Encopresis
Repeated stool passage in inappropriate places by a child.
Encopresis refers to a child repeatedly passing stool in inappropriate places, such as underwear or the floor, when they are old enough developmentally to have learned toilet skills. The word comes from Ancient Greek. It is most often used for soiling linked to long-term constipation and overflow incontinence, but it can also occur without constipation. In the DSM-5, it is classified as an elimination disorder. The term is generally applied to children; in adults, the same symptom is more often called fecal incontinence, which includes soiling, leakage, or seepage.
The main sign is involuntary or voluntary soiling of underwear. There are two types: retentive, which involves constipation and overflow incontinence, and non-retentive, which does not. Children with constipation may have a poor appetite, stomach pain, pain during bowel movements, fewer bowel movements, and stools that are either very hard or very soft. Those without constipation do not have these symptoms.
Constipation is a common cause in children, often from reflexively holding in stool. Other causes include physiological, psychological, or neurological disorders, and rarely, surgery. Encopresis can also happen without constipation. Normally, the colon removes excess water from stool. If stool stays in the colon too long—due to conditioned withholding or accidental constipation—too much water is removed, making the stool hard and painful to pass. This can start a vicious cycle: the child avoids bowel movements to escape the expected pain, which can deeply condition the holding response, leading to a condition called rectal anal inhibitory response (RAIR) or anismus. RAIR can occur even under anesthesia or when voluntary control is lost. The hard stool builds up, stretching the colon or rectum until normal sensations of needing a bowel movement disappear. Eventually, softer stool leaks around the blockage, and the anus cannot hold it back, causing soiling. The child usually has no control over these leaks and may not feel them happening because of lost rectal sensation and RAIR. Chronic soiling can cause distress, embarrassment, and social problems for the child and family, making treatment harder.
The onset is usually benign, often linked to toilet training, demands to sit for long periods, or strong negative parental reactions to feces.
Quick Facts
- Field
- Psychiatry, clinical psychology, pediatrics
Facts from the source article.
Lore & Background
Encopresis is commonly caused by constipation in children, by reflexive withholding of stool, by various physiological, psychological, or neurological disorders, or from surgery. The colon normally removes excess water from feces; if stool remains in the colon too long due to conditioned withholding or incidental constipation, it becomes hard and painful to expel. A vicious cycle can develop where the child avoids moving their bowels to avoid pain, leading to the rectal anal inhibitory response (RAIR) and loss of normal sensation. Softer stool then leaks around the blockage, resulting in soiling that the child typically cannot control or feel.
Reader's Guide
The onset of encopresis is most often benign, associated with toilet training, demands for long sitting periods, and intense negative parental reactions to feces. Beginning school or preschool, feuding parents, siblings, moving, and divorce can also inhibit toileting behaviors. Treatment for retentive encopresis typically involves a three-pronged approach: cleaning out the bowel with enemas or laxatives, using stool-softening agents, and scheduling sitting times after meals. Behavioral treatment focuses on establishing a regular toileting routine, and dietary changes include increasing fiber and water while limiting constipating foods. The estimated prevalence in four-year-olds is between one and three percent, and the disorder is more common in males.
Did You Know?
- Encopresis is categorized as an elimination disorder in the DSM-5.
- The term comes from Ancient Greek ἐγκόπρησις (enkóprēsis).
- In adults, the symptom is more commonly known as fecal incontinence.
- The disorder is thought to be more common in males than females, by a factor of 3:1 to 6:1.
More in Symptoms and signs: Digestive system and abdomen 1-24
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