Encopresis In Children: Causes, Symptoms And Ways To Treat It

Constipation, diet change, or stress may cause encopresis. Laxatives and enemas may help.

Medically reviewed by Dr. Priya Thomas, MD Dr. Priya Thomas Dr. Priya ThomasMD insta_icon Specialty: PediatricsExperience: 10 years
Written by Dr Bisny T. Joseph
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Encopresis in Children

Encopresis in children is a common condition that affects at least two in 100 children (1). It’s also known as fecal incontinence or soiling and occurs when a child (aged 4 years or more) has frequent episodes of involuntary passing of feces on their clothing even after being potty trained.

Chronic constipation, which causes stool leakage and a loss of control over bowel motions, is the most prevalent cause of encopresis. However, children with emotional problems are more prone to develop encopresis than others. Nevertheless, children can overcome encopresis with encouragement and positive reinforcement along with appropriate treatment.

Read on to know the causes, risk factors, symptoms, and diagnosis of encopresis and how it can be treated and prevented in children.

Risks Factors And Causes Of Encopresis In Children

Constipation is the most common cause of encopresis in children, and it often begins with the child holding back their bowel movements. The most common reasons for holding back bowel movements, which eventually leads to encopresis, may include (1) (2).

  • Dietary changes such as eating a low fiber diet, not drinking enough water, eating high-sugar, high-fat junk foods, and consuming excess soft drinks and sugary drinks
  • Illnesses
  • Pain during or after bowel movements
  • Travel and changes in toilet routines
  • New bathrooms or less-privacy in bathrooms, which can make them uncomfortable
  • Continuing to play or do other activities when they have the urge to empty their bowels
  • Emotional stress due to reasons such as the birth of a new sibling, parental conflicts, or divorce
  • Premature, difficult, or conflict-filled toilet training
  • Hesitance to use bathrooms at school or anywhere other than home
  • Lack of physical activity
  • Stress and other emotional issues such as anxiety and depression
  • Autism spectrum disorder and attention deficit hyperactivity disorder (ADHD)
  • Use of certain medications such as cough suppressants

Although the exact reason is not known, encopresis tends to occur more in boys than girls. Also, although nightmares and medical conditions are linked to enuresis (bedwetting or urinating) in children, they are not known to cause encopresis.

Symptoms Of Encopresis In Children

Encopretic symptoms may vary in each child. Some children may cross or shake their legs, scream, and cry when they try to hold poop, and parents may often mistake this behavior for children trying to pass poop. The common symptoms of encopresis may include (2) (3).

  • Watery or loose stools, which can often be mistaken for diarrhea
  • Constipation with dry, hard stool
  • Involuntary bowel movements—the urge to poop with little or no warning signs
  • Soiling the underwear before the child can get into the bathroom or before removing the clothes
  • Hiding soiled underwear
  • Withdrawal from friends and family
  • Rubbing or scratching the anal area since watery stools may irritate the skin
  • Lack of appetite
  • Abdominal pain

Note: Stool leakage and anal itching can also be symptoms of other health conditions. Seek pediatric care to know the exact diagnosis and effective ways to manage or prevent encopresis in your child.

Complications Of Encopresis

Encopresis may lead to emotional and physical issues in children. And many children may experience abdominal pain, loss of appetite, and bladder infections due to the hardened stools in the intestines (3).

Bowel accidents such as the soiling of clothes can emotionally upset the children. In most cases, bowel leakage or accidents are not controllable, and when a child with encopresis is teased or criticized, they may experience shame, low self-esteem, and anger. Fear of accidents may also confine the child to the house. However, children with parental support may not develop these complications and often overcome encopresis.

Diagnosis Of Encopresis

The pediatrician may do a physical examination and obtain a detailed medical history, including enquiring about the child’s toilet training and routines. This is often enough to identify the reasons and diagnose encopresis in most children.

Imaging tests such as abdominal X-rays are recommended if stool (fecal) impaction is suspected. The doctor may also perform contrast enema, a test that checks the intestine for blockage, narrow areas, and other abnormalities.

Referrals to pediatric psychologists are made if a child has any emotional issues or mental health problems due to encopresis(3) (4).

