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.