Encopresis is a condition that affects children over the age of four, who have repeated episodes of soiling their underwear with stool. It is frequently associated with chronic constipation, but it can also be caused by emotional or psychological factors. In spite of the frustration and embarrassment it can cause, it can be treated with positive reinforcement and patience by both the child and the parents.
The most common cause of encopresis is constipation, which means having hard, dry, and painful stools that are difficult to pass. Constipation can be caused by:
A low-fiber diet
Not drinking enough fluids
Not getting enough exercise
Holding in stool due to fear of using the toilet or pain
Changes in the child’s routine, such as toilet training, starting school, or traveling
When a child is constipated, the stool can build up in the colon and rectum, stretching and weakening the muscles and nerves that control bowel movements. This can lead to:
Leakage of liquid or soft stool around the hard stool, staining the underwear
Loss of sensation and control over bowel movements
Enlargement of the colon, which can affect the child’s appetite and cause abdominal pain
Less commonly, encopresis can be caused by emotional or psychological factors, such as:
Stress, anxiety, or trauma
Behavioral problems, such as oppositional defiant disorder or conduct disorder
Sexual abuse
Poor self-esteem or body image
Fear of using public toilets or unfamiliar bathrooms
The main symptom of encopresis is soiling the underwear with stool, which can be mistaken for diarrhea. Other symptoms may include:
Constipation, which means having fewer than three bowel movements per week, or having hard, dry, and painful stools
Abdominal pain or bloating
Loss of appetite or nausea
Urinary problems, such as bedwetting, daytime wetting, or urinary tract infections
Emotional problems, such as shame, guilt, anger, or depression
Social problems, such as isolation, bullying, or teasing
To diagnose encopresis, the doctor will ask about the child’s medical history, bowel habits, diet, and emotional well-being. The doctor will also perform a physical examination, which may include:
Checking the child’s abdomen for signs of distension or tenderness
Feeling the child’s rectum for signs of stool impaction or anal fissures
Taking the child’s temperature, blood pressure, and pulse
Ordering blood tests, urine tests, or stool tests to rule out other conditions
In some cases, the doctor may also order imaging tests, such as:
X-rays, to see the size and shape of the colon and rectum, and the amount and location of stool
Ultrasound, to see the movement and function of the colon and rectum
Anorectal manometry, to measure the pressure and coordination of the muscles and nerves in the anus and rectum
Colonic transit study, to measure how long it takes for stool to move through the colon
The treatment of encopresis depends on the cause and severity of the condition, but it usually involves a combination of:
Medications, such as laxatives, stool softeners, or enemas, to help the child pass the stool and prevent constipation
Dietary changes, such as increasing the intake of fiber, fluids, and fruits and vegetables, to help the stool become softer and easier to pass
Behavioral changes, such as establishing a regular toilet routine, using positive reinforcement, and avoiding punishment or criticism, to help the child overcome the fear or embarrassment of using the toilet
Psychological counseling, such as cognitive-behavioral therapy, family therapy, or play therapy, to help the child cope with the emotional or psychological issues that may contribute to encopresis
The treatment of encopresis may take several weeks or months, depending on the child’s progress and cooperation. The goal of treatment is to:
Clear the colon and rectum of stool
Restore normal bowel function and sensation
Prevent recurrence of constipation and soiling
Improve the child’s self-esteem and quality of life
Encopresis can be prevented by:
Encouraging the child to have a balanced diet that is rich in fiber, fluids, and fruits and vegetables
Encouraging the child to get enough exercise and physical activity
Encouraging the child to use the toilet regularly, preferably after meals, and to avoid holding in stool
Providing the child with a comfortable and private toilet environment, with a stool or a footrest to support the feet
Praising the child for using the toilet and having normal bowel movements, and avoiding punishment or criticism for soiling
Monitoring the child’s bowel habits and seeking medical help if constipation or soiling persists or worsens
Supporting the child’s emotional and social well-being, and addressing any stressors or problems that may affect the child’s bowel function
With proper diagnosis, treatment, and prevention, encopresis can be overcome and the child can live a happy and healthy life.
