Encopresis in Children: Symptoms, Causes, Diagnosis, and Treatment

What Is Encopresis?

Encopresis is when a child aged four and above passes stools unintentionally in their underpants. It is sometimes referred to as soiling or functional fecal incontinence. It affects young children aged four and up who have completed their toilet training. Boys are more likely than girls to have the disease. It impacts one to four percent of four-year-old children, and as children grow, the disorder becomes less common.

What Are the Signs and Symptoms of Encopresis?

Children with encopresis often experience the following symptoms -

• • Feces or liquid feces leaking onto underpants.

  • Constipation accompanied by firm, dry stools.

  • Passing a big stool that nearly or completely clogs the toilet.

  • Being unable to hold the stool till reaching a restroom.

  • Avoiding bowel motions.

  • Extended intervals between bowel movements.

  • Absence of appetite.

  • Pain in the abdomen.

  • Bloating.

  • Recurring bladder infections in females.

What Are the Types of Encopresis?

Encopresis is of two types, depending on the cause. They are -

1. Retentive (With Chronic Constipation):

• Retentive encopresis is the most prevalent type, accounting for 80 to 95 percent of the cases.

• It occurs when stool is retained in the rectum for a long time, causing the rectum to stretch and reducing both sensation and control over bowel movements.

• The child with this condition may have chronic constipation, consume a low-fiber diet, and may be afraid of defecation due to painful bowel movements.

• Symptoms include hard stools followed by liquid stools, abdominal discomfort, bloating, and irregular and painful bowel movements. Children will also show stool-withholding behaviors like squatting, concealing, and crossing their legs.

2. Non‑Retentive (Without Constipation):

• This type of fecal incontinence in children is less common and is not caused by constipation.

• Accidents (childhood soiling) are frequently caused by psychological or behavioral issues, but not due to stool impaction.

• Non-retentive encopresis is frequently associated with:

  • Stressful life circumstances, such as beginning school and parental separation.

  • Challenges with toilet training.

  • Oppositional behavior (for instance, refusing to follow rules or saying no to use toilets) or attention-seeking (your child may soil and hide clothes to draw your attention).

• Symptoms seen in this type include proper bowel movements without pain, soft stools, and accidents occurring in familiar settings like school or home, and during the daytime.

What Are the Causes of Encopresis?

Encopresis can be brought on by constipation, underlying medical conditions, or emotional issues.

1. Constipation:

Chronic constipation is the primary cause of encopresis in children. Children with constipation have dry, firm stools and often struggle to defecate due to painful bowel movements. Thus, they avoid using the restroom, which further exacerbates the condition.

When the feces that are hard and dry stay in the colon for a long time, it will be difficult for children to defecate. The longer it stays in the colon, the more difficult it becomes. This causes colon stretching, which will affect the nerves that signal the brain that it is time to defecate when the colon is full. When the colon gets full, liquid stools pass through the dry and firm stools, resulting in leakage.

Causes of pediatric constipation include -

• Withholding stool since passing stools may be painful, or not wanting to use the restroom, especially outside the home.

• To avoid interrupting play or other activities.

• Consuming a low-fiber diet.

• Insufficient intake of fluids.

• Overconsumption of cow's milk.

2. Underlying Medical Conditions:

Encopresis can be a sign of a few underlying medical conditions, which include -

• Colonic inertia (the colon fails to move stools as it should).

• Damage to the digestive tract muscles (the muscles at the end of the digestive tract fail to close properly).

• Infection or rectum tear.

3. Emotional Issues:

Encopresis can be triggered by emotional stress in children, including very early or forceful toilet training and changes in their lives, such as changes in their regular diet, toilet training, or beginning school. Emotional pressures, such as a parent's divorce or a sibling's birth, also contribute to encopresis.

What Are the Risk Factors of Encopresis?

Risk factors of encopresis include the following -

• Taking drugs that might cause constipation.

• If your child has anxiety or depression, then the risk of encopresis is high.

• Also, if the child has ADHD (attention deficit hyperactivity disorder) or autism spectrum disorder, the likelihood of encopresis increases. ADHD is a condition where a child will be very active and find it challenging to stay focused, sitting in one place.

How to Diagnose Encopresis?

To diagnose encopresis, your child’s doctor will ask about the history and do a physical examination, which includes -

• Ask about the symptoms, bowel movements, diet, and emotional well-being of the child.

• Your child’s doctor will insert a gloved and lubricated finger into the rectum to check for muscle tone and impacted stool.

• Abdominal X-ray to locate impacted stools.

• Mental health evaluation to check if that contributes to the condition.

How to Treat Encopresis?

Treatment for encopresis varies between children depending on the cause. It includes the following -

• Bowel Clean‑Out and Stool Softeners: The main objective of bowel clean-out is to remove the impacted stools and restore normal function. Multiple ways are available to clean the colon, including the use of laxatives, enemas, and rectal suppositories. Using stool softeners for kids helps to keep stools soft and reduce stool impaction.

• Behavioral Retraining and Toileting Routines: These focus on stress-free bowel habits. You should encourage your child to sit on the toilet for five to ten minutes after meals to use the body’s natural response to pass stool. Following this for a few days will eventually help your child to have proper bowel movements and help defecate easily.

What Diet and Lifestyle Strategies Help Manage Encopresis in Children?

Particular diet and lifestyle changes help your child overcome encopresis, which include -

• Encourage your child to eat more fruits and vegetables.

• You must insist that your child consume whole-grain breads and cereals.

• Avoid giving your child junk foods that are high in fat and sugar.

• Insist on drinking more water.

• Avoid giving caffeine-containing drinks to your child.

• Encourage your child to be involved in any form of physical activity that helps stimulate bowel movements.

What Are the Prevention Tips for Parents to Help Avoid Encopresis in Children?

Below are some tips for parents to help avoid encopresis in their children

• Provide a well-balanced meal rich in fiber to avoid constipation. Also, encourage drinking more water.

• Avoid starting toilet training too early, and wait till your child is ready. Positively reinforce (like praising or giving stickers) your child to motivate and make slow progress.

• Involve your child in outdoor activities like cycling, which will stimulate their bowel movements naturally.

• Also, create a behavioral toileting schedule (a regular, planned process for using the toilet) to encourage your child to use the toilet.

• Involve your kid in a bowel retraining program to help regain regular bowel habits.

When to Consider Psychological Support?

Parents must consider psychological support in the following situations -

• When encopresis does not improve with medical or toilet retraining.

• When your child refuses to use the toilet, has a fear of using the toilet, or experiences toilet training regression.

• When your child experiences anxiety or low self-esteem.

• Also, when there are changes like parental separation or sibling birth.

Conclusion:

Soiling or encopresis is a condition where the child will poop in their underpants accidentally. Treatment generally focuses on bowel cleaning, toilet retraining, and behavioral changes. These help children overcome the difficulty of using the restroom and recover from the condition. Our online mental health support team will help your child overcome behavioral and mental health issues.

Key Takeaways:

• Encopresis occurs in children aged four and above, where they accidentally soil their underpants.

• Lifestyle and dietary changes help the children manage the condition better, along with medications and toilet retraining.

• If these fail to support, your child might need psychological support; at iCliniq, our online psychologist consultation will guide you through the process that helps your child recover.