No matter what the initial cause of a child's chronic constipation, the end result is the same. A large chunk of stool builds up and stretches the rectum until it loses its normal tone and feeling. This makes it more difficult for the rectum to push out the stool, so more and more stool builds up. This unhealthy cycle can only be broken when the bowel is completely cleared of stool, so it can return to its normal size. Then a child can learn how to empty his or her bowel on a more regular schedule.

In rare cases, encopresis is related to medical problems involving the nerves in the spine or the bowel wall, or to psychological issues, such as anger, abnormally impulsive behavior, grief over the death of a loved one, sexual abuse or some other stress.

Symptoms

In most children with encopresis, the most obvious signs are soiled underpants and a foul body odor (the smell of stool). Other signs and symptoms may include:

• Periods of constipation (no bowel movements) alternating with very large bowel movements

• Streaks of blood on the outside of stool, or on toilet tissue used to wipe after a bowel movement

• Pain in the lower abdomen or rectum

• Stool-stained clothes hidden in closets, under the bed or elsewhere

• Bedwetting, probably related to pressure from the large chunk of stool in the rectum - This occurs in about 40% of cases of encopresis.

In rarer cases, when encopresis is caused by serious psychological problems, a child may drop or smear stool on floors, walls or furniture.