Overview

Encopresis (en-ko-PREE-sis), sometimes called fecal incontinence or soiling, is the repeated passing of stool (usually involuntarily) into clothing. Typically it happens when impacted stool collects in the colon and rectum: the colon becomes too full and liquid stool leaks around the retained stool, staining underwear. Eventually, stool retention can cause swelling (distention) of the bowels and loss of control over bowel movements.

Encopresis usually occurs after age 4, when the child has already learned to use a toilet. In most cases, soiling is a symptom of chronic constipation. Far less frequently it occurs without constipation and may be the result of emotional issues.

Encopresis can be frustrating for parents — and embarrassing for the child. However, with patience and positive reinforcement, treatment for encopresis is usually successful.

Source: http://www.mayoclinic.com

Symptoms

Signs and symptoms of encopresis may include:

• Leakage of stool or liquid stool on underwear, which can be mistaken for diarrhea
• Constipation with dry, hard stool
• Passage of large stool that clogs or almost clogs the toilet
• Avoidance of bowel movements
• Long periods of time between bowel movements
• Lack of appetite
• Abdominal pain
• Problems with daytime wetting or bedwetting (enuresis)
• Repeated bladder infections, typically in girls

When to see a doctor

Call your doctor if your child is already toilet trained and starts experiencing one or more of the symptoms listed above.

Source: http://www.mayoclinic.com

Causes

There are several causes of encopresis, including constipation and emotional issues.

Constipation

Most cases of encopresis are the result of chronic constipation. In constipation, the child's stool is hard, dry and may be painful to pass. As a result, the child avoids going to the toilet — making the problem worse.

The longer the stool remains in the colon, the more difficult it is for the child to push stool out. The colon stretches, ultimately affecting the nerves that signal when it's time to go to the toilet. When the colon becomes too full, soft or liquid stool may leak out around the retained stool or loss of control over bowel movements may occur.

Some causes of constipation include:

• Withholding stool due to fear of using the toilet (especially when away from home) or because stools are painful
• Not wanting to interrupt play or other activities
• Eating too little fiber
• Not drinking enough fluids
• Drinking too much cow's milk or, rarely, an intolerance to cow's milk — though research results conflict on these issues

Emotional issues

Emotional stress may trigger encopresis. A child may experience stress from:

• Premature, difficult or conflict-filled toilet training
• Changes in the child's life, such as dietary changes, toilet training, starting school or schedule changes
• Emotional stressors, for example, the divorce of a parent or the birth of a sibling

Source: http://www.mayoclinic.com

Diagnosis

To diagnose encopresis, your child's doctor may:

• Conduct a physical exam and discuss symptoms, bowel movements and eating habits to rule out physical causes for constipation or soiling
• Do a digital rectal exam to check for impacted stool by inserting a lubricated, gloved finger into your child's rectum while pressing on his or her abdomen with the other hand
• Recommend an abdominal X-ray to confirm the presence of impacted stool
• Suggest that a psychological evaluation be done if emotional issues are contributing to your child's symptoms

Source: http://www.mayoclinic.com

Complications

A child who has encopresis may experience a range of emotions, including embarrassment, frustration, shame and anger. If your child is teased by friends or criticized or punished by adults, he or she may feel depressed or have low self-esteem.

Source: http://www.mayoclinic.com

Prevention

Below are some strategies that can help prevent encopresis and its complications.

Avoid constipation

Help your child avoid constipation by providing a balanced diet that's high in fiber and encouraging your child to drink enough water.

Learn about effective toilet training techniques

Educate yourself on effective toilet training techniques. Avoid starting too early or being too forceful in your methods. Wait until your child is ready, and then use positive reinforcement and encouragement to help make progress. Ask your doctor about resources on toilet training.

Get early treatment for encopresis

Early treatment, including guidance from your child's doctor or mental health professional, can help prevent the social and emotional impact of encopresis. Regular follow-up visits with your doctor can help identify ongoing or recurring problems so that adjustments in treatment can be made as needed.

Lifestyle and home remedies

Avoid using enemas or laxatives — including herbal or homeopathic products — without first talking to your child's doctor.

Once your child has been treated for encopresis, it's important that you encourage regular bowel movements. These tips can help:

• Focus on fiber. Feed your child a balanced diet that includes plenty of fruits, vegetables, whole grains and other foods high in fiber, which can help form soft stools.
• Encourage your child to drink water. Drinking enough water helps keep stool from hardening. Other fluids may help, but watch the calories.
• Limit cow's milk if that's what the doctor recommends. In some cases, cow's milk may contribute to constipation, but dairy products also contain important nutrients, so ask the doctor how much dairy your child needs each day.
• Arrange toilet time. Have your child sit on the toilet for five to 10 minutes at regular times every day. This is best done after meals because the bowel becomes more active after eating. Praise your child for sitting on the toilet as requested and trying.
• Put a footstool near the toilet. This may make your child more comfortable, and changing the position of his or her legs can put more pressure on the abdomen, making a bowel movement easier.
• Stick with the program. It may take months to resume normal bowel sensation and function and develop new habits. Sticking with the program can also reduce relapses.
• Be encouraging and positive. As you help your child overcome encopresis, be patient and use positive reinforcement. Don't blame, criticize or punish your child if he or she has an accident. Instead, offer your unconditional love and support.

Source: http://www.mayoclinic.com

Risk factors

Encopresis is more common in boys. These risk factors may increase the chances of having encopresis:

• Using medications that may cause constipation, such as cough suppressants
• Attention-deficit/hyperactivity disorder (ADHD)
• Autism spectrum disorder
• Anxiety or depression

Source: http://www.mayoclinic.com