What Is Encopresis?

Encopresis is a condition that causes a child to involuntarily leak stool even after they've already been toilet trained.

You might notice signs of bowel movement on their clothes, underwear, or sheets. The condition is also known as fecal soiling or fecal incontinence.

For a diagnosis of encopresis to be made, the child must be at least four years old. This is because the child should typically already have control over their bowel movements at that age.

Most cases of encopresis are caused by chronic constipation; this is known as retentive encopresis. But a child experiencing encopresis could also be in severe emotional distress. Some research shows that the condition appears to be more likely to develop in boys than girls. 

Symptoms of Encopresis 

Symptoms of encopresis vary from child to child. However, in most cases of the condition, the following signs will be present: 

• Voluntary or involuntary passing of stool in inappropriate places 
• Constipation 
• Signs of stool stains on your child's underwear 
• Passing very watery or loose stool 
• Becoming withdrawn as a result of discomfort or embarrassment 
• Hiding soiled clothes 
• Loss of appetite 
• Stomach pain 

Diagnosis of Encopresis 

The Diagnosis and Statistic Manual Disorders (DSM 5) provides for specific criteria to be met before a diagnosis of encopresis can be made. They are:

• The child must be at least four years old.
• Their passage of stool in inappropriate places should have happened repeatedly. However, it could be either voluntary or involuntary.
• Symptoms of the condition must have been present for at least three months. 

Your healthcare provider will conduct several tests before making a diagnosis of encopresis. This extensive testing also rules out any underlying conditions causing encopresis.

Some of the tests that might be done include: 

• An x-ray: This is done to see how much stool is stuck in the rectum 
• A rectal biopsy: This examines the cells of the rectum for signs of any abnormality 
• A digital rectal exam: This involves your child's doctor putting a gloved finger into their rectum to check for any abnormalities 
• Anorectal manometry: This is a test done to check the strength of your child's anal and rectal muscles
• Barium enema: This is a test that's done to check if there's any obstruction or abnormality in the large intestine 
  

Causes of Encopresis 

In most cases, encopresis occurs because the child is constipated. The stool overflows either voluntarily or involuntarily in inappropriate places when this happens. This will happen whenever the sphincter muscles which control the anal canal relax.

However, because your child is constipated, they can't relax enough for the stool to pass, and some parts of the stool leak out over time. This could happen in their sleep or whenever they are at ease.

The amount of stool that overflows is usually just enough to stain their clothes or underwear. Your child might be retaining stool for any of the following reasons: 

• They've been experiencing painful bowel movements
• They find stooling to be an unpleasant experience
• They are reluctant to use the bathrooms in public spaces such as school
• There has been a sudden change in their bathroom routine (e.g., they started going to school)
• They are taking particular medication that can cause constipation

In some instances, encopresis might signify an underlying condition like diabetes or hypothyroidism. Your doctor will conduct a detailed medical examination to rule this out in making a diagnosis. Nerve damage to the end of the anal muscles could also prevent it from closing correctly and cause stool to leak out.

Certain factors put some kids at a higher risk of developing encopresis than others. Factors such as:

• Having a poor diet 
• Not drinking enough water 
• Being emotionally distressed 
• Not getting enough exercise. 
• Having a neurodevelopmental disease such as autism or attention deficit hyperactive disorder (ADHD)

Types of Encopresis 

There are two forms of encopresis. The classification is made according to the appearance of stool that is being passed and why it's occurring, they include: 

• Constipation-associated encopresis or retentive encopresis: This form of encopresis accounts for more than 80% of children who have been diagnosed. It's a form of encopresis caused by constipation.
• Non-retentive encopresis: This form of encopresis involves involuntary stool leaking without constipation. 
  

Treatment for Encopresis 

In most encopresis cases, the root cause of the condition is constipation. This is known as retentive encopresis. In treating encopresis in these cases, healthcare providers focus on what's causing constipation and how to treat it.

However, in less severe cases, the impaction can be loosened with laxatives. Your doctor will also ensure that constipation doesn't reoccur as part of a treatment plan. Your doctor will typically recommend a modification to your child's diet and some lifestyle changes. A diet rich in fluids and fiber is great to keep the bowels moving smoothly.

Other tips that can help prevent constipation in the future include:

• Getting more exercise (e.g., increasing outdoor playtime)
• Cutting down on sugary drinks and processed sugars
• Drinking more water
• Eating on a regular schedule 

Treatment for Non-retentive Encopresis 

WIth non-retentive encopresis, treatment looks a little different. Here, treatment plans focus on toilet training, or retraining if the child has already been toilet trained.

In severe cases, drugs used to treat diarrhea, such as Imodium (loperamide) and Pepto-Bismol (bismuth subsalicylate), might be prescribed. However, this isn't a long-term treatment plan, and it's usually stopped when the child is successfully toilet trained or retrained.

Coping With Encopresis 

Encropesis can be a complex condition to handle for the child's parents, especially in situations where the child repeatedly soils their clothes and underwear. It's essential to be patient with your child and work together to resolve the problem. Changes to your child's diet and other lifestyle changes might initially be met with some resistance.

It's essential to stay the course to treat encopresis and prevent it from recurring. You can also keep a bowel diary for your child to catch patterns of constipation early.