. If teased by friends or criticized or punished by adults, the child may feel depressed or have low self-esteem.

Below are some strategies that can help prevent encopresis and its complications.

Avoid constipation

Help your child avoid constipation by providing a balanced diet that's high in fiber and encouraging your child to drink enough water.

Learn about effective toilet training techniques

Educate yourself on effective toilet training techniques. Avoid starting too early or being too forceful in your methods. Wait until your child is ready, and then use positive reinforcement and encouragement to help make progress. Ask your child's healthcare team about resources on toilet training.

Get early treatment for encopresis

Early treatment, including guidance from your child's medical professional or mental health professional, can help prevent the social and emotional impact of encopresis. Regular follow-up visits with a medical professional or mental health professional can help identify ongoing or recurring problems so that adjustments in treatment can be made as needed.