What is encopresis?

Encopresis is also known as fecal soiling. It occurs when a child (usually over the age of 4) has a bowel movement and soils their pants. This problem is most often linked to constipation.

Constipation occurs when stool becomes backed up in the intestines. Treating constipation will typically eliminate soiling, though it may take time.

Symptoms of encopresis

The most common symptom of encopresis is soiled underpants. Constipation happens before encopresis, but may not be recognized. If your child hasn’t had a bowel movement in three days or passes hard, painful stools, they may be constipated.

Other symptoms may include:

Your child 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.

What causes a child to develop encopresis?

Fecal matter can become hard and difficult to pass if your child doesn’t get enough fiber, water, or exercise, or if they hold in a bowel movement. This can cause bowel movements to be painful. Liquid fecal matter or a soft bowel movement can then leak around the hard stool in the rectum and into a child’s underpants. The child can’t consciously control this soiling.

In some cases, the intestines may become so enlarged from fecal blockage that your child loses the sensation of needing to poop.

Common causes of constipation leading to 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

Less common psychological causes may include:

  • behavioral problems, such as conduct disorder
  • familial, school, and other stressors
  • anxiety over toileting

Just because encopresis is associated with psychological causes doesn’t mean that the symptoms are under your child’s control. They’re most likely not soiling themselves on purpose. The problem may begin because of controllable situations, such as fear of using a public toilet or not wanting to be toilet trained, 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 Stanford Children’s Health, boys are six times more likely to develop encopresis than girls. The reason for this difference is unknown.

Other less common risk factors for encopresis include:

  • health conditions causing constipation, such as diabetes or hypothyroidism
  • sexual abuse
  • emotional and behavioral disturbances
  • a tissue tear in the rectum, which is usually the result of chronic constipation

How is encopresis diagnosed?

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

An abdominal X-ray is sometimes used to help determine the amount of fecal buildup, but it’s often not necessary or recommended.

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 doctor might prescribe or recommend a product to remove the blockage and relieve constipation. Such products may include:

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
  • bran cereal
  • beans
  • grapes
  • broccoli

For children ages 4 to 8, drinking five cups of water daily can help keep stools soft for easy passage. Restricting caffeine consumption can also help prevent dehydration.

Daily exercise helps move materials 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 sitting on the toilet, eating high-fiber foods, and cooperating with treatments as recommended. Rewards can range from positive praise to tangible objects, as long as there’s consistency. Avoid scolding your child for soiling. This can increase their anxiety about going to the bathroom. 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 related 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. Don’t start toilet training until your child is ready. Typically, children aren’t ready for training until after they turn 2 years old. Watch closely for any hard or painful stools or any signs they’re withholding stools or afraid to use the toilet. If this happens, back off on toilet training for the time being and talk to their doctor about how to proceed and keep their stools soft.

Other ways to prevent encopresis include:

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