What Is It?
Encopresis is when a child who is toilet trained passes stool (bowel movements) into his or her underwear. To have encopresis, the child must be at least four years old, the age by which most children can control bowel movements. Encopresis is also called fecal incontinence.
In most children, encopresis is related to chronic constipation. Constipation is when bowel movements don't occur often enough. Also, the stool is hard and dry.
When stool needs to be passed, it collects in the lower bowel (rectum). There, it stretches the bowel wall. This feeling of the bowel being stretched is what normally makes us realize we have to go to the bathroom.
However, if the bowel wall is stretched for long periods without passing a bowel movement, the rectum loses its normal muscle tone and feeling. This makes it harder and harder to pass the hard stool collecting in the rectum. Also it becomes more difficult for your child to know when stool is ready to be passed.
As newer stool continues to be made in the intestines, it leaks around the large chunk of hard stool. It passes out of the rectum, and soils the child's underpants. In almost all children with encopresis caused by constipation, this is not done on purpose. In fact, many children do not even realize that the stool has leaked out. The first clue that the child has a problem may come when someone notices that the child smells bad.
Chronic constipation that turns into encopresis can have many different causes. These include:
No matter what the initial cause of a child's chronic constipation, the end result is the same. A large chunk of stool builds up and stretches the rectum until it loses its normal tone and feeling. This makes it more difficult for the rectum to push out the stool. So, more and more stool builds up.
This unhealthy cycle can only be broken when the bowel is completely cleared of stool. At that point, the bowel can return to its normal size. Then a child can learn how to empty his or her bowel on a more regular schedule.
In rare cases, encopresis is related to:
Boys have encopresis more often than girls.
In most children with encopresis, the most obvious signs are:
Other signs and symptoms may include:
In rarer cases, when encopresis is caused by serious psychological problems, a child may drop or smear stool on floors, walls or furniture.
The doctor will begin by asking about your child's bowel habits, including:
The doctor also will ask about your child's diet, especially about:
Some doctors ask parents to keep a diary of the child's diet and stools for a week. This can help to figure out how best to treat the child. The doctor also will want to know about any unusual stresses in your child's life, either at home or at school.
The doctor will examine your child. He or she will look for any physical abnormalities in your child's abdomen, genital area or lower spine. He or she also may examine your child's rectum to look for any fissures or other abnormalities. The doctor may check to see how much stool is in the rectum.
In most cases, your doctor can diagnose encopresis based on your child's:
Usually no further tests are necessary. Sometimes an X-ray is done of the abdomen to see how much stool is present.
If the doctor thinks the problem may be related to abnormalities in your child's lower digestive tract, he or she may order additional tests. These may include an X-ray procedure called a barium enema or a procedure called a rectal biopsy.
In a biopsy, a small piece of tissue from the rectum is removed to be examined in a laboratory.
If your child has signs of hypothyroidism, your doctor may order blood tests to measure thyroid hormone levels.
With treatment, most children will recover from encopresis. The length of treatment varies greatly depending on the child and the circumstances. Almost all children with encopresis stop soiling by the time they reach their mid-teen years.
To help prevent encopresis caused by chronic constipation, you can:
Remember, even after your child has become completely toilet trained, occasional accidents will happen. It is important that you remain calm and casual as you change your child's soiled clothing. Try not to show disgust, disappointment or frustration with your child.
If your child has encopresis because of chronic constipation, treatment is a three-step process. It involves:
Your doctor also may suggest that you try motivating your child. One example is to use a "token and reward system." This typically involves using a colorful chart to keep track of your child's progress. A gold star or sticker is awarded for every "clean" day. When the chart is filled, your child will earn some sort of reward. Every child is different when it comes to what motivates them to change.
If your child has encopresis because of a neurological or developmental problem involving the digestive tract, your doctor will refer you to a specialist for treatment. The specialist may be a neurologist or gastroenterologist.
If your child's encopresis seems to be related to serious psychological problems, your doctor most likely will refer your child to a psychiatrist or other mental health professional.
When to Call a Professional
Call your doctor if your child is older than age four and consistently soils his pants with stool. Also call if your child has started soiling after being clean for many months or years. Call your doctor if your child frequently has constipation, even if he or she is not having a problem with encopresis.
Call your doctor immediately if your child begins to intentionally drop or smear stool anywhere, including around the home or school.
Most children with encopresis either outgrow the problem or respond to treatment. Treatment may involve changes in diet, medication and motivational therapy.
When encopresis is related to psychological or emotional problems, treatment may take longer.
National Digestive Diseases Information Clearinghouse (NDDIC)
2 Information Way
Bethesda, MD 20892-3570
American College of Gastroenterology (ACG)
P.O. Box 342260
Bethesda, MD 20827-2260
American Academy of Family Physicians (AAFP)
11400 Tomahawk Creek Parkway
Leawood, KS 66211-2672
American Academy of Pediatrics (AAP)
141 Northwest Point Blvd.
Elk Grove Village, IL 60007-1098