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Encopresis—Child

Definition

Encopresis is the passage of stool in places other than the toilet. It is often done without control. It can happen in children older than four years of age.

Causes

The most common cause is chronic constipation. Large amounts of hard, dry stool can make it hard to know when to go to the bathroom. This can cause liquid stool to leak around the hard mass of stool.

Other causes may be:

  • Dietary problems, such as lack of fiber in the diet and not drinking enough water
  • Lack of activity
  • Mental health or emotional problems, including conduct disorders and sexual abuse
  • Problems or malformations in the intestines
  • Certain medicines that may cause constipation

Risk Factors

This problem is more common in boys and in children who are 5 to 10 years of age. Other things that may raise the risk are:

  • Constipation
  • Poor toilet training or refusal to use the toilet for bowel movements
  • Having other family members who had encopresis
  • Stress
  • Being overweight

Anal fissure and fistula

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Symptoms

The main symptom is the accidental passage of stool, usually into the underwear. Other problems may be:

  • Infrequent bowel movements
  • Trying to avoid bowel movements
  • Passing small amounts of liquid stool
  • Pain or bleeding when stool passes
  • Belly pain
  • Passing urine without control

When Should I Call the Doctor?

Call the doctor if your child is passing stool in places other than the toilet.

Diagnosis

The doctor will ask about your child's symptoms and health history. A physical exam will be done. A digital rectal exam may be done to check for hard, dry stool in the rectum.

Images may be taken of the abdomen to check for stool in the rectum. This can be done with an x-ray.

Treatment

The goal of treatment is to help stool pass on a regular basis. Choices are:

  • An enema to inject fluid in the colon to empty stool from the body
  • Medicines, such as:
    • Laxatives to help stool pass
    • Stool softeners to make it easier to pass stool on a regular basis
  • Retraining the bowels to have regular movements at the same time each day
  • Dietary changes, such as drinking plenty of water and eating foods that are high in fiber
  • Mental health counseling to address emotional or behavioral issues

Prevention

The risk of this problem may be lowered by:

  • Offering a high fiber diet and plenty of fluids
  • Encouraging regular exercise
RESOURCES:

Family Doctor—American Academy of Family Physicians
https://familydoctor.org

National Institute of Diabetes and Digestive and Kidney Diseases
https://www.niddk.nih.gov

CANADIAN RESOURCES:

Canadian Digestive Health Foundation
http://www.cdhf.ca

Health Canada
https://www.canada.ca

REFERENCES:

Fecal incontinence in children (encopresis). EBSCO DynaMed website. Available at: https://www.dynamed.com/approach-to/fecal-incontinence-in-children-encopresis. Accessed March 15, 2021.

Fecal soiling. Healthy Children—American Academy of Pediatrics website. Available at: https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Fecal-Soiling.aspx. Accessed March 15, 2021.

Nurko S, Scott SM. Coexistence of constipation and incontinence in children and adults. Best Pract Res Clin Gastroenterol. 2011 Feb;25(1):29-41.

Soiling (encopresis). Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/en/parents/encopresis.html. Accessed March 15, 2021.

Stool soiling and constipation in children. Family Doctor—American Family Physician website. Available at: https://familydoctor.org/stool-soiling-and-constipation-in-children. Accessed March 15, 2021.

Last reviewed December 2020 by EBSCO Medical Review Board Daniel A. Ostrovsky, MD  Last Updated: 03/15/2021