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.
Rarely, encopresis is caused by an anatomic abnormality or disease that the child is born with. In the vast majority of cases, encopresis develops as a result of chronic (long-standing) constipation.
What is constipation?
Many people think of constipation as not passing a bowel movement every day. However constipation implies not only infrequent bowel movements, but also having difficulty in passing bowel movements and/or experiencing pain with the passage of stools. In most cases of childhood constipation, the constipation develops after the child experiences pain when passing stools.
- Each person has his or her own schedule for bowel movements, and many healthy people do not have a bowel movement every day.
- A constipated child might have a bowel movement every third day or less often.
- Most importantly, a constipated child tends to pass large and hard stools and experience pain while doing so.
Symptoms can include any of the following:
- Being unable to hold stool before getting to a toilet (bowel incontinence)
- Passing stool in inappropriate places (as in the child’s clothes)
- Keeping bowel movements a secret
- Having constipation and hard stools
- Sometimes passing a very large stool that almost blocks the toilet
Encopresis Treatment at Home
Although parents will be following a regimen recommended by the child’s health care provider, most of the work of treating encopresis is done at home.
It is very important that parents and other caregivers keep a complete record of the child’s medication use and bowel movements during the treatment period. This record can be very helpful in determining whether the treatment is working.
Medical Treatment for Encopresis
Although many different regimens have been developed for the treatment of encopresis, most rely on the following principles:
- Empty the colon of stool
- Establish regular soft and painless bowel movements
- Maintain very regular bowel habits
While there is almost always a large behavioral component to chronic encopresis, behavioral therapy alone, such as offering rewards or reasoning with the child, usually is not effective. Rather, a combination of medical and behavioral therapy works best.