Soiling; Incontinence - stool; Constipation - encopresis; Impaction - encopresis
If a child over 4 years of age has been toilet trained, and still passes stool and soils clothes, it is called encopresis. The child may or may not be doing this on purpose.
The child may have constipation. The stool is hard, dry, and stuck in the colon (called fecal impaction). The child then passes only wet or almost liquid stool that flows around the hard stool. It may leak out during the day or night.
Other causes may include:
Whatever the cause, the child may feel shame, guilt, or low self-esteem, and may hide signs of encopresis.
Factors that may increase the risk of encopresis include:
Encopresis is much more common in boys than in girls. It tends to go away as the child gets older.
Symptoms can include any of the following:
The health care provider may feel the stool stuck in the child's rectum (fecal impaction). An x-ray of the child's belly may show impacted stool in the colon.
The provider may perform an examination of the nervous system to rule out a spinal cord problem.
Other tests may include:
The goal of treatment is to:
It is best for parents to support, rather than criticize or discourage the child.
Treatments may include any of the following:
For encopresis without constipation, the child may need a psychiatric evaluation to find the cause.
Most children respond well to treatment. Encopresis often recurs, so some children need ongoing treatment.
If not treated, the child may have low self-esteem and problems making and keeping friends. Other complications may include:
Contact your provider for an appointment if a child is over 4 years old and has encopresis.
Encopresis can be prevented by:
Marcdante KJ, Kliegman RM, Schuh AM. Digestive system assessment. In: Marcdante KJ, Kliegman RM, Schuh AM, eds. Nelson Essentials of Pediatrics. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 126.
Noe J. Constipation. In: Kliegman RM, Toth H, Bordini BJ, Basel D, eds. Nelson Pediatric Symptom-Based Diagnosis. 2nd ed. Philadelphia, PA: Elsevier; 2023:chap 19.
Roy D, Akriche F, Amlani B, Shakir S. Utilisation and safety of polyethylene glycol 3350 with electrolytes in children under 2 years: A Retrospective Cohort. J Pediatr Gastroenterol Nutr. 2021;72(5):683-689. PMID: 33587408 pubmed.ncbi.nlm.nih.gov/33587408/.BACK TO TOP
Review Date: 7/28/2022
Reviewed By: Charles I. Schwartz MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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