Definition

What is encopresis?

Encopresis is the soiling of underwear with stool by children who are past the age of toilet training. Because each child achieves bowel control at his or her own rate, medical professionals do not consider stool soiling to be a medical condition unless the child is at least 4 years old. This stool or fecal soiling usually has a physical origin and is involuntary — the child doesn’t do it on purpose.

How common is encopresis?

In the U.S., it is estimated that 1%-2% of children younger than 10 years are affected by encopresis. Many more boys than girls experience encopresis; approximately 80% of affected children are boys. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of encopresis?

The common symptoms of encopresis are:

  • Leakage of stool or liquid stool on underwear, which can be mistaken for diarrhea
  • Constipation with dry, hard stool
  • Passage of large stool that clogs or almost clogs the toilet
  • Avoidance of bowel movements
  • Long periods of time between bowel movements
  • Lack of appetite
  • Abdominal pain
  • Problems with daytime wetting or bedwetting (enuresis)
  • Repeated bladder infections, typically in girls

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

You should contact your doctor if you have any of the following:

  • Severe, persistent, or recurrent constipation
  • Pain during bowel movements
  • Reluctance to have bowel movements, including straining to hold stool in
  • Soiling in a child who is at least 4 years old

Causes

What causes encopresis?

Rarely, encopresis is caused by an anatomic abnormality or disease that the child is born with. In the great majority of cases, encopresis develops as a result of chronic (long-standing) constipation.

Risk factors

What increases my risk for encopresis?

There are many risk factors for encopresis, such as:

  • Using medications that may cause constipation, such as cough suppressants
  • Attention-deficit/hyperactivity disorder (ADHD)
  • Autism spectrum disorder
  • Anxiety or depression

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is encopresis diagnosed?

To diagnose enopresis, your child’s health care provider will ask many questions about his medical history, toilet training history, diet, lifestyle, habits, medications, and behavior. A thorough physical exam will be done to assess the child’s general health as well as the status of the colon, rectum, and anus. The examiner may insert a gloved finger into the child’s rectum to feel for stool and make sure the anal opening and rectum are of normal size and that the anal muscles are of normal strength.

In most cases, blood tests are not part of the evaluation of constipation and/or encopresis. In some cases, an X-ray of the child’s abdomen or pelvis is performed to determine how much stool is present in the colon and assess if the colon and rectum are enlarged. Occasionally, a barium enema is performed. This is a special type of X-ray. A small tube is inserted into the child’s rectum, and the colon is slowly filled with a radiopaque dye (barium). X-rays are taken throughout the procedure to see if areas of narrowing, twisting, or kinking in the lower intestine are causing the child’s symptoms.

In some cases, anorectal manometry may be performed. With this test, a small tube is inserted into the child’s rectum. The tube has several pressure sensors in it. During the test, the doctor can determine how the child is using his or her abdominal, pelvic, and anal muscles during defecation. Many children who have chronic constipation and/or encopresis do not use their muscles in a coordinated fashion during bowel movements.

The main objective of manometry is to confirm increased pressure within the anus. Manometry can also show whether the nerves controlling the anal sphincter, anus, and rectum are present and working by measuring reflexes in this area. Manometry can measure how far the rectum is distended and whether sensation in this area is normal. Abnormal contractions of the muscles in the pelvic floor can be documented by using manometry.

Anorectal manometry can also be helpful to rule out Hirschsprung disease, a very rare cause of constipation without encopresis. If Hirschsprung disease is seriously considered as a cause of your child’s encopresis, a biopsy of the rectum may be necessary. A biopsy is the removal of a very tiny piece of tissue for examination under a microscope. This is done to look for the absence of nerve function in the rectum, a characteristic sign of Hirschsprung disease.

How is encopresis treated?

Generally, the earlier that treatment begins for encopresis, the better. The first step involves clearing the colon of retained, impacted stool. After that, treatment focuses on encouraging healthy bowel movements. In some cases, psychotherapy may be a helpful addition to treatment.

Clearing the colon of impacted stool

There are several methods for clearing the colon and relieving constipation. Your child’s doctor will likely recommend one or more of the following:

  • Certain laxatives
  • Rectal suppositories
  • Enemas

Your child’s doctor may recommend close follow-up to check the progress of the colon clearing.

Encouraging healthy bowel movements

Once the colon is cleared, it’s important to encourage your child to have regular bowel movements. Your child’s doctor may recommend:

  • Dietary changes that include more fiber and drinking adequate fluids
  • Laxatives, gradually discontinuing them once the bowel returns to normal function
  • Training your child to go to the toilet as soon as possible when the urge to have a bowel movement occurs
  • A short trial of going off cow’s milk or checking for cow’s milk intolerance, if indicated

Behavior modification

Your child’s doctor or mental health professional can discuss techniques for teaching your child to have regular bowel movements. This is sometimes called behavior modification or bowel retraining.

Your child’s doctor may recommend psychotherapy with a mental health professional if the encopresis may be related to emotional issues. Psychotherapy may also be helpful if your child feels shame, guilt, depression or low self-esteem related to encopresis.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage encopresis?

The following lifestyles and home remedies might help you cope with encopresis:

  • Focus on fiber. Feed your child a balanced diet that includes plenty of fruits, vegetables, whole grains and other foods high in fiber, which can help form soft stools.
  • Encourage your child to drink water. Drinking enough water helps keep stool from hardening. Other fluids may help, but watch the calories.
  • Limit cow’s milk if that’s what the doctor recommends. In some cases, cow’s milk may contribute to constipation, but dairy products also contain important nutrients, so ask the doctor how much dairy your child needs each day.
  • Arrange toilet time. Have your child sit on the toilet for five to 10 minutes at regular times every day. This is best done after meals because the bowel becomes more active after eating. Praise your child for sitting on the toilet as requested and trying.
  • Put a footstool near the toilet. This may make your child more comfortable, and changing the position of his or her legs can put more pressure on the abdomen, making a bowel movement easier.
  • Stick with the program. It may take months to resume normal bowel sensation and function and develop new habits. Sticking with the program can also reduce relapses.
  • Be encouraging and positive. As you help your child overcome encopresis, be patient and use positive reinforcement. Don’t blame, criticize or punish your child if he or she has an accident. Instead, offer your unconditional love and support.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: August 14, 2017 | Last Modified: August 14, 2017

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