Encopresis is a condition where a toilet-trained child has bowel movements when they are not on the toilet. Constipation usually causes these accidents. While encopresis can be frustrating, as a parent, have patience and offer encouragement as your child adjusts to toilet training.
Encopresis, also known as functional fecal incontinence or soiling, is when children pass stool (poop) into their underwear, in most cases accidentally. It occurs in children 4 years of age and older who have been toilet trained. The condition is more common in boys than girls. It affects 1% to 4% of children who are 4 years old, and the frequency of this condition decreases with older age.
Children with encopresis often have the following symptoms:
Encopresis can be caused by:
The most common cause of encopresis is constipation. When a child experiences constipation, it’s difficult to have a bowel movement because their stool is dry and hard inside their colon and it can be painful to pass.
When children withhold or delay going to the bathroom, stool builds up in their colon. This makes the child’s colon grow larger, making it hard for them to feel when it is time to have a bowel movement. Liquid stool might leak out around harder stool, and parents might mistake this for diarrhea.
Encopresis with constipation is called “retentive encopresis.”
Encopresis could be a symptom of an underlying medical condition. Possible conditions that have encopresis as a symptom include:
Encopresis could be the result of emotional stress, behavioral challenges or fear that affects the actions of your child. Psychological causes could include:
To diagnose encopresis, your healthcare provider will examine your child. Their exam could include:
Your provider might order additional urine tests to rule out similar conditions that will help them diagnose your child with encopresis.
Treatment is unique to each child diagnosed with encopresis and could include:
Parents should encourage and offer support to their child by creating a “potty routine” to keep up with good bowel habits including:
Based on the severity of your child’s diagnosis, your provider might recommend taking your child to see:
It’s important that your child’s diet doesn’t contain foods high in fat and sugar.
Instead, add fiber to your child’s diet. Foods high in fiber include:
Treatment is long-term with the goal of creating regular bowel movements for your child. It could take several months to achieve this goal. Have patience with your child as they become more comfortable using the toilet.
Children will also need to learn about the sensation of having a bowel movement, which could take time if their intestines are stretched because of constipation.
Always encourage and praise your child after they use the toilet. Some parents use a sticker chart to mark the days when their child sits on the toilet and has a bowel movement, earning a small reward if they reach a certain goal by the end of the week. Small rewards can increase your child’s interest in using the toilet on their own.
You can prevent encopresis by avoiding constipation and creating positive toileting experiences for your child. You can do this by:
While you might see some progress early in treatment, it usually takes months for your child to overcome encopresis. There will be accidents along the way. Parents must keep their reactions to accidents low-key and continue to support the child. Most children who receive treatment for encopresis eventually are free from constipation and become accident-free as they grow older.
If you notice your child has symptoms of encopresis, visit their healthcare provider. It can be easier to treat encopresis and constipation early, at the first sign of a problem. If your child is not having any bowel movements, experiences pain or refuses to eat due to discomfort, visit your provider immediately.
When toilet training your child, accidents will happen. Sometimes, those accidents happen because your child didn’t make it to the toilet in time. Work with your child to help them understand when it is time to use the toilet by:
Sometimes children with encopresis lose the feeling in their body that tells them it is time to use the toilet. If they have constipation, the buildup of stool could stretch their colon, and they won’t feel the need to go until there is a large amount of stool. Once your child begins treatment to loosen their stool, they will need to re-learn when their body tells them it is time to use the toilet. This process could take several months, but be patient with your child as they better understand their body.
A note from Cleveland Clinic
It may be challenging as your child’s caretaker to deal with encopresis and frequently soiled clothes. Always be patient. Your child will notice if you are angry that they had an accident and they may hide future accidents from you as a result. Always provide positive encouragement for your child and have patience when you toilet train them. A good experience in the bathroom will help your child not be fearful of the toilet and will lead to fewer accidents.
Last reviewed by a Cleveland Clinic medical professional on 04/01/2022.
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