Encopresis (soiling) occurs when your child resists having bowel movements, causing impacted stool to collect in the colon and rectum. When your child's colon is full of impacted stool, liquid stool can leak around the impacted stool then out of the anus, staining your child's underwear. Encopresis may also be called stool withholding. In most cases, encopresis is not a disease, but rather a symptom of chronic constipation. Less frequently, it may be the result of developmental or emotional issues. Encopresis usually occurs more commonly in boys after age 4, when your child has already learned to use a toilet.

Causes

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 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.

Motility (ability of colon to move stool through)

Some children are born with a physical condition in which their colon doesn't function properly, causing them to be predisposed to constipation.

Emotional issues

Emotional stress, such as premature toilet training or an important change in the child's life – for instance, the divorce of a parent or the birth of a sibling — also may trigger encopresis.

Symptoms

• Leakage of stool or liquid stool on your child's underwear when he or she isn't sick. If the amount of leakage is large, you may misinterpret it as diarrhea.
• Constipation and dry, hard stool
• Passage of large stool that clogs or almost clogs the toilet
• Avoidance of bowel movements
• Lack of appetite
• Abdominal pain

Exams and Tests

The pediatric GI specialist will ask about your child's symptoms. He or she may conduct a physical examination, including a rectal examination to check for impacted stool. During this exam, the doctor inserts a lubricated, gloved finger into your child's rectum. The pediatric gastroenterologist also may recommend an abdominal X-ray to confirm the presence of impacted stool. If the cause of encopresis is unclear, the doctor may recommend a psychological evaluation to help determine the cause.

Anorectal Manometry

This test uses small balloons to test the function of the anal muscles. The test can be conducted in the endoscopy suite under general anesthesia. More extensive studies can be conducted in cooperative children while they are awake in the motility lab.

Treatment

Treatment of encopresis focuses on clearing the colon of retained, impacted stool and encouraging healthy bowel movements. This includes training your child to go to the bathroom as soon as reasonably able when he or she gets the urge to have a bowel movement. There are several methods for clearing the colon and relieving constipation. Your child's pediatric GI specialist will likely recommend one or more of the following:

• Stool softeners
• Colon lubricants, such as mineral oil
• Rectal suppositories
• Enemas
• More fluids

Your child's doctor may recommend abdominal X-rays to check the progress of the colon cleaning. Once the colon has been cleared, it's important to encourage your child to have regular bowel movements. In addition to self-care measures such as recommending a high-fiber diet, your child's doctor may recommend the use of stool softeners for six to 12 months.

Points to Remember

• Encopresis (soiling) occurs when stool leaks from the anus. This typically happens as a result of chronic constipation and the collection of a large amount of hard, dry stool in the colon.
• A child may hold his/her stool because it is painful to void.
• The best treatment for encopresis is to encourage regular bowel movements.
• Stool softeners may be prescribed to help clear the colon.
• Emotional issues can also play a role in children holding their stool and becoming constipated.

For More Information

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition - NASPGHAN.org