Encopresis, also known less formally as soiling, is categorized in the DSM-5 as an elimination disorder and is defined as the repeated passage of feces into inappropriate places. The behavior can be either deliberate or accidental, though in most cases it is involuntary, often resulting from a long period of holding in bowel movements. It can only be diagnosed in children over the age of four, which is past the usual age when children become potty trained. The soiling often results from a child resisting bowel movements until the stool becomes impacted, and softer stool leaks out around the blockage, into his underwear.
- Passing of feces in inappropriate places such as clothing or the floor at least once a month for at least three months, over the age of four years old. (For developmentally delayed children, it is diagnosed when their mental age is older than four.)
- Passage of feces that is not exclusively caused by a medical condition or a substance such as a laxative
- Constipation due to psychological reasons or dehydration, leading to involuntary leakage or passage of feces
- Smearing involuntarily passed feces as an effort to hide it or clean it up
- Feelings of shame and avoidance of situations that could cause embarrassment
Doctors may recommend medication such as laxatives or stool softener to empty the rectum and enable frequent bowel movements. Then the child needs to learn, or relearn, health bowel movement habits, including trying to move the bowels once a day. The goal is to eventually wean children off medication.
In the case of deliberate passing of feces, symptoms of oppositional defiant disorder and conduct disorder may also be present. Enuresis, which is a repeated passage of urine in inappropriate places such as beds or clothes, over the mental age of five, also tends to appear in children with encopresis.