Encopresis | Diagnosis & Treatment

How is encopresis diagnosed?

Diagnosis starts with a complete medical history that includes questions about the child’s toilet training and a physical exam. This often provides enough information to diagnose encopresis. In some cases, doctors obtain an abdominal x-ray to evaluate the amount of stool in the large intestine.

How is encopresis treated?

Treatment for encopresis depends on the root cause.

If encopresis is caused by constipation, treatment may include:

  • laxatives to help the child pass the impacted stool
  • medication to keep bowel movements soft so the stool will pass easily
  • five to ten minutes sitting on the toilet at home after breakfast and dinner

In some cases, physicians prescribe enemas to help remove the impacted stool. An enema is a liquid that is placed in the rectum that helps loosen the hard, dry stool. Important: It is unsafe to give a child an enema without the approval of their physician. Enemas should only be used when medically indicated and both the child and parents are comfortable.

Overtime, the intestine and rectum will shrink to their normal size and the child should be able to have normal bowel movements without any medication or prompting.

In the case of toilet refusal, treatment includes a combination of the medical treatments described above and behavioral treatments to help the child become more comfortable using the toilet for bowel movements.

What happens after the impacted stool is passed?

After a child passes an impacted stool, it’s important to develop a good routine to ensure that stool does not get backed up again. The child may still have problems with leakage until the intestine and rectum return to their normal size.

To reduce the number of accidental bowel movements, the child should continue to sit on the toilet two to three times a day for five to ten minutes, preferably shortly after a meal.

How to avoid constipation

Often, making changes in a child's diet will help prevent future constipation:

  • adding more fruits and vegetables
  • adding more whole-grain cereals and breads
  • drinking more fluids, especially water
  • limiting fast foods and junk foods that are usually high in fats and sugars
  • limiting whole milk to 16 ounces a day for the child over 2 years of age, but not eliminating milk altogether; children need the calcium and Vitamin D in milk to help their bones grow strong
  • serving meals on a regular schedule
  • serving breakfast early so the child has time for a bowel movement before school
  • increasing exercise
  • if a child has a limited diet/sensory aversion, a fiber supplement can be helpful