Encopresis

Alternative names 
Soiling; Incontinence - stool

Definition

Encopresis is the voluntary or involuntary passage of stools causing soiling of clothes by a child over 4 years of age. Otherwise known as overflow incontinence, encopresis results from chronic constipation.

See also bowel incontinence.

Causes, incidence, and risk factors
Encopresis can be divided into two groups. The first in which there is a physiologic basis for the encopresis, the second in which there seems to be an emotional basis.

  1. Encopresis frequently is associated with constipation and fecal impaction. Often, hard fecal material is retained in the colon, with a passage of soft or semi-liquid stool around the impacted stool. This problem is not under the conscious control of the child. Leakage of stool may occur during the day or night. There are rarely physical causes other than constipation (sometimes present since infancy).
  2. Other causes may be related to a lack of toilet training or training at too early an age or an emotional disturbance such as Oppositional Defiant Disorder or a Conduct Disorder.

Whatever the cause the child may develop associated shame, guilt, or loss of self-esteem. The child may try to hide the discovery of the problem. The incidence is not well documented but is thought to be about 1 percent. Risk factors include male gender, low socioeconomic status, and chronic constipation.

Symptoms

     
  • inability to retain feces (bowel incontinence)  
  • the passage of stool in inappropriate places (generally in the child’s clothes)  
  • secretive behavior associated with bowel movements  
  • evidence of constipation and hard stool

Signs and tests

     
  • Digital examination of the rectal vault may demonstrate a fecal impaction  
  • An abdominal X-ray may confirm impacted stool in the colon

Treatment

The goal is to prevent constipation and encourage good bowel habits. Laxatives, and sometimes enemas, are used to remove fecal impaction. A stool softener is often prescribed.

A diet high in fiber, including fruits, vegetables, whole grain products, and adequate fluid intake will promote the passage of softer stools and minimize the discomfort associated with bowel movements.

Parents should be supportive and refrain from criticism or discouragement. Pediatric gastroenterologists often provide education to the parents and child and use biofeedback for the child to treat the more difficult cases. Psychotherapy can help the child deal with associated shame, guilt, or loss of self-esteem. For encopresis in the absence of constipation, psychiatric evaluation may help determine the underlying cause.

Expectations (prognosis)
Most children respond to treatment.

Complications
The child may suffer from low self-esteem and peer disapproval related to this problem. If routine bowel habits are not developed, the child may suffer from chronic constipation.

Calling your health care provider
Call for an appointment with your health care provider if this behavior is noted in a child over 4 years old.

Prevention
Because the causes often are obscure prevention is difficult. As a general rule, refrain from too early and too coercive toilet training.

Johns Hopkins patient information

Last revised: December 7, 2012
by Sharon M. Smith, M.D.

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