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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

Encopresis

Soiling; Incontinence - stool

Last reviewed: August 30, 2014.

If a child over the age of 4 has been toilet trained and then passes stool and soils clothes again, this is called encopresis. The child may or may not be doing this on purpose.

Causes

The child usually has constipation. The stool is hard, dry, and stuck in the colon (called fecal impaction). The child then passes only wet or almost liquid stool that flows around the hard stool. It may leak out during the day or night.

Other causes may include:

  • Not toilet training the child 
  • Starting toilet training when the child was too young
  • Emotional problems, like oppositional defiant disorder
  • Conduct disorder

Whatever the cause, the child may feel shame, guilt, or low self-esteem, and may hide signs of encopresis.

Factors that may increase the risk of encopresis:

  • Being male
  • Chronic constipation
  • Low socioeconomic status

Symptoms

Symptoms can include any of the following:

  • Being unable to hold stool before getting to a toilet (bowel incontinence)
  • Passing stool in inappropriate places (as in the child's clothes)
  • Keeping bowel movements a secret
  • Having constipation and hard stools
  • Sometimes passing a very large stool that almost blocks the toilet

Exams and Tests

The doctor may feel the stool stuck in the child’s rectum (fecal impaction). An x-ray of the child’s belly may show impacted stool in the colon.

Treatment

The goal is to:

  • Prevent constipation
  • Keep good bowel habits

It is best for parents to support, rather than criticize or discourage the child.

Treatments may include any of the following:

  • Giving the child laxatives or enemas to remove dry, hard stool.
  • Giving the child stool softeners.
  • Having the child eat a diet high in fiber (fruits, vegetables, whole grains) and drink plenty of fluids to keep the stools soft and comfortable.
  • Taking flavored mineral oil for a short period of time. This is only a short-term treatment because mineral oil interferes with the absorption of calcium and vitamin D.
  • Seeing a pediatric gastroenterologist when these treatments aren't enough. The doctor may use biofeedback, or teach the parents and child how to manage encopresis.
  • Seeing a psychotherapist to help the child deal with associated shame, guilt, or loss of self-esteem.

For encopresis without constipation, the child may need a psychiatric evaluation to find the cause.

Outlook (Prognosis)

Most children respond to treatment.

Possible Complications

  • If encopresis is not treated, the child may have low self-esteem and problems making and keeping friends.
  • If encopresis is not corrected, the child may develop chronic constipation.

When to Contact a Medical Professional

Call for an appointment with your health care provider if a child is over 4 years old and has encopresis.

Prevention

Toilet train in a positive way when the child is the right age.

If your child shows signs of constipation, such as dry, hard, or infrequent stools, ask your doctor how to treat it.

References

  1. Har AF, Croffie JM. Encopresis. Pediatr Rev. 2010;31:368-374. [PubMed: 20810701]
  2. Katz ER, DeMaso DR. Encopresis. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 21.4.

Review Date: 8/30/2014.

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Stimulant laxatives for constipation and soiling in childrenStimulant laxatives for constipation and soiling in children
    Constipation is a common childhood disorder traditionally treated with a combination of medical and behavioural approaches. There is insufficient evidence on the use and effectiveness of stimulant laxatives for the treatment of childhood constipation. More research is required.
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