Treatment For Encopresis In Children

Encopresis treatment may vary depending on the cause. The following treatments are prescribed if encopresis is due to constipation (4).

  • Doctors may recommend the child sits in the toilet for five to ten minutes after breakfast and dinner. This may help them pass bowel movements.
  • Laxatives may be used to loosen stools in severe constipation and fecal impaction.
  • Enemas may be recommended to loosen dry and hard impacted stools. Enema is liquid administered rectally to enhance bowel emptying.

Constipation and encopresis may require daily treatment with enemas. Experts at the International Center for Colorectal and Urogenital Care recommend daily enemas for a short time to clear the impacted stool and treat fecal incontinence (5). Although enemas and laxatives are available over the counter, it is recommended to seek pediatric consultation before using them since the dosage and duration vary in each child.

The following treatments are offered for encopresis due to emotional or behavioral issues (3).

  • Bowel retraining or behavior modification may help some children have regular bowel movements
  • Psychotherapy is often recommended by mental health professionals for managing emotional issues due to encopresis, such as depression, feelings of shame, low self-esteem, or guilt.

Prevention Of Encopresis

The following strategies may help prevent encopresis and its complications in children (3).

  • Take a balanced diet high in fiber and drink enough fluid. Early management of constipation can also reduce the risk of encopresis.
  • Begin potty training when your child is ready and offer positive reinforcements when they make progress. However, keep in mind that starting too early or late and forceful methods and punishments may lead the child to hold bowel movements.
  • Cut down on sugary or high-fat junk food and limit milk intake.
  • Encourage children to sit on the toilet seat for five to ten minutes after meals, as the bowel becomes more active after meals.
  • Use a footstool or toilet seat according to age. Using a footstool may help empty the bowel due to pressure exerted by the legs on the abdomen.

Frequently Asked Questions

1. What is voluntary encopresis?

Both voluntary and involuntary encopresis refers to the passing of stool in inappropriate places rather than the toilet (6). But voluntary encopresis includes passing of normal stool in clothes, which is not runny or loose, and may be a physical manifestation of psychological problems (7).

2. Can one have encopresis without constipation?

Yes, encopresis without constipation may be called nonretentive encopresis, where the child refuses to poop in the toilet willingly. In such cases, the doctor may perform various physical tests and also examine the child for behavioral problems and other underlying issues (8).

Encopresis in children can occur even after being potty trained and is caused by dietary changes, a reluctance to use the bathroom outside the home, or certain medications that make it difficult to control their bowel movements. While it may irritate you, remember that your patience and care will go a long way, and punishing, blaming, or being enraged will do more harm than good. Children with encopresis can benefit by seeing a doctor, sticking to routines, eating a nutritious diet, and living a healthy lifestyle. You can also encourage your child to maintain their toileting routines following the treatment to avoid recurrence.

Key Pointers

  • Encopresis is characterized by frequent soiling or fecal incontinence in children aged four years or above.
  • Children with encopresis may exhibit symptoms such as crossing or shaking legs, holding poop, watery loose stools.
  • Consuming a balanced diet, maintaining ample hydration, and cutting down on sugary food help prevent this condition.

References

1. Encopresis; Cincinnati Children’s Hospital
2. Encopresis; Lucile Packard Children’s Hospital Stanford
3. Encopresis; St. Clair Health
4. Encopresis- Diagnosis & Treatment; Boston Children’s Hospital
5. How to give a child an enema at home; Children’s Hospital Colorado
6. FACT SHEET: ENCOPRESIS IN CHILDREN AND ADOLESCENTS; Society of PEDIATRIC PSYCHOLOGY
7. What is Constipation & Fecal Soiling?; GI Kids
8. BRETT R. KUHN et al. (1999); Treatment Guidelines for Primary Nonretentive Encopresis and Stool Toileting Refusal; American Family Physician
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Dr. Priya Thomas
Dr. Priya ThomasMD
Dr. Priya Thomas is a board-certified pediatrician practicing in Alpharetta, Georgia, with over ten years of experience. She grew up in Kerala and completed her undergraduate degree at Georgia State University and Her medical education at Medical College of Georgia.

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