Encopresis

What is Encopresis

Encopresis happens when a child who is age 4 or older has soiling accidents in which he or she passes stool somewhere other than the toilet. Encopresis is usually caused by long-term (chronic) constipation.

A child has constipation if he or she has fewer than three bowel movements per week for at least 2 weeks, has difficulty having a bowel movement, or has stools that are dry, hard, or larger than normal.

Encopresis that happens in a child who has never been toilet trained is called primary encopresis. If encopresis happens in a child after he or she has been toilet trained, the condition is called secondary encopresis.

When treated properly, encopresis eventually stops, although it may take months or years to resolve.

What are the causes?

In most cases, encopresis is caused by severe, chronic constipation. When stool blocks the large intestine, newer, softer stool from higher up in the intestine leaks past the blockage and out of the rectum.

Occasionally, encopresis may be caused by emotional problems. These problems can happen in response to major life changes. Encopresis can also happen in cases of sexual abuse.

What increases the risk?

This condition is more common in boys. It is also more likely to develop in children who:

  • Have difficulty with toilet training.
  • Are born with colon problems.
  • Experience extreme stress at home.

What are the signs or symptoms?

Symptoms of this condition may include:

  • Stool leaking into underwear.
  • Constipation.
  • Stools that are dry, hard, or larger than normal.
  • Swelling in the abdomen (distension).
  • An abnormal smell that your child may not notice or be bothered by.
  • Refusal to have bowel movements in the toilet (stool withholding).
  • Reduced appetite.
  • Stomach pain.
  • Painful bowel movements.
  • Frequent urinary tract infections.

How is this diagnosed?

This condition is often diagnosed based on your child’s symptoms and medical history. Your child’s heath care provider may diagnose encopresis if your child has soiling accidents at least one time per month for at least three months. Your child may have X-rays to check for constipation. In some cases, your child’s health care provider may perform a physical exam to check for the presence of hard stool.

How is this treated?

Treatment for this condition involves relieving constipation and establishing normal bowel habits. Treatment to relieve constipation may include:

  • Medicines that soften stool (stool softeners).
  • Medicines that help your child have bowel movements (laxatives).
  • Injecting liquid into your child’s rectum (enema).
  • Placing medicine in your child’s rectum (suppository).

Treatment to establish normal bowel habits may include:

  • Changing your child’s diet.
  • Planning when to give your child laxatives.
  • Encouraging regular toilet habits.
  • Psychological counseling.

Encopresis can take up to one year to resolve. It may return (recur) over time, even after treatment.

Follow these instructions at home:

  • Give your child over-the-counter and prescription medicines only as told by your child’s health care provider.
  • Keep track of how often your child has a bowel movement.
  • Keep all follow-up visits as told by your child’s health care provider. This is important.

How is this prevented?

Work with your child’s health care provider to create a plan for preventing constipation and encopresis. This plan may include:

  • Making sure that your child eats a healthy diet with plenty of fruits, vegetables, and fiber. Follow instructions from your child’s health care provider about eating or drinking restrictions that can help to prevent constipation. Restrictions may include limiting dairy in your child’s diet.
  • Making sure that your child drinks enough fluid to keep his or her urine clear or pale yellow.
  • Keeping a regular schedule for meals, bathroom trips, and bedtime.
  • Encouraging exercise. Physical activity helps stool to move through the bowels.
  • Being patient and consistent, and making sure that your child does not feel guilty about soiling.

Contact a health care provider if:

  • Your child has a fever.
  • Your child continues to have encopresis or constipation.
  • Your child has:
    • Painful bowel movements.
    • Pain in the abdomen.
    • Pain or a burning feeling when he or she urinates.
    • Blood in his or her stool.
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