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What is encopresis?

Encopresis (or soiling) is a disorder in which a child over the age of four repeatedly poops in places other than the toilet, like their clothes or the floor. Some children with encopresis have problems with normal pooping, like constipation. Some children are afraid or anxious about pooping, so they try to hold it. In either case, not pooping for a long time makes it so the child can’t control it when they do finally poop. In some cases, when the encopresis is not because of constipation or holding it on purpose, it may be a sign of another psychiatric disorder.

What are the symptoms of encopresis?

Encopresis is diagnosed when a child is over the age of four and often poops in places other than the toilet, like in their clothes or on the floor.

What are the risk factors for encopresis?

Constipation is the most likely cause of encopresis. When a child becomes constipated then pooping can be painful and so the child tries not to poop at all. This causes the poop to get hard and then it’s even more painful for the child to defecate. This pattern causes the child to hold it to avoid the pain. After a while, the softer poop behind the hard poop leaks out at times and places the child can’t control.

Other times, encopresis happens when a child has a bad experience with toilet training or when they start school and have to use a public or shared bathroom for the first time.

Other upsetting things in a child’s life — like moving or parents getting a divorce — can cause constipation that leads to encopresis.

Encopresis sometimes goes along with developmental disorders. In those cases, the child might never have been toilet trained. When kids who have already been toilet trained develop encopresis, the cause is usually some kind of stressful experience.

How is encopresis diagnosed?

A child must be at least the age of four and poop in places like their underwear or the floor. It must happen at least once a month for at least three months. Before making a diagnosis of encopresis, a doctor will rule out things like food allergies or medicines that act as laxatives.

How is encopresis treated?

There are a few steps to treating encopresis:

  • First, a doctor will give the child something like a laxative to help get out built-up poop.
  • Then, the child will take a smaller daily dose of a medicine to keep their poop soft so that it doesn’t hurt when they go.
  • The third part of treatment is teaching the child to poop normally. This usually means having them sit on the toilet for 10–15 minutes at the same time every day (usually after eating), to get them used to pooping in a regular way that doesn’t hurt. The doctor might also recommend changes in the child’s diet.
  • If the child has feelings of shame or guilt about their encopresis, a therapist can help them deal with those feelings and learn ways of pooping normally.

Risk for other disorders

Kids with encopresis are often teased by siblings and classmates. Parents should watch out for low self-esteem and depression in children with encopresis.