Encopresis

Definition

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.

See also: Bowel incontinence

Alternative Names

Soiling; Incontinence - stool

Causes, incidence, and risk factors

Encopresis is frequently is associated with constipation and fecal impaction. Often, hard fecal material remains in the colon and the child only passes a soft or semi-liquid stool around the impacted stool. Leakage of stool may occur during the day or night. There are rarely physical causes other than constipation (sometimes present since infancy).

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

Symptoms

• 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 abdominal x-ray may confirm impacted stool in the colon.

Treatment

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 fiber, including fruits, vegetables, whole grain products, and adequate fluid intake will promote the passage of softer stools and minimize the discomfort associated with bowel movements. Another way to treat this problem is to give flavored mineral oil to the child in sufficient quantity for the oil to leak from the rectum. This is an excellent short-term treatment, but it must be avoided long-term because of interference with calcium and vitamin D absorption.

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.

Support Groups

Expectations (prognosis)

Most children respond to treatment.

Complications

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.

Prevention

Because the causes often are obscure, prevention is difficult. As a general rule, refrain from too early and too coercive toilet training.

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References

Boris NW. Dalton R. Vegetative disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 22.

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