Encopresis

Encopresis is the passage of stool in places other than the toilet. It is most often an involuntary action. Encopresis is often called stool soiling because of the stains left on underwear. Accidents are normal in infants and toddlers until they learn bowel control. It is considered abnormal in children aged four years and older.

  • Causes


    Encopresis
    may be caused by a variety of conditions such as:


    • Chronic
      constipation
      • Most common cause
      • When a large amount of hard, dry stool is filling the rectum, over time the child becomes unable to recognize the sensation of fullness and the need to go to the bathroom.
      • Liquid stool may leak around the hard mass of stool, causing staining of the underwear.
      • May be associated with a diet low in fiber and fluids, and lack of exercise
    • Poor toilet training or refusal to use the toilet for bowel movements
    • Emotional problems
    • Organic causes (rare)—result of problems or malformations in the intestines

  • Definition

    Encopresis is the passage of stool in places other than the toilet. It is most often an involuntary action. Encopresis is often called stool soiling because of the stains left on underwear.

    Accidents are normal in infants and toddlers until they learn bowel control. It is considered abnormal in children aged four years and older.

  • Diagnosis

    The doctor will ask about your child's symptoms and medical history. A physical exam will also be done. The diagnosis can usually be made this way. A rectal exam may reveal the presence of a large quantity of hard, dry stool in the rectum


    To make help a diagnosis, the doctor may order imaging studies, such as:

    • Abdominal x-ray—may show excessive stool in the rectum
    • Other imaging tests to look for organic causes if the constipation is not relieved with treatment or if your child passes blood with their stool

  • Prevention

    Following guidelines for toilet training may help prevent encopresis. A healthy, high-fiber diet and adequate liquid intake may also help prevent this condition.

  • Risk Factors


    Risk factors include:

    • Sex: male

    • Children with emotional problems, such as:

      • Oppositional defiant disorder
      • Conduct disorders
      • Toileting phobias
    • Passage of firm stool that causes a painful tear or "fissure" at the opening of the anus

    • Children who have suffered
      sexual abuse
      (according to some researchers)
    Bowel and Rectum
    Anal fissure and fistula
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  • Symptoms


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

    • Low self-esteem
    • Feelings of embarrassment, shame, or guilt


    If associated with constipation your child may have:

    • Infrequent bowel movement
    • Pain or bleeding with defecation
    • Abdominal pain
    • Bed wetting

    Parents are often unaware that their child is constipated. However, they may see their child forcibly holding stool when they haves the urge to move their bowels. Your child may also be unwilling to use the toilet in certain locations. These descriptions of stool holding are important for the doctor to know about.

  • Treatment

    Treatments will depend on the cause of soiling. As a parent, it is important that you do not shame your child. Treatment will include some or all of these: