Encopresis is usually an involuntary passage of feces (stools) by a child age four or more in inappropriate places such as clothing. It is frequently the result of chronic constipation, which over time results in fecal impaction and in the leakage of liquid stool accumulated above the impacted feces. This leakage may occur during the day or night and it is not under the conscious control of the child. Leakage varies in frequency; it can range from infrequent occurrences to almost a continuous flow.
Encopresis is categorized according to the subtype that characterizes the presentation—primary is with constipation and overflow incontinence; secondary is without constipation and overflow incontinence. The primary subtype has evidence of constipation on physical examination or a history of a bowel movement frequency of fewer than three per week. Feces in overflow incontinