Encopresis

Overview

Encopresis (en-ko-PREE-sis) is the repeated passing of stool into clothing in a child who has already been toilet trained. The passing of stool usually cannot be controlled. Encopresis typically happens when impacted stool collects in the colon and rectum. The colon becomes too full and liquid stool leaks around the retained stool, staining underwear. Eventually, stool retention can cause stretching, also called distention, of the bowels and loss of control over bowel movements. Encopresis is sometimes called fecal incontinence or soiling.

Encopresis usually happens after age 4, when a child has already learned to use a toilet. In most cases, soiling is a symptom of long-standing constipation. Rarely, it happens without constipation. In these cases, emotional issues may be the cause.

Encopresis can be frustrating for parents — and embarrassing for the child. However, with patience and positive reinforcement, treatment is usually successful.

When to see a doctor

Call your child's healthcare team if your child is already toilet trained and starts experiencing one or more of the symptoms listed above.

Risk factors

Encopresis is more common in boys than in girls. These risk factors may increase the chances of having encopresis:

• Using medicines that may cause constipation, such as cough suppressants.
• Attention-deficit/hyperactivity disorder (ADHD).
• Autism spectrum disorder.
• Anxiety or depression.

Prevention

Below are some strategies that can help prevent encopresis and its complications.

Avoid constipation

Help your child avoid constipation by providing a balanced diet that's high in fiber and encouraging your child to drink enough water.

Learn about effective toilet training techniques

Educate yourself on effective toilet training techniques. Avoid starting too early or being too forceful in your methods. Wait until your child is ready, and then use positive reinforcement and encouragement to help make progress. Ask your child's healthcare team about resources on toilet training.

Get early treatment for encopresis

Early treatment, including guidance from your child's medical professional or mental health professional, can help prevent the social and emotional impact of encopresis. Regular follow-up visits with a medical professional or mental health professional can help identify ongoing or recurring problems so that adjustments in treatment can be made as needed.

Treatment

Generally, the earlier that treatment begins for encopresis, the better. The first step involves clearing the colon of retained, impacted stool. After that, treatment focuses on encouraging healthy bowel movements. In some cases, psychotherapy may be a helpful addition to treatment.

Clearing the colon of impacted stool

There are several methods for clearing the colon and relieving constipation. One or more of the following will likely be recommended:

• Certain laxatives.
• Rectal suppositories.
• Enemas.

Close follow-up to check the progress of the colon clearing may be recommended.

Encouraging healthy bowel movements

Once the colon is cleared, it's important to encourage your child to have regular bowel movements. A healthcare professional may recommend:

• Dietary changes that include getting more fiber and drinking enough fluids.
• Laxatives, then gradually discontinuing them once the bowel returns to typical function.
• Training your child to go to the toilet as soon as possible when the urge to have a bowel movement happens.
• A short trial of going off cow's milk or checking for cow's milk intolerance, if indicated.

Behavior modification

A medical or mental health professional can discuss techniques for teaching your child to have regular bowel movements. This is sometimes called behavior modification or bowel retraining.

Psychotherapy with a mental health professional may be recommended if the encopresis may be related to emotional issues. Psychotherapy also may be helpful if your child feels shame, guilt, depression or low self-esteem related to encopresis.

Preparing for your appointment

You'll likely first bring up your concerns with your child's healthcare team. You may be referred to a doctor who specializes in digestive disorders in children, called a pediatric gastroenterologist. If your child is distressed, very embarrassed, frustrated or angry because of encopresis, a mental health professional may be recommended.

What you can do

It's a good idea to be prepared for your child's appointment. Ask if there's anything you need to do in advance, such as modify your child's diet. Before your appointment, make a list of:

• Your child's symptoms, including how long they've been occurring.
• Key personal information, such as any major stresses or recent life changes.
• All medicines, including nonprescription medicines and any vitamins, herbs or other supplements that your child is taking, and the doses.
• What your child eats and drinks on a typical day, including the amount and types of dairy products, types of solid foods, and the amount of water and other fluids.
• Questions to ask during the appointment.

Some basic questions to ask include:

• What's the most likely cause of my child's symptoms?
• Are there other possible causes for these symptoms?
• What kinds of tests does my child need? Do these tests require any special preparation?
• How long might this problem last?
• What treatments are available, and which do you recommend?
• What side effects can be expected with this treatment?
• Are there alternatives to the primary approach that you're suggesting?
• Are there any dietary changes that might help?
• Would more physical activity help my child?
• Are there any brochures or other printed material that I can have?
• What websites do you recommend?

What to expect from your doctor

Be ready to answer questions from your child's healthcare team. Questions may include:

• How long has your child been toilet trained?
• Did your child experience any problems with toilet training?
• Does your child have hard, dry stools that sometimes clog the toilet?
• How often does your child have a bowel movement?
• Does your child take any medicines?
• Does your child regularly resist the urge to use the toilet?
• Does your child experience painful bowel movements?
• How often do you notice stains or fecal matter in your child's underwear?
• Have there been any significant changes in your child's life? For instance, has your child started a new school, moved to a new town, or experienced a death or divorce in the family?
• Is your child embarrassed or depressed by this condition?
• How have you been managing this issue?
• If your child has siblings, how was their toilet training experience?