Encopresis (soiling)

Overview

What is encopresis?

Encopresis is a disorder in which a child who has already been toilet-trained is having bowel movements when he or she is not on the toilet. Other terms for this are soiling and fecal incontinence. Encopresis is a diagnosis for children who are at least four years old and still soiling their clothes. It is more common in boys than girls.

Symptoms and Causes

What causes encopresis?

The most common cause of encopresis is chronic (long-term) constipation, which makes the stool hard and dry, and makes it difficult to have a bowel movement. Encopresis with constipation is sometimes called “retentive encopresis.” Liquid stool might leak out around the harder stool, and parents might mistake this for diarrhea.

Encopresis has both physical and emotional causes, which are sometimes linked. Encopresis can be related to the following:

  • Too much fat and sugar in the diet, which makes it more likely that a child will become constipated
  • Not drinking enough water
  • The child is busy playing, and doesn’t want to stop to go to the bathroom.
  • A lack of exercise
  • Stressful events in the child’s life, such as a new school, marital problems between the father and mother, etc.
  • Availability of a toilet, especially a private one (for example, when the child begins going to school)
  • Stress during the process of toilet training
  • A physical problem in the colon, such as colonic inertia (stool doesn’t move normally through the colon)
  • Hirschsprung disease, a birth defect in which nerve endings in the bowel are missing, which causes a blockage of the intestine so that stool cannot pass through
  • Oppositional defiant disorder, a pattern of disobedience and hostility toward authority figures (including parents)
  • Behavioral problems (the child has difficulty following rules or social expectations)

What are the signs and symptoms of encopresis?

Children with encopresis often have the following signs and symptoms:

  • A poor appetite
  • Pain in the abdomen
  • Hiding their soiled clothes
  • Large, infrequent bowel movements that may clog the toilet
  • Delaying or avoiding going to the bathroom because it’s uncomfortable. This makes things worse, because stool can become packed in the colon. The colon then grows larger, which makes it harder to feel the congestion that tells the child it’s time to go to the bathroom.

Diagnosis and Tests

How is encopresis diagnosed?

To diagnose encopresis, the doctor will do a physical exam, which might include a rectal examination (the doctor inserts a gloved, lubricated finger into the rectum). The doctor will also ask about the child’s history of difficulty with bowel movements.

In some cases, the doctor will order an X-ray of the child’s abdomen. This might include a barium enema, which uses a fluid that makes the X-ray image clearer.

The doctor will want to know about the child’s toilet-training history and diet. The doctor may ask how the child feels about the problem, and about changes that have happened in his or her life. A psychological evaluation is another possible tool for finding the cause of a child’s encopresis.

Management and Treatment

How is encopresis treated?

The first step in treating encopresis is cleaning impacted stool out of the colon. A doctor may give the child enemas, laxatives and medication to soften the stool. If the colon has expanded to make room for a large volume of hard stool, those muscles will need time to return to their normal size.

Parents can help by encouraging the child to establish good bowel habits. This can be done by scheduling regular bathroom visits after meals -- at the time the child is most likely to have a bowel movement -- and making that a pleasant experience, rather than something the child dreads. Parents should praise and reward the child for sitting on the toilet, and avoid scolding if nothing happens.

Changes in diet are also part of the strategy. Eating high-fiber foods, including fruits, vegetables and certain breads and cereals, and drinking enough water can help to soften stool. Junk food with high fat and sugar content should be limited.

Prevention

How can encopresis be prevented?

The best way to prevent encopresis is by avoiding constipation with a high-fiber diet, and making sure the child drinks lots of water and gets plenty of exercise.

When your child is ready for toilet training, make it a positive experience. Try to avoid putting pressure on the child.

Outlook / Prognosis

What is the outlook for children who have encopresis?

While you might see some progress early in treatment, it usually takes months to overcome encopresis. There will be accidents along the way. It’s important that parents keep their reactions to accidents low-key and continue to support the child. Most children who are treated for encopresis eventually are free from chronic constipation.

Living With

When should I call the doctor about my child’s encopresis?

Encopresis is easier to treat if it’s addressed quickly, so if you see symptoms that cause you to suspect it, call your doctor.

Last reviewed by a Cleveland Clinic medical professional on 05/31/2018.

References

  • American Academy of Pediatrics. Soiling (Encopresis). (https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Soiling-Encopresis.aspx) Accessed 6/1/2018.
  • American Academy of Child & Adolescent Psychiatry. Encopresis: Problems with Soiling and Bowel Control. (https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Problems-With-Soiling-and-Bowel-Control-048.aspx) Accessed 6/1/2018.
  • International Foundation for Functional Gastrointestinal Disorders. Colonic Inertia. (https://www.aboutconstipation.org/colonic-inertia.html) Accessed 6/1/2018.
  • National Institute of Diabetes and Digestive and Kidney Diseases. Hirschsprung Disease. (https://www.niddk.nih.gov/health-information/digestive-diseases/hirschsprung-disease) Accessed 6/1/2018.

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