Encopresis Basics

Also known as soiling, encopresis is characterized by the repeated passage of feces in inappropriate places, such as clothing or on the floor, in a child over four. In this guide you'll learn how encopresis is identified, diagnosed and treated.

Encopresis: What Is It?

Encopresis is condition in which a child older than 4 repeatedly defecates in inappropriate places, such as clothing or the floor.

Some children with encopresis may have problems with their bowel functioning, including constipation and overflow incontenance. In some instances, often for unknown reasons, a child may resist having bowel movements; this causes impacted stools to build up in the colon and rectum, and liquid stool to leak out around it.  This liquid is hard for the child to control so it leaks out as fecal incontinence.

In cases where constipation or withholding stools is not at issue, the feces are a more normal consistency, and the defecation takes places at times and places that are inappropriate. It can be related to many disorders, including developmental disorders and even oppositional defiant disorder or conduct disorder.”

Encopresis: What to Look For

Encopresis is condition in which a child older than 4 repeatedly defecates in inappropriate places, such as clothing or the floor.

Some children with encopresis may have problems with their bowel functioning, including constipation and overflow incontenance. In some instances, often for unknown reasons, a child may resist having bowel movements; this causes impacted stools to build up in the colon and rectum, and liquid stool to leak out around it.  This liquid is hard for the child to control so it leaks out as fecal incontinence.

In cases where constipation or withholding stools is not at issue, the feces are a more normal consistency, and the defecation takes places at times and places that are inappropriate. It can be related to many disorders, including developmental disorders and even oppositional defiant disorder or conduct disorder.

Encopresis: Risk Factors

Encopresis is most often caused by constipation. If stool remains in the colon for too long without being passed, the stool loses water and hardens; it may then become painful for a child to expel it. As a result of associating bowel movements with pain, a child may begin avoiding bowel movements, which can lead to stool hardening in the colon again, which in turn can lead to another pain-ridden expulsion of feces. A child affected by this cycle can become conditioned to holding in his or her bowel movements to avoid pain. It is at this point that softer stool begins leaking out past the blocked stool and staining the child’s clothes. Children with prolonged constipation may lose muscle tone in their bowel, making it difficult to contain and expel stool. This tone must be restored as part of treatment.

Encopresis can also be associated with emotional and developmental difficulties that express themselves in an unwillingness or inability to have regular bowel movements. Some children experience particularly negative reactions to toilet training, aggravated by a variety of parental responses. Others develop encopresis in reaction to changes in social circomstances, such as when shifting from private to shared bathrooms at the beginning of preschool or kindergarten. Stress resulting from a move, parents divorcing and other major changes to a child’s environment can all trigger constipation that may eventually result in the cycle that leads to encopresis.

Children with encopresis associated with developmental disorders may have never been fully toilet trained, whereas children with other types of encopresis may have been toilet trained but developed the disorder in response to apparent environmental stressors.

Encopresis: Diagnosis

To be diagnosed with encopresis, a child must be at least the age of 4 and experience the repeated leakage or passage of feces into inappropriate places, such as the floor or her underwear, at least once a month for at least three months. Before making a diagnosis of encopresis, a doctor will rule out possible physiological factors such as food allergies or medicines that act as laxatives.

Encopresis: Treatment

Treatment for encopresis will typically involve cleaning out the colon and rectum, using stool-softening agents and beginning to build the habit of having frequent, healthy bowel movements. The initial cleaning of the colon and rectum is done using enemas, laxatives or both. During the next phase, a doctor will most likely continue to prescribe a daily dose of stool softeners or laxatives, to keep the child’s stool soft while her bowel returns from “stretched” to normal size.

The third part of treatment focuses on learning, or re-learning, healthy bowel movement habits. Doctors recommend that a child being treated for encopresis be required to sit on the toilet for 10-15 minutes per day at a regularly scheduled time, usually following a meal, and attempt to have a bowel movement. Doctors may also recommend dietary changes such as increased fiber and the reduction of constipation-causing foods. Over time, with the proper guidance, children can redevelop a positive association with regular, healthy bowel movements.

If a child has experienced feelings of shame, guilt or depression as a result of having encopresis, a knowledgeable psychotherapist can help her both understand those feelings and develop techniques for having regular healthy bowel movements.

Encopresis: Risk For Other Disorders

Encopresis can be embarrassing, and can prompt teasing from siblings and peers. Watch out for depression and low self-esteem as a result of this condition.