• Knowledgebase: Stooling and Constipation questions

    Questions about stooling and constipation.

    8. Soiling (Encopresis) - Top

    Alternative Names
    incontinence - stool; soiling

    Definition

    The voluntary or involuntary passage of stools causing soiling of clothes by a child over 4 years of age. (See also fecal incontinence).

    Causes, Incidence and Risk Factors
    Encopresis can be divided into two groups. The first in which there is a physiologic basis for the encopresis, the second in which there seems to be an emotional basis.

    Encopresis frequently is associated with constipation and fecal impaction. Often, hard fecal material is retained in the colon, with a passage of soft or semi-liquid stool around the impacted stool. This problem is not under the conscious control of the child. Leakage of stool may occur during the day or night. There are rarely physical causes other than constipation (sometimes present since infancy).
    Other causes may be related to a lack of toilet training or training at too early an age or an emotional disturbance such as Oppositional Defiant Disorder or a Conduct Disorder.
    Whatever the cause the child may develop associated shame, guilt, or loss of self-esteem. The child may try to hide the discovery of the problem. The incidence is not well documented but is thought to be about 1 percent. Risk factors include male gender, low socioeconomic status and chronic constipation.
    Symptoms
    inability to retain feces (fecal incontinence)
    the passage of stool in inappropriate places (generally in the child's clothes)
    secretive behavior associated with bowel movements
    evidence of constipation and hard stool
    Signs And Tests
    Digital examination of the rectal vault may demonstrate a fecal impaction
    An abdominal x-ray may confirm impacted stool in the colon,.



    Treatment
    The goal of treatment is to prevent constipation and encourage good bowel habits.
    A diet high in fiber, including fruits, vegetables, and whole grain products and adequate fluid intake will promote the passage of softer stools and minimize the discomfort associated with bowel movements.
    Parental support and refrain from criticism or discouragement is important. Education of the parents and child, and biofeedback for the child is often used by Pediatric Gastroenterologists to treat the more difficult cases. Psychotherapy can help the child deal with associated shame, guilt, or loss of self-esteem. For encopresis in the absence of constipation, psychiatric evaluation may help determine the underlying cause.

    Expectations (Prognosis)

    Most children respond to treatment.

    Complications

    The child may suffer from low self-esteem and peer disapproval related to this problem. If routine bowel habits are not developed, the child may suffer from chronic constipation.

    - Updated: March 7, 2001

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    • James L Horwitz, MD

    David C. Thomas, MD

    Barbara Lindberg, PNP