Encopresis (Fecal Soiling)

What Is It?

Encopresis, also called fecal soiling, is when a child passes stool (bowel movements) into his or her underpants or some other inappropriate place. The medical definition of encopresis says that the child must be at least 4 years old, the age by which most children can control bowel movements. However, some experts say that any child over age 3 who is not toilet trained has encopresis. Encopresis occurs in 1% to 2% of all school-aged children in the United States. Boys have the problem more often than girls.

In 9 out of 10 children with encopresis, the problem is related to chronic constipation, which means bowel movements don't occur often enough, and the stool is hard and dry.

When stool needs to be passed, it collects in the lower bowel (rectum), stretching the bowel wall. This feeling of the bowel being stretched is what normally makes us realize we have to go to the bathroom. However, if the bowel wall is stretched for long periods without passing a bowel movement, the rectum loses its normal muscle tone and feeling. This makes it harder and harder to pass the chunk of hard stool collecting in the rectum. As newer stool continues to be made in the intestines, it leaks around the large chunk of hard stool, passes out of the rectum, and soils the child's underpants. In almost all children with encopresis caused by constipation, this is not done on purpose. In fact, many children do not even realize that the stool has leaked out. The first clue that the child has a problem may come when a parent, teacher or playmate notices that the child smells bad.

Chronic constipation that turns into encopresis can have many different causes, including:

• Tension and anxiety because of problems during toilet training

• A diet that is low in fiber (found in fruits, vegetables, whole grains) and high in foods that tend to cause constipation (whole milk, cheese, bananas, white rice, white bread)

• Not drinking enough liquids

• An inactive lifestyle with too little exercise (exercise stimulates the intestines to move)

• Fear and anxiety about using an unfamiliar bathroom, for example, at school, a friend's house, hotel or summer camp

• Not paying attention to the feeling (urge) that it's time to have a bowel movement: Some children do not go to the bathroom when they have the urge to do so because they are too busy playing a game, watching television or doing some other engaging activity. At school, they may be afraid to ask for permission to leave class to use the bathroom.

• A fissure - When a child with constipation finally passes a bowel movement, the abnormally large stool may injure the skin of his or her rectum, producing a painful tear in the skin called a fissure. Because of this painful fissure, the child may become more and more anxious about having a bowel movement for fear of pain.

• Hypothyroidism - Having low levels of thyroid hormones can make a child's digestive system function more slowly than normal, leading to constipation.