Encopresis is the voluntary or involuntary passage of stools in a child who has been toilet trained (typically over age 4), which causes the soiling of clothes.
Soiling; Incontinence - stool
Causes, incidence, and risk factors
Encopresis is frequently associated with
Other causes may be related to:
- A lack of toilet training
- Toilet training at too early an age
- Emotional disturbance such as oppositional defiant disorder
- Conduct disorder
Whatever the cause, the child may develop associated shame, guilt, or loss of self-esteem. The child may try to hide the discovery of the problem.
The following may increase the risk for encopresis:
- Being male
- Chronic constipation
- Low socioeconomic status
- Inability to retain feces (bowel incontinence)
- Passing stool in inappropriate places (generally in the child's clothes)
- Secretive behavior associated with bowel movements
- Constipation and hard stools
- Occasional passage of very large stool that almost blocks up the toilet
Signs and tests
Digital examination of the rectal area may show a fecal impaction. An
The goal is to prevent constipation and encourage good bowel habits. Laxatives, and sometimes enemas, are used to remove fecal impaction. A stool softener is often prescribed.
A diet high in
Parents should be supportive and refrain from criticism or discouragement. Pediatric gastroenterologists often provide education to the parents and child and use biofeedback for the child to treat the more difficult cases. Psychotherapy can help the child deal with associated shame, guilt, or loss of self-esteem. For encopresis in the absence of constipation, psychiatric evaluation may help determine the underlying cause.
Most children respond to treatment.
The child may suffer from low self-esteem and peer disapproval related to this problem. If routine bowel habits are not developed, the child may suffer from chronic constipation.
Calling your health care provider
Call for an appointment with your health care provider if this behavior is noted in a child over 4 years old.
Because the causes often are obscure, prevention is difficult. As a general rule, refrain from too early and too coercive toilet training.
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.