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Encopresis, also referred to as fecal incontinence or soiling, is a recurring situation where stool is passed involuntarily into clothing. This often occurs due to the accumulation of impacted stool in the colon and rectum. As the colon becomes overly full, liquid stool leaks around the compacted stool, leading to staining of underwear. Over time, this stool retention can result in the bowels becoming stretched and distended, causing a loss of control over bowel movements.
Primarily observed in children aged 4 and older who have already undergone toilet training, encopresis is more commonly seen in boys than girls. Prevalence rates range from 1% to 4% among 4–year–olds, with the occurrence diminishing as children grow older. Typically, soiling serves as an indicator of prolonged constipation. In rarer cases, it may manifest without concurrent constipation, potentially stemming from emotional factors.
Encopresis can prove to be a source of frustration for parents and embarrassment for the affected child. Nevertheless, through the application of patience and positive reinforcement, treatment for encopresis tends to yield successful outcomes.
Symptoms
Encopresis symptoms and signs can include:
- Passing large stool that clogs or almost clogs the toilet
- Leakage of stool or liquid stool on underwear, which can be mistaken for diarrhea
- Constipation with dry, hard stool
- Long periods of time between bowel movements
- Avoidance of bowel movements
- Abdominal pain
- Repeated bladder infections, typically in girls
- Lack of appetite
- Problems with daytime wetting or bedwetting (enuresis)
If your toilet–trained child begins to show one or more of the symptoms listed above, consider reaching out to a doctor.
Causes
Encopresis, often caused by chronic constipation, results in hard and painful–to–pass stool. This discomfort leads children to avoid using the toilet, exacerbating the issue. Prolonged stool retention stretches the colon, affecting the nerves signaling bowel movements. This can lead to involuntary leakage or loss of control.
Common constipation causes include:
- Fear of toilet use, especially outside home or due to painful experiences.
- Reluctance to interrupt play or activities for bathroom breaks.
- Low fiber intake and inadequate fluid consumption.
- Excessive cow’s milk consumption or rare cow’s milk intolerance (debated in research).
Additionally, emotional stressors trigger encopresis, including:
- Challenging or conflict–ridden toilet training.
- Life changes like diet, toilet training, school entry, or schedule adjustments.
- Emotional stressors such as parental divorce or sibling birth.
Encopresis may indicate an underlying medical issue. Potential conditions linked to encopresis are:
- Colonic inertia: Where the colon’s stool propulsion is inadequate.
- Nerve damage in the digestive tract: Resulting in improper closure of the anus muscles.
- Hirschsprung disease: Involving absent bowel nerve endings, leading to intestinal blockages.
- Rectal infection or tear.
- Insufficient hydration.
- Malnutrition or a diet high in fat and sugar.
Risk factors
Boys experience encopresis more frequently than girls. These potential risk factors could raise the likelihood of developing encopresis:
- Depression
- Anxiety
- Attention–Deficit/Hyperactivity Disorder (ADHD)
- Taking drugs that could make you constipated, like cough medicines.
- Autism spectrum disorder
Diagnosis
The doctor treating your child might:
- Inquire regarding the child’s diet, potty training, emotional health (stress), and medical history.
- Perform physical assessment to rule out physical causes for constipation or soiling, talk about your symptoms, bowel motions, and food habits.
- Conduct digital rectal exam to observe for impacted stools by pressing on your child’s belly with one hand while putting a greased, gloved finger into your child’s rectum.
- Abdominal X–ray to verify stool impaction.
- Psychological evaluation if your child’s symptoms are being exacerbated by emotional problems.
Treatment
Encopresis treatment involves several steps aimed at addressing the condition. These steps include clearing the colon of impacted stool, encouraging healthy bowel movements, and utilizing behavior modification techniques. In some cases, psychotherapy might be recommended if emotional factors are involved.
- Clearing the Colon of Impacted Stool: The initial stage focuses on relieving constipation by clearing the colon of retained stool. Doctors may suggest using specific laxatives, rectal suppositories, or enemas to achieve this. Regular follow–up is important during this phase to monitor progress.
- Encouraging Healthy Bowel Movements: After the colon is cleared, the emphasis shifts to promoting regular bowel movements. Recommendations might include dietary changes to increase fiber intake and proper fluid consumption. Gradual reduction of laxatives as bowel function improves is also part of this stage. Training your child to respond promptly to the urge for bowel movements is encouraged.
- Behavior Modification: Behavior modification, also known as bowel retraining, can play a crucial role. Doctors and mental health professionals offer techniques to help your child establish consistent bowel habits. This approach helps in avoiding future episodes of encopresis.
- Psychotherapy: In situations where emotional factors might contribute to encopresis, psychotherapy with a mental health professional can be considered. This is especially relevant if your child experiences emotions like shame, guilt, depression, or low self-esteem related to the condition.
