Encopresis – Symptoms and Causes

Overview

Encopresis is a condition where a person repeatedly passes stool into their clothing, usually without meaning to. This typically happens when hardened stool builds up in the colon and rectum.

As the colon becomes overfilled, watery stool leaks around the blockage and stains underwear. Over time, the bowels can stretch, and the person may lose control of their bowel movements.

This condition usually affects children over age 4 who have already learned toilet skills. In most cases, encopresis happens because of long-term constipation. Less commonly, it occurs without constipation and may be related to emotional issues.

Encopresis can be difficult for parents to manage and often causes embarrassment for children. With the right approach, patience, and positive support, treatment is generally successful.

Symptoms

Children with fecal soiling problems may show several signs. Stool leakage in underwear often occurs, which parents might mistake for loose stools. Hard, dry bowel movements and very large stools that might clog toilets are common indicators.

Some children actively avoid using the bathroom and may go days between bowel movements. This can lead to stomach pain and reduced interest in food.

Additional symptoms include:

• Urinary problems (daytime accidents or bedwetting)
• Recurring bladder infections, particularly in girls

These signs often cause embarrassment and social difficulties for the child.

When to Visit a Doctor

If your child has already learned to use the toilet but begins showing signs of going back to having accidents, call your doctor. This change in bathroom habits may need medical attention.

Why Fecal Soiling Happens

Fecal soiling most often happens because of ongoing constipation. When a child becomes constipated, their stool gets hard and dry, making bathroom trips painful. Children then try to avoid going to the toilet, which only makes things worse.

The longer stool stays in the large intestine, the harder it becomes to push out. The intestine stretches over time, which affects the nerve signals that tell a child when they need to use the bathroom.

When the intestine gets too full, soft or liquid stool may leak around the harder stool, or the child may lose control of their bowel movements completely.

Several things can cause constipation:

• Fear of using toilets, especially in unfamiliar places
• Pain when passing stool
• Not wanting to stop playing or other activities
• Diet issues like not enough fiber
• Not drinking enough water
• Drinking too much milk (though research isn’t completely clear on this)

Stress and emotional issues can also trigger fecal soiling. Toilet training problems that happened too early or included conflict, life changes such as new foods, and family situations like parents divorcing can all lead to emotional pressure on children.

When children feel emotional pressure, it can affect how their body works, including bowel control.

Risk Factors

Boys face higher chances of having encopresis than girls. Several factors may increase the risk:

• Certain medications, particularly cough suppressants, that can cause constipation
• Having ADHD
• Being on the autism spectrum
• Suffering from anxiety or depression

These conditions can affect bowel habits and a child’s awareness of bodily functions.

Emotional Impact

Children with encopresis often feel embarrassed, frustrated, ashamed and angry about their condition. These emotions can be difficult to manage. When peers tease them or adults criticize their behavior, children may develop:

• Depression
• Low self-esteem
• Social withdrawal

These emotional challenges can make treatment more complex and require sensitivity from parents and healthcare providers.

Ways to Prevent Problems

To prevent constipation in your child, focus on diet and hydration. Make sure they eat plenty of high-fiber foods like fruits, vegetables, and whole grains. Encourage them to drink water throughout the day. Regular physical activity also helps keep bowel movements normal.

• Fiber-rich foods: Apples, berries, broccoli, beans.
• Hydration: 6-8 cups of water daily.
• Exercise: At least 60 minutes of play daily.

Proper Toilet Training Methods

Use gentle, patient approaches to toilet training. Wait until your child shows readiness signs like interest in the bathroom or staying dry for longer periods. Never shame or punish bathroom accidents.

Effective techniques include:

• Using praise for successes
• Creating a comfortable routine
• Reading children’s books about potty training
• Being consistent but not forceful

Quick Treatment Response

If you notice signs of soiling or constipation, seek help right away. Early help from doctors prevents both physical problems and emotional stress.

Regular check-ups can catch issues before they become serious.

Watch for warning signs like:

• Avoiding bowel movements
• Pain during bathroom trips
• Hiding soiled underwear
• Changes in behavior around bathroom use