Encopresis: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Encopresis?
A pediatrician, a doctor who treats children, usually manages encopresis. If treatment is not enough, a pediatric gastroenterologist, a children's digestive system doctor, may help. A psychotherapist, a counselor, can help with feelings such as shame. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is encopresis?
Encopresis means passing stool into underwear after the age when children usually use the toilet regularly. Doctors use the word when a child over 4 years old has been toilet trained and still passes stool and soils clothes.
Encopresis is not a disease. It is a sign that the bowel is not working normally, most often because of long-term constipation. Constipation means having hard, dry stools that are hard to pass.
Encopresis happens more often in boys than in girls. It tends to go away as the child gets older.
Symptoms
The main sign is stool in a child's underwear or clothes. Softer or liquid stool can leak around hard stool and stain the underwear. Many children do not realize this is happening. Other signs can include:
- Being unable to hold stool before getting to a toilet.
- Keeping bowel movements a secret.
- Constipation and hard stools.
- Passing a very large stool that may block the toilet.
- Loss of appetite.
- Refusing to sit on the toilet.
The child may feel shame, guilt, or low self-esteem, and may hide signs of encopresis.
Causes and who gets it
The most common cause is constipation. Stool gets stuck in the colon, the large intestine, and becomes hard and dry. 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.
As stool builds up, it stretches the colon. The nerves that tell a child they need to poop become less sensitive, so the child may not feel the urge to use the toilet. Stool then becomes larger, harder, and painful to pass. This can make children avoid the bathroom, which makes constipation worse.
Children most often get constipated from holding in their stool to avoid or delay a bowel movement. Some feel stressed about potty training, feel embarrassed to use a public bathroom, or fear a painful bowel movement.
Encopresis is not caused by laziness, defiance, or bad behavior. It is not caused by poor parenting or lack of discipline. It is not related to family income, family size, or the parents' age.
How doctors diagnose it
A doctor may feel for stool stuck in the child's rectum, the end of the large intestine. An x-ray of the belly may show stool stuck in the colon. The doctor may also check the nervous system for a spinal cord problem.
Other tests may include:
- A urine test.
- A thyroid function test.
- Screening tests for celiac disease.
If constipation does not improve with nutrition changes, a doctor may use bowel function tests, such as colorectal transit studies. These tests help a doctor see how well stool moves through the colon.
Treatment
Most children respond well to treatment. Treatment happens in steps and should be supervised by a doctor. The goals are to prevent constipation and keep good bowel habits.
First, the bowel may need to be emptied. For a short time, a child may need laxatives or enemas. Do not give a child a laxative unless a doctor tells you to.
After that, children often take a daily stool-softening medicine. They also sit on the toilet at regular times, often after meals, and eat foods with fiber and drink enough fluids. This phase usually lasts several months or longer.
Parents should support the child rather than criticize or discourage the child. Some families use simple reward systems, like stickers or charts. A pediatric gastroenterologist may use biofeedback or teach the parents and child how to manage encopresis when these treatments are not enough. A psychotherapist can help the child deal with shame, guilt, or low self-esteem.
When to see a doctor
Contact your child's doctor for an appointment if a child is over 4 years old and has encopresis. Take your child to a doctor right away if your child has constipation and bleeding from the rectum, blood in the stool, bloating, constant belly pain, vomiting, or weight loss.
Without treatment, a child may have low self-esteem and problems making and keeping friends.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. A direct primary care or concierge doctor can examine your child and start a treatment plan. They can also refer your child to a pediatric gastroenterologist or a psychotherapist when treatment is not enough.
Common questions
Is encopresis caused by bad behavior?
No, encopresis is not caused by laziness, defiance, or bad behavior. Blaming, shaming, or punishing a child does not help.
Does encopresis go away?
Yes, most children improve with treatment. Encopresis often comes back, so some children need ongoing treatment.
Is encopresis the same as diarrhea?
No, but stool in the underwear can look like diarrhea. In encopresis, wet or almost liquid stool leaks around hard stool stuck in the colon.
Can encopresis be prevented?
Parents can help prevent encopresis by toilet training their child at the right age and in a positive way. They can also talk to their child's doctor if the child shows signs of constipation, such as dry, hard, or infrequent stools.
Sources
- MedlinePlus - Encopresis
- HealthyChildren.org - Encopresis (Fecal Soiling) in Children
- NIDDK - Constipation in Children
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
