Encopresis is the accidental passing of bowel movements that is not caused by illness or physical abnormality.
Encopresis occurs in about 3% of 4-year-old children and becomes less common as age increases. It occurs most often in conjunction with toilet teaching or starting school. As children struggle to establish control of stooling, they sometimes block the urge to defecate too much, resulting in retention of stool. This retention leads to chronic constipation, which stretches the bowel wall and reduces the child's awareness of a full bowel, impairing muscle control. Stool leakage occurs when hard, dry stool is pushed out or when wet stool oozes around the impacted stool.
A doctor first tries to determine the cause. If the cause is constipation, a laxative is prescribed and other measures (such as changes to the child's toileting regimen, diet, environment, and behavior) are instituted to ensure regular bowel movements. Once regular bowel movements are achieved, the leakage often stops. Maintaining soft stools for several months can be necessary for the stretched bowel wall to return to normal and for awareness of rectal fullness to return. If these measures fail, diagnostic tests may be done, such as abdominal x-rays and rarely a biopsy of the rectal wall, in which a tissue sample is taken and examined under a microscope. If a physical cause is found, it often can be treated. In the most severe cases, psychologic counseling may be needed for children whose encopresis is the result of emotional or behavioral problems.
Last full review/revision February 2009 by Stephen Brian Sulkes, MD