Encopresis (Soiling)

What is encopresis?

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.

What are the symptoms of encopresis?

Children with encopresis often have the following symptoms:

• Not being able to hold their stool until they get to a toilet.
• Passing stool in their clothes.
• Hiding bowel movements (poop) or keeping them a secret.
• Hiding soiled clothes.
• Not having regular bowel movements.
• Feeling bloated or experiencing pain in their abdomen or stomach.
• Loss of appetite.

What causes encopresis?

Encopresis can be caused by:

• Constipation.
• An underlying medical condition.
• Psychological causes.

Constipation

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.”

Underlying medical conditions

Encopresis could be a symptom of an underlying medical condition. Possible conditions that have encopresis as a symptom include:

• Colonic inertia: The colon doesn’t move stool as it should.
• Digestive tract nerve damage: Muscles at the end of the digestive tract (anus) don’t close properly.
• Hirschsprung disease: Nerve endings in the bowel are missing, which causes a blockage of the intestine so stool can’t pass.
• Infection or tear in the rectum.
• Dehydration (not drinking enough water).
• Malnutrition or diet consisting of too much fat and sugar.

Psychological causes

Encopresis could be the result of emotional stress, behavioral challenges or fear that affects the actions of your child. Psychological causes could include:

• The child is busy playing and doesn’t want to stop to go to the bathroom.
• Fear of the toilet.
• Stressful events in the child’s life, such as starting school.
• Availability of a toilet, especially a private one, or not wanting to use a public toilet.
• Oppositional defiant disorder: A pattern of disobedience toward authority figures.
• Behavioral problems: Your child has difficulty following rules or meeting social expectations.

How is encopresis diagnosed?

To diagnose encopresis, your healthcare provider will examine your child. Their exam could include:

• Questions about the child’s medical history, symptoms, emotional wellbeing (stress), toilet training and diet.
• Physical examination of your child.
• Rectal examination where your provider will insert a gloved, lubricated finger into their rectum to check for blockages and muscle tone.
• X-ray of your child’s abdomen.
• Psychological evaluation to determine the cause if it relates to emotional stress, fear or behavioral challenges.

Your provider might order additional urine tests to rule out similar conditions that will help them diagnose your child with encopresis.

How is encopresis treated?

Treatment is unique to each child diagnosed with encopresis and could include:

• Removal of any stool ball.
• Taking stool softeners, laxatives or enemas to ensure regular, soft stools.
• Scheduled toilet sitting.
• Eating a diet high in fiber (fruits, whole grains, vegetables).
• Drinking plenty of water.

How can parents help their child with encopresis?

Parents should encourage and offer support to their child by creating a “potty routine” to keep up with good bowel habits including:

• Scheduling regular bathroom visits after meals.
• Praising or rewarding your child for using the toilet regularly.
• Not scolding or yelling at your child if accidents happen.

Does my child need to see a specialist to treat encopresis?

Based on the severity of your child’s diagnosis, your provider might recommend taking your child to see:

• A psychologist to help your child work through the fear, shame or guilt they feel when going to the bathroom or having accidents, as well as any emotional stress your child may have.
• A gastroenterologist who specializes in treating gastrointestinal tract conditions and conditions that affect the colon.

What foods should my child avoid if they have encopresis?

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:

• Beans and lentils.
• Vegetables (broccoli, asparagus).
• Fruits (berries, apples).
• Whole grains (pasta, brown rice).

How soon after treatment will my child feel better?

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.

How can I prevent encopresis?

You can prevent encopresis by avoiding constipation and creating positive toileting experiences for your child. You can do this by:

• Eating a diet high in fiber.
• Staying hydrated and drinking a lot of fluids.
• Making sure your child gets plenty of exercise.
• Scheduling times to use the toilet after meals.
• Making your child’s toilet training experience positive with encouragement and support.

What can I expect if I have encopresis?

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.

When should I see my healthcare provider?

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.

What questions should I ask my doctor?

• Should I change my child’s diet to include more fiber?
• Does my child need to take laxatives or any medications?
• Will my child’s encopresis affect their ability to learn in school?

How do I teach my child to hold in their poop until they reach a toilet?

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:

• Scheduling times to use the toilet throughout the day, especially after meals.
• Teaching your child what it feels like when their body tells them that they need to use the toilet.
• Making sure your child knows where the bathroom is if they’re in a new environment.
• Encourage your child to stop what they are doing to use the bathroom.

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.