Encopresis Symptoms & Causes

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It can be upsetting to see your child suffer from the constipation. And the onset of constipation, which can lead to encopresis, can be so gradual that parents do not realize their child is having a problem. School-aged children go to the bathroom on their own, and it is natural for parents to assume everything is OK unless their child tells them otherwise.

Our physicians and nurse practitioners are experts in helping kids have regular bowel movements on the toilet. We’ve had years of experience treating kids just like yours. So not to worry — your child will be fine and you and your family will get through this challenging time.

How does encopresis happen?

Constipated children have fewer bowel movements than normal, and their bowel movements can be hard, dry, difficult to pass and so large that they can often even block up the toilet. Here are some examples why:

  1. Your child's stool can become impacted (packed into her rectum and large intestine).
  2. Her rectum and intestine become enlarged due to the retained stool.
  3. Eventually, her rectum and intestine have problems sensing the presence of stool, and the anal sphincter (the muscle at the end of the digestive tract that helps hold stool in) becomes dilated, losing its strength.
  4. Stool can start to leak around the impacted stool, soiling your child's clothing.
  5. As more and more stool collects, your child will be less and less able to hold it in, leading to accidents. Because of decreased sensitivity in your child’s rectum due to its larger size, she may not even be aware she’s had an accident until after it has occurred.

In kids who haven’t yet been toilet trained, struggling to hold in excess stool, or constipation that arises from refusing to have a bowel movement on the toilet, can also lead to encopresis.

How common is encopresis in children?

It’s difficult to say for certain because many cases of encopresis are not reported. There seems to be a stigma attached to this condition that prevents many parents from reaching out and talking to other parents whose children may have had the same problem.

We estimate that between one and three percent of kids have this problem at one time or another in childhood.

Which children develop encopresis?

Any child with chronic constipation may develop encopresis. Some situations that may contribute to your child’s constipation include:

  • eating a “junk-food” diet that is low in fiber
  • painful bowel movements
  • lack of exercise
  • stress in the family, with friends or at school
  • change in bathroom routine, such as when a child starts a new school year and bathroom breaks are less frequent
  • being too busy to take time to use the bathroom

For children who have never been toilet trained and who refuse to have a bowel movement on the toilet, additional concerns apply including:

  • reluctance to use bathrooms at home or in public
  • anxiety about using the toilet

What kind of problems might my child have with encopresis?

Encopresis can cause your child to have both physical and emotional problems.

Physical problems

  • Impacted (backed up) stool in her intestine can cause abdominal pain, a loss of appetite and stool accidents.
  • Some children, especially girls, develop urinary tract and/or bladder infections.
  • The enlarged bowel can push on the bladder causing urine accidents during the day or night.
  • Rarely, other health problems may cause the chronic constipation leading to encopresis, including:

Emotional problems

Your child might feel emotionally upset by soiling her clothes, leading to feelings of shame and embarrassment.

You, too, might feel guilt, shame and anger because of your child’s encopresis. It’s very important to try not to communicate this to your child, as this may worsen her emotional state.

Is encopresis painful?

While encopresis itself isn’t usually painful (unless the leaking stool leads to a rash on your child’s skin), the constipation that leads to it may be.

What causes encopresis?

There are two basic causes: long-term constipation and toilet refusal. At Boston Children’s Hospital, we first determine the cause and then treat your child appropriately.

  • long-term constipation — Encopresis is usually due to chronic constipation, which can be easily overlooked in children. There’s often no clear cause of this constipation, although sometimes it does run in families.
  • toilet refusal — Your child has never been toilet trained and refuses to have a bowel movement in the toilet, which leads to constipation and encopresis.

It’s rare that a child has an underlying medical condition that causes encopresis, but we do consider these causes when we see your child.

Encopresis signs and symptoms

Here are some signs that your child might be constipated, which could lead to encopresis:

  • large stools that block up the toilet
  • involuntary bowel movements or needing to have a bowel movement with little or no warning
  • soiling underwear when a child cannot get to the bathroom in time
  • small, frequent bowel movements

Long-Term outlook for children with encopresis

Though it may seem as though your child will suffer from encopresis forever, this isn’t the case. The vast majority of kids (the possible exceptions being those who have an underlying medical issue) will stop having stool accidents and have regular bowel movements on the toilet.

The end result of treatment is the same for both causes of encopresis, but the way we get there is different.

  • long-term constipation— We’ll help your child pass the impacted stool and then help keep stool soft so that it passes easily and doesn’t get backed up again. After about six months, your child’s intestine and rectum will shrink to their normal size and your child should be able to have normal bowel movements on her own without any medication or prompting.
  • toilet refusal— These children will get a combination of medical (laxatives, stool softeners) and behavioral treatments to help them become more comfortable using the toilet for bowel movements.

We understand this is a challenging time, but we’ve cared for many kids with this problem — and we’ve helped them (and their families) get through it.

Questions to Ask Your Doctor

You and your family are key players in your child’s medical care. It’s important that you share your observations and ideas with your child’s health care provider and that you understand your provider’s recommendations.

If your child is suffering from the constipation that leads to encopresis and you’ve set up an appointment, you probably already have some ideas and questions on your mind. But at the appointment, it can be easy to forget the questions you wanted to ask. It’s often helpful to jot them down ahead of time so that you can leave the appointment feeling like you have the information you need.

Some questions you may want to ask include:

  • Does encopresis go away on its own?
  • What are our treatment options?
  • Are laxatives safe?
  • What are examples of positive reinforcement strategies?
  • What can we do at home to help?
  • Where can we go for further information?

Keep in mind that your doctor will want to ask you some questions, too. These may include:

  • How long has your child had this problem?
  • Has your child been toilet trained?
  • Is there a history of encopresis in the family?
  • What’s your child’s diet like?
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- Sandra L. Fenwick, President and CEO

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