Encopresis

Written by April Kahn | Published on August 20, 2012
Medically Reviewed by George Krucik, MD

What is Encopresis?

Encopresis is also known as fecal soiling. It occurs when a child over the age of 4 years has a bowel movement and soils his or her pants. This behavior is often linked to constipation.

Constipation occurs when stool becomes backed up in the intestines. Treating constipation is fairly easy and will typically eliminate soiling.

What Causes a Child to Develop Encopresis?

Fecal matter can become hard and difficult to pass if your child does not get enough fiber, water, or exercise. This can cause bowel movements to be painful. Then liquid fecal matter or soft poop can leak into a child’s underpants. This is known as soiling. The child cannot consciously control soiling.

Encopresis is caused by hard fecal matter blocking the rectum. The body needs to dispel waste and is forced to leak the feces around the blockage. The intestines may become so enlarged that your child loses the sensation of needing to poop.

Common causes of encopresis include:

  • fewer than one bowel movement every three days
  • a low-fiber diet
  • little to no exercise
  • a lack of water
  • toilet training too early

Psychological causes may include:

Just because encopresis is associated with psychological causes does not mean that the symptoms are under your child’s control. They are not soiling themselves on purpose. The problem may begin because of controllable worries, such as fear of using a public toilet, but it becomes involuntary over time.

Factors Increasing Your Child’s Risk

Certain common risk factors increase your child’s likelihood of developing encopresis. These include:

  • repeated bouts of constipation
  • changing your child’s toileting routine
  • poor toilet training

According to the Children’s Hospital of Pittsburgh, boys are six times more likely to develop encopresis than girls. (CHP)

Other less common risk factors for encopresis include:

  • health conditions causing constipation, such as diabetes or hypothyroidism
  • sexual abuse
  • emotional and behavioral disturbances
  • tissue tear in the rectum

Signs and Symptoms of Encopresis

The most common sign of encopresis is soiled underpants. Constipation may be a precursor of encopresis. If your child has not had a bowel movement in three days, he or she may be constipated.

Children may also experience shame and guilt as a result of soiling. They may even be teased at school, if their classmates find out about the problem. As a result, some children may show signs of secretive behavior around the issue. For example, they may hide their soiled underwear.

How Is Encopresis Diagnosed?

Encopresis is typically diagnosed based on reported symptoms, medical history, and a physical exam. The physical exam may involve an examination of the rectum. The physician will be looking for a large amount of dried and hard fecal matter.

An abdominal X-ray can help determine the amount of fecal buildup.

A psychological evaluation may be used to look for an underlying emotional cause for this problem.

How Is Encopresis Treated?

Removing the Blockage

Your child’s physician might prescribe or recommend a product to remove the blockage and relieve constipation. Such products may include:

  • mineral oil
  • enemas
  • laxatives

Lifestyle Changes

There are several lifestyle changes that can help your child overcome encopresis.

Adopting a diet high in fiber will encourage the flow of bowel movements. Examples of high-fiber foods include strawberries, raisin bran, beans, grapes, and broccoli.

Drinking eight 8-oz. glasses of water daily can help keep stools soft for easy passage. Restricting caffeine consumption can also assist in preventing dehydration.

Exercising daily aids in moving matter through the intestines. Encourage your child to exercise regularly. Limiting media time may increase your child’s activity level.

Behavior Modification

Employ behavioral techniques to reward your child for using the toilet, eating high-fiber foods, and not soiling his or her pants. Rewards can range from positive praise to tangible objects, as long as there is consistency. Avoid scolding your child for soiling. This can induce anxiety toward toileting. Instead, try to stay neutral after a soiling incident.

Psychological Counseling

If emotional distress or an underlying behavioral problem is present, your child may need psychological counseling. A counselor can help address contributing issues. They can help children develop coping skills and build self-esteem. They can also teach effective behavior modification techniques to parents.

How Can I Help My Child Avoid Encopresis?

Adopt a healthy approach to toilet training your child. Do not start toilet training until your child is ready. Typically, children are not ready for training until after they turn 2 years old. Other ways to prevent encopresis include:

  • making certain your child eats high-fiber foods
  • encouraging your child to drink plenty of water
  • exercising regularly with your child
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