Soiling; Incontinence - stool
If a child over the age of 4 has been toilet trained and then passes stool and soils clothes again, this is called encopresis. The child may or may not be doing this on purpose.
The child usually has 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:
Symptoms can include any of the following:
The doctor 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 goal 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 to treatment.
Call for an appointment with your health care provider if a child is over 4 years old and has encopresis.
Toilet train in a positive way when the child is the right age.
If your child shows signs of constipation, such as dry, hard, or infrequent stools, ask your doctor how to treat it.
Katz ER, DeMaso DR. Encopresis. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 21.4.
Last reviewed on: 8/30/2014
Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.