Encopresis, also called stool holding or soiling, occurs when your child resists having bowel movements, causing impacted stool to collect in the colon and rectum. When your child's colon is full of impacted stool, liquid stool can leak around the impacted stool and out of the anus, staining your child's underwear.

Encopresis usually occurs after age 4, when your child has already learned to use a toilet. In most cases, encopresis is a symptom of chronic constipation. Less frequently, it may be the result of developmental or emotional issues.

Doctors categorize encopresis as primary or secondary. Primary encopresis happens in a child who has never been successfully toilet trained. In secondary encopresis, a child develops the condition after having been successfully toilet trained.

Encopresis can be frustrating for you — and embarrassing for your child. However, with patience and positive reinforcement, treatment for encopresis is usually successful.

Symptoms Causes Risk factors Complications Prevention

Signs and symptoms of encopresis may include:

  • Leakage of stool or liquid stool on your child's underwear. If the amount of leakage is large, you may misinterpret it as diarrhea.
  • Constipation with dry, hard stool.
  • Passage of large stool that clogs or almost clogs the toilet.
  • Avoidance of bowel movements.
  • Long periods of time between bowel movements, possibly as long as a week.
  • Lack of appetite.
  • Abdominal pain.
  • Repeated urinary tract infections.

When to see a doctor

Call your doctor if your child is already toilet trained and starts experiencing one or more of the symptoms listed above.

There are several causes of encopresis. The most common are:

  • Constipation. Most cases of encopresis are the result of chronic constipation. In constipation, the child's stool is hard, dry and may be painful to pass. As a result, the child avoids going to the toilet — making the problem worse. The longer the stool remains in the colon, the more difficult it is for the child to push stool out. The colon stretches, ultimately affecting the nerves that signal when it's time to go to the toilet. When the colon becomes too full, soft or liquid stool may leak out.

    Common causes of constipation include withholding stool due to fear of using the toilet (especially when away from home) or not wanting to interrupt play, eating too little fiber or not drinking enough fluids. Sometimes, an allergy to cow's milk or drinking too much cow's milk leads to constipation, although milk allergy causes diarrhea more often than constipation.

  • Emotional issues. Emotional stress also may trigger encopresis. A child may experience stress from premature toilet training or an important life change — for instance, the divorce of a parent or the birth of a sibling.

These risk factors may increase your child's chances of having encopresis:

  • Sex of the child. Encopresis is more common in boys.
  • Chronic constipation. This may cause your child to avoid passing stool.
  • Not drinking enough fluids. This aggravates existing constipation.

A child who has encopresis may experience a range of emotions, including embarrassment, frustration, shame and anger. If your child is teased by friends or chastised by adults, he or she may feel depressed or have low self-esteem.

Early treatment, including guidance from a mental health provider, can help prevent the social and emotional impact of encopresis.

Help your child avoid constipation by providing a diet high in fiber and encouraging your child to drink plenty of water.

Educate yourself on effective toilet training techniques. Avoid starting too early or being too forceful in your methods. Wait until your child is ready, and then use positive reinforcement and encouragement to help him or her progress.

Most children aren't ready for toilet training until after their second birthdays. Some guidelines for readiness include:

  • Your child is able to pull pants down
  • Your child can ask one-word questions
  • Your child has an interest in stopping activities when body sensations indicate a bowel movement is needed

When your child seems ready, make sure your child's feet are firmly planted on a stool or the floor — not dangling — so that he or she feels secure and can push.

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