Encopresis: What it is and how to manage it

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Encopresis is repeated episodes of stool soiling in children who are more than 4 years old.

For a diagnosis of encopresis, stool soiling must occur at least once a month for a minimum of 3 months. It must not be the direct result of a medical condition, or substance usage, such as medication.

Encopresis can result from biological, developmental, psychosocial, and environmental factors. Potential causes include:

Constipation

Doctors most commonly associate encopresis with chronic constipation and the withholding of a bowel movement. According to some research, 90–95% of children with the condition also experience constipation and stool retention.

When stool is hard and difficult to pass, it can become impacted in the rectum and colon. This is known as fecal impaction. Eventually, liquid stool begins to leak around the hard stool, leading to stool soiling.

Children may also avoid trying to pass stool when they are constipated because it hurts. This can make both constipation and encopresis worse.

Other physical causes

Other physical causes of chronic constipation and encopresis include:

• hypothyroidism
• inflammatory bowel disease (IBD)
• nerve damage, so the anal sphincter cannot close correctly, and leakage occurs
• rectal infections
• rectal tears

Emotional and psychosocial causes

Emotional issues can trigger encopresis.

The condition is more common among children from homes where abuse is happening. However, any incident that a child perceives as stressful may trigger stool soiling.

Examples of stress can include:

• early or difficult toilet training
• starting school
• moving home
• the death of a parent
• the birth of a sibling
• parental separation or divorce

Children with mental health conditions or a challenging family environment may be more at risk of encopresis.

Research indicates that children with encopresis are more likely than others to have:

• symptoms of anxiety and depression
• more disruptive behavior
• poor school performance
• social problems

Other causes and risk factors

Some other factors increase a child’s risk of developing encopresis and constipation. These include:

• Being male. Encopresis is approximately twice as common among boys as girls.
• Having a neurodevelopmental disorder. Having attention-deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) increases the risk of encopresis.
• Taking certain medications. Some medicines, especially those that cause constipation, increase the risk of encopresis.
• Dietary habits. Eating a high-fat or high-sugar diet increases the risk of chronic constipation. Lack of adequate fluid intake also raises the risk.
• Being inactivity. Children who do not engage in enough physical activity may develop constipation.
• Avoiding the passing of stool. Children who avoid passing stool because they are too busy playing or they fear public restrooms, for example, have a greater risk of constipation.

Signs and symptoms of encopresis include:

• needing to pass stool suddenly, with little warning
• avoiding bowel movements
• loose, watery stools resembling diarrhea
• constipation
• stomach pain
• passing very large, hard, dry stools
• rubbing the anal area, due to pain
• hiding soiled underwear
• loss of appetite
• feelings of stress, anxiety, or guilt

The treatment for encopresis depends on the severity of the condition and the child’s age, among other factors. Typically, the earlier a child begins treatment, the better the outlook.

Treatment usually involves one or more of the following:

Removing impacted stool

A doctor will typically begin treatment by removing the dry, impacted stool from the colon. To do this, they may recommend:

• enemas
• laxatives
• rectal suppositories

Encouraging regular bowel movements

It is essential that children learn healthy habits to encourage regular bowel movements and prevent a recurrence of constipation and encopresis.

Examples of these habits include:

• eating a balanced diet with plenty of fiber and fluids
• exercising daily to prevent constipation
• learning to go to the toilet as soon as they feel the need
• sitting on the toilet for a few minutes at regular times each day
• using stool softeners, with a doctor’s approval, to prevent further impaction
• stopping stool softener or laxative use slowly to support healthy bowel function
• using disposable training pants for accidents until bowel function returns to normal

Parents and caregivers may also want to arrange for testing for a child to look for allergies, such as dairy, that may contribute to constipation.

Psychotherapy

If emotional issues underlie encopresis, a child may benefit from psychotherapy. During therapy, they can explore the issues that are contributing to encopresis.

They can also learn healthier ways to cope with fear, shame, loss, and low self-esteem.

Caregiver support

Support from parents or other caregivers can play a pivotal role in helping children overcome encopresis.

It is essential not to shame, blame, or punish children for accidents. Instead, patient, positive reinforcement, and support can help them learn to overcome emotional distress and develop new bowel habits.

Individuals who think that their child may have encopresis or chronic constipation can consult their doctor.

A doctor can diagnose encopresis and recommend a course of treatment. Diagnosis may involve:

• a physical examination plus description of symptoms
• a full medical and family history
• an abdominal X-ray, to see stool volume in the intestine
• a barium enema to check for blockages or other intestinal problems
• a psychological evaluation if emotions are triggering physical symptoms

Most children with encopresis will overcome the condition with treatment and caregiver support. It may take several months for children to regain normal bowel function. During this time, relapses can be frequent.

It is important not to shame or blame children when they have accidents. Reassurance and positive enforcement can help them stick to the treatment program and make progress.

According to some studies, up to 30% of children with encopresis will continue to experience chronic constipation into adulthood. However, lifestyle changes and treatments can help them manage their symptoms and improve their quality of life.