Learn About Encopresis

What is the definition of Encopresis?

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

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What are the alternative names for Encopresis?

Soiling; Incontinence - stool; Constipation - encopresis; Impaction - encopresis

What are the causes of Encopresis?

The child may have 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, such as oppositional defiant disorder or 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 include:

  • Chronic constipation
  • Low socioeconomic status

Encopresis is much more common in boys than in girls. It tends to go away as the child gets older.

What are the symptoms of Encopresis?

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
  • Passing a very large stool sometimes that almost blocks the toilet
  • Loss of appetite
  • Urine retention
  • Refusal to sit on toilet
  • Refusal to take medicines
  • Bloating sensation or pain in the abdomen
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What are the current treatments for Encopresis?

The goal of treatment 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 are not 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.

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What is the outlook (prognosis) for Encopresis?

Most children respond well to treatment. Encopresis often recurs, so some children need ongoing treatment.

What are the possible complications of Encopresis?

If not treated, the child may have low self-esteem and problems making and keeping friends. Other complications may include:

  • Chronic constipation
  • Urinary Incontinence
When should I contact a medical professional for Encopresis?

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

How do I prevent Encopresis?

Encopresis can be prevented by:

  • Toilet training your child at the right age and in a positive way.
  • Talking to your provider about things you can do to help your child if your child shows signs of constipation, such as dry, hard, or infrequent stools.
What are the latest Encopresis Clinical Trials?
Non-invasive Sacral Nerve Stimulation in Children and Adolescents With Chronic Constipation: a Case-control Study on External Neuromodulatory Treatment

Summary: The purpose of this study is to assess the efficacy of additional neuromodulation for treatment of chronic constipation in pediatric patients

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A Multidisciplinary Approach to the Treatment of Encopresis in Children With Autism Spectrum Disorders

Summary: This study is comparing a multidisciplinary intervention for encopresis (MIE), consisting of both medical and behavioral components to treatment as usual control (TAU). Participants are first screened by a pediatric gastroenterologist and assessed and treated for any constipation or other potential medical complications. Following this, caregivers collect data on bowel movements and continence dur...

What are the Latest Advances for Encopresis?
Long term evaluation of transanal surgery with automatic suture in Hirschsprung's disease.
The impact of bowel management on the quality of life in children with spina bifida with overactive bladder and detrusor sphincter dyssynergia.
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Long-term outcomes of antegrade continence enema in children with chronic encopresis and incontinence: what is the optimal flush to use?
Who are the sources who wrote this article ?

Published Date: August 29, 2020
Published By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Marcdante KJ, Kliegman RM. Digestive system assessment. In: Marcdante KJ, Kliegman RM, eds. Nelson Essentials of Pediatrics. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 126.

Noe J. Constipation. In: Kliegman RM, Lye PS, Bordini BJ, Toth H, Basel D, eds. Nelson Pediatric Symptom-Based Diagnosis. Philadelphia, PA: Elsevier; 2018:chap 16.