Encopresis

Encopresis occurs when a child over the age of 4 has soiling accidents in which he or she passes stool. The term "encopresis" is applied to children who have already accomplished toilet training, but who develop stool leakage. This condition can be a very embarrassing. It is important to know that this is different than fecal incontinence which is usually caused by a spinal cord disorder.

CAUSES

In many cases, encopresis occurs due to very severe, chronic constipation. When very hard, dry stool is filling the large intestine, the muscles that hold stool in become stretched, and the nerves that control passing a bowel movement become insensitive to the need to defecate. Newer, more liquid stool from higher up in the digestive tract slowly leaks around and past the blockage, and out of the rectum.

Occasionally, encopresis may occur due to emotional issues, in response to major life changes such as divorce, a new baby or recent death in the family. It can also happen in cases of sexual abuse.

SYMPTOMS

Symptoms may include:

  • Stool leaking into underwear.

  • Constipation.

  • Large, dry, hard stools.

  • Abdominal swelling (distension).

  • Presence of an abnormal smell, and the child is not bothered or concerned by it.

  • Stool withholding, or avoiding having bowel movements in the toilet.

  • Decreased appetite.

  • Stomach pain.

DIAGNOSIS

In some cases, the diagnosis is obvious, due to the symptoms. In other cases, the caregiver may put a gloved finger into the anus to check for the presence of hard stool. During the physical exam, a fecal mass may be felt in the abdomen and there may be bloating. An x-ray of the abdomen may also reveal accumulated stool.

TREATMENT

Treating encopresis starts with thoroughly cleaning out the intestine to get rid of accumulated stool. This may require the use of stool softeners, enemas, laxatives and/or suppositories. Once the stool has been cleaned out, it will be important to prevent build-up again. To do this, the child should be encouraged to:

  • Drink lots of fluids.

  • Eat a high fiber diet.

  • Sit on the toilet after two meals each day, for five to ten minutes at a time.

Your caregiver may prescribe or recommend a stool softener. It may help to keep a journal that records how frequently stools occur. It is very important to try to keep a positive attitude towards the child. Punishing the child will not help.

RELATED COMPLICATIONS

Children with encopresis can develop complications including:

  • Frequent urinary tract infections.

  • Bedwetting and day time urinary incontinence.

  • Psychosocial problems such as teasing and no friends.

  • Either abnormal weight gain or abnormal weight loss.

HOME CARE INSTRUCTIONS

  • Take all medications exactly as directed.

  • Eat a high fiber diet (lots of fruits, vegetables, and whole grains). Typically this is at least five servings per day.

  • Ask your caregiver how much dairy to include in the diet. Excessive amounts may worsen constipation.

  • Drink lots of fluids.

  • Keep meals, bathroom trips, and bedtimes on a regular schedule.

  • Encourage exercise, which helps stool move through the bowels.

  • Be patient and consistent. Encopresis can take a while to resolve (6 months to a year) and can frequently recur.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Your child experiences increasingly severe pain.

  • Your child is having both urinary and fecal soiling.

  • Your child has any muscle weakness.

  • Your child develops vomiting.

  • Your child has any blood in their stool.