Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention

Definition

Stool soiling (or encopresis) is inappropriate loss of control of the bowels. This usually results in stool staining the underwear.

In order to be diagnosed with this condition, there must be no other physical problem or condition that could be causing the loss of stool. Encopresis occurs in children aged four years and older.

Causes

Causes include:

  • Chronic constipation (accounts for most cases)—When a large amount of hard, dry stool is filling the rectum, over time the child becomes unable to recognize the sensation of fullness and the need to defecate. Liquid stool may leak around the hard mass of stool, causing staining of the underwear.
  • Poor toilet training or refusal to use the toilet for bowel movements
  • Emotional problems
  • Rare physical problems that may lead to constipation and fecal incontinence

Risk Factors

Risk factors include:

  • Sex: male
  • Children with emotional problems, such as:
  • Children who have suffered sexual abuse (according to some researchers)
  • Passage of firm stool that causes a painful tear or "fissure" at the opening of the anus

Bowel and Rectum

Anal fissure and fistula
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Symptoms

The main symptom is the accidental passage of stool, usually into the underwear. Other symptoms may include:

  • Low self-esteem
  • Feelings of embarrassment, shame, or guilt

When Should I Call the Doctor?

Call the doctor if your child has stool staining in his underwear. The doctor can help find the underlying cause.

Diagnosis

The doctor will ask about your child's symptoms and medical history. A physical exam will also be done.

Most children with encopresis do not have physical problems. While parents are often unaware that their child is constipated, they may see their child forcibly holding stool when he has the urge to move his bowels. This description of stool holding is important for the doctor to know about.

To make a diagnosis, the doctor may order tests, such as:

  • Rectal exam—may reveal the presence of a large quantity of hard, dry stool in the rectum
  • Abdominal x-ray—may also show stool in the rectum

Treatment

The doctor will explain why encopresis is occurring. As a parent, it is important that you do not shame your child.

Bowel Clean-Out

If constipation is a problem, enemas and laxatives may be used on a short-term basis to clean out your child's bowel.

If symptoms are not improving rapidly or if your child is passing blood with stools, further testing will need to be done to find the underlying cause.

Dietary Changes

To help prevent constipation, encourage your child to:

  • Eat a healthy diet that is high in fiber.
  • Drink plenty of liquids.

Bowel Training

Help your child learn when to use the toilet. For example, encourage your child to go to the bathroom at certain times during the day.

You may want to give your child rewards for keeping his clothes clean and for passing a bowel movement in the toilet.

Counseling

Counseling may be needed if your child:

  • Has severe problems with toilet training
  • Has emotional problems (including family problems)
  • Is experiencing shame, guilt, or low self-esteem due to fecal incontinence

Prevention

Following guidelines for toilet training may help prevent encopresis. A healthy, high-fiber diet and adequate liquid intake may also help prevent this condition.