Encopresis

(Stool Soiling; Fecal Incontinence; Soiling, Stool)
  • Definition

    Encopresis is the passage of stool in places other than the toilet. It is most often an involuntary action. Encopresis is often called stool soiling because of the stains left on underwear.
    Accidents are normal in infants and toddlers until they learn bowel control. It is considered abnormal in children aged four years and older.
  • Causes

    Encopresis may be caused by a variety of conditions such as:
    • Chronic constipation
      • Most common cause
      • When a large amount of hard, dry stool is filling the rectum, over time the child becomes unable to recognize the sensation of fullness and the need to go to the bathroom.
      • Liquid stool may leak around the hard mass of stool, causing staining of the underwear.
      • May be associated with a diet low in fiber and fluids, and lack of exercise
    • Poor toilet training or refusal to use the toilet for bowel movements
    • Emotional problems
    • Organic causes (rare)—result of problems or malformations in the intestines
  • Risk Factors

    Risk factors include:
    Bowel and Rectum
    Anal fissure and fistula
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  • Symptoms

    The main symptom is the accidental passage of stool, usually into the underwear. Other symptoms may include:
    • Low self-esteem
    • Feelings of embarrassment, shame, or guilt
    If associated with constipation your child may have:
    • Infrequent bowel movement
    • Pain or bleeding with defecation
    • Abdominal pain
    • Bed wetting
    Parents are often unaware that their child is constipated. However, they may see their child forcibly holding stool when they haves the urge to move their bowels. Your child may also be unwilling to use the toilet in certain locations. These descriptions of stool holding are important for the doctor to know about.
    When Should I Call the Doctor?
    Call the doctor if your child has stool staining in his underwear. The doctor can help find the underlying cause.
  • Diagnosis

    The doctor will ask about your child's symptoms and medical history. A physical exam will also be done. The diagnosis can usually be made this way. A rectal exam may reveal the presence of a large quantity of hard, dry stool in the rectum
    To make help a diagnosis, the doctor may order imaging studies, such as:
    • Abdominal x-ray—may show excessive stool in the rectum
    • Other imaging tests to look for organic causes if the constipation is not relieved with treatment or if your child passes blood with their stool
  • Treatment

    Treatments will depend on the cause of soiling. As a parent, it is important that you do not shame your child. Treatment will include some or all of these:
    Bowel Clean-Out
    Enemas and laxatives may be recommended if constipation is a problem. It will help to clean out your child's bowel. These treatments are only used short term.
    Medications
    Your doctor may recommend:
    • Short-term treatment with laxatives.
    • Long-term treatment (up to one year) with MiraLax, Metamucil, or other stool softeners. This can make it easier for your child to pass stool. It may also decrease your child's reluctance to pass stool.
    Dietary Changes
    Mild constipation can be prevented through simple dietary changes. To help prevent constipation, encourage your child to:
    • Eat a healthy diet that is high in fiber.
    • Drink plenty of liquids.
    Bowel Training
    Help your child learn when to use the toilet. For example, encourage your child to go to the bathroom at regular times during the day.
    Keep positive. Consider rewards for your child for keeping their clothes clean and using the toilet.
    Counseling
    Counseling may be needed if your child:
    • Has severe problems with toilet training
    • Has emotional problems (including family problems)
    • Is experiencing shame, guilt, or low self-esteem due to fecal incontinence
  • Prevention

    Following guidelines for toilet training may help prevent encopresis. A healthy, high-fiber diet and adequate liquid intake may also help prevent this condition.
  • RESOURCES

    FamilyDoctor.org – American Academy of Family Physicians http://familydoctor.org

    National Digestive Diseases Information Clearinghouse http://www.niddk.nih.gov

    CANADIAN RESOURCES

    Canadian Digestive Health Foundation http://www.cdhf.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Encopresis. Nemours kids health website. Available at: http://kidshealth.org/parent/general/sick/encopresis.html. Updated January 2012. Accessed August 9, 2012.

    Fecal soiling. American Academy of Pediatrics Health Children website. Available at: http://kidshealth.org/parent/general/sick/encopresis.html. Updated May 2011. Accessed August 9, 2012.

    Fecal incontinence in children (encopresis). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. May 11, 2012. Accessed August 9, 2012.

    Stool soiling and constipation in children. American Family Physician Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/kids/toileting/stool-soiling-and-constipation-in-children.html. Updated November 2011. Accessed August 9, 2012.

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