If a child over the age of 4 has been toilet trained and then passes stool and soils clothes again, this is called encopresis. The child may or may not be doing this on purpose.
Soiling; Incontinence - stool
The child usually has constipation. The stool is hard, dry, and stuck in the colon (called fecal impaction). The child then passes only wet or almost liquid stool that passes around the hard stool. It may leak out during the day or night.
The child was not toilet trained
Toilet training began when the child was too young
The child has emotional problems, like oppositional defiant disorder
Whatever the cause, the child may feel shame, guilt, or lose self-esteem, and may hide signs of encopresis.
The risk for encopresis may increase with:
Low socioeconomic status
Not able hold stool until at a toilet (bowel incontinence)
Passing stool in inappropriate places (as in the child's clothes)
Keeping bowel movements a secret
Constipation and hard stools
Sometimes passing a very large stool that almost blocks the toilet
Exams and Tests
The doctor may feel the stool stuck in the child’s rectum (fecal impaction). An x-ray of the child’s belly may show impacted stool in the colon.
Keep good bowel habits
It is best for parents to support rather than criticize or discourage the child
Treatments may include:
Laxatives or enemas to remove dry, hard stool.
Take stool softener.
Eat a diet high in fiber (fruits, vegetables, whole grains) and enough fluid to keep the stools soft and comfortable.
A short-term treatment of flavored mineral oil. This is only a short-term treatment because mineral oil interferes with the absorption of calcium and vitamin D.
A pediatric gastroenterologist can help when these treatments aren't enough. They may use biofeedback, or teach the parents and child about how to manage encopresis.
Psychotherapy can help the child deal with associated shame, guilt, or loss of self-esteem.
For encopresis without constipation, the child may need a psychiatric evaluation to find the cause.
Most children respond to treatment.
If encopresis is not treated, the child may have low self-esteem and problems making and keeping friends.
If encopresis is not corrected, the child may develop chronic constipation.
When to Contact a Medical Professional
Call for an appointment with your health care provider if a child is over 4 years old and has encopresis.
Toilet train in a positive way when the child is the right age.
If your child shows signs of constipation, such as dry, hard, or infrequent stools, ask your doctor how to treat it.
Feigelman S. Growth, development, and behavior. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 6.
Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.