What is encopresis?

Encopresis is the involuntary leaking of feces, most often caused by chronic constipation. An estimated 1 to 3 percent of children have this problem at one time or another in childhood.

How does encopresis happen?

Constipation can cause a child's bowel movements to be hard, dry, difficult to pass and so large that they can clog the toilet. Encopresis happens when soft or liquid feces leak out of the rectum. Constipation leads to encopresis in the following way:

  • A child's stool becomes impacted, which means a large amount of it gets stuck in the rectum and large intestine.
  • The impacted stool stretches the rectum and intestine, causing them to become enlarged.
  • Eventually, the enlarged rectum and intestine lose their ability to detect the presence of stool. The anal sphincter, the muscle that helps hold stool in, becomes weak.
  • Soft stool starts to leak around the impacted stool, soiling the child's underwear and clothes.
  • As more stool collects, it becomes even more difficult to hold it in and the child has more accidents. Because of decreased sensitivity in the rectum, the child may not even be aware they've had an accident until after it has occurred.

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

How encopresis can affect a child’s health

Encopresis can cause both physical and emotional problems.

Physical problems

  • abdominal pain, a loss of appetite and stool accidents
  • urinary tract bladder infections
  • urine accidents during the day or night
  • rash and irritated skin
  • painful bowel movements

Emotional problems

A child with encopresis can feel ashamed and embarrassed.

Parents may also feel guilt, shame and anger over their child’s accidents. It’s important to understand that encopresis is a medical issue, not a behavior that can be changed through punishment or discipline.

How we care for encopresis

The physicians and nurse practitioners in the Division of Gastroenterology, Hepatology and Nutrition at Boston Children’s Hospital are experts in helping children have regular bowel movements on the toilet. We start with a complete medical history, questions about toilet training and a thorough physical exam. In some cases, children also have an abdominal x-ray to evaluate the amount of stool in the large intestine, and blood tests may also be needed