Definition

Encopresis is the passage of stool in places other than the toilet. It is most often an involuntary action. Encopresis is often called stool soiling because of the stains left on underwear.

Accidents are normal in infants and toddlers until they learn bowel control. It is considered abnormal in children aged 4 years and older.

Causes

Encopresis may be caused by a variety of conditions such as:

• Chronic constipation
  • When a large amount of hard, dry stool is filling the rectum, over time the child becomes unable to recognize the sensation of fullness and the need to go to the bathroom.
  • Liquid stool may leak around the hard mass of stool, causing staining of the underwear.
  • May be associated with a diet low in fiber and fluids, and lack of exercise
• Poor toilet training or refusal to use the toilet for bowel movements
• Emotional problems
• Organic causes (rare)—result of problems or malformations in the intestines

Risk Factors

This condition is more common in males. It is also more common in children with emotional problems such as:

• Oppositional defiant disorder
• Conduct disorders
• Toileting phobias

Risk factors include:

• Passage of firm stool that causes a painful tear or “fissure” at the opening of the anus
• Children who have suffered sexual abuse (according to some researchers)

Symptoms

The main symptom is the accidental passage of stool, usually into the underwear. Other symptoms may include:

• Low self-esteem
• Feelings of embarrassment, shame, or guilt

If associated with constipation your child may have:

• Infrequent bowel movement
• Pain or bleeding with defecation
• Abdominal pain
• Bed wetting

Parents are often unaware that their child is constipated. However, they may see their child forcibly holding stool when they haves the urge to move their bowels. Your child may also be unwilling to use the toilet in certain locations. These descriptions of stool holding are important for the doctor to know about.

Diagnosis

You will be asked about your child’s symptoms and medical history. A physical exam will also be done. The diagnosis can usually be made this way. A rectal exam may reveal the presence of a large quantity of hard, dry stool in the rectum

To make help a diagnosis, the doctor may order imaging studies, such as:

• Abdominal x-ray —may show excessive stool in the rectum
• Other imaging tests to look for organic causes if the constipation is not relieved with treatment or if your child passes blood with their stool

Treatment

Treatments will depend on the cause of soiling. As a parent, it is important that you do not shame your child. Treatment will include some or all of these:

Prevention

Following guidelines for toilet training may help prevent encopresis. A healthy, high-fiber diet and adequate liquid intake may also help prevent this condition.

National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov

Health Canada http://www.hc-sc.gc.ca

Fecal soiling. American Academy of Pediatrics Health Children website. Available at:
http://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Fecal-Soiling.aspx
Updated May 11, 2013. Accessed December 18, 2014.

Fecal incontinence in children (encopresis). EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated September 30, 2014. Accessed December 18, 2014.

Stool soiling and constipation in children. Family Doctor—American Family Physician Family Doctor website. Available at:
http://familydoctor.org/familydoctor/en/kids/toileting/stool-soiling-and-constipation-in-children.html
Updated November 2010. Accessed December 18, 2014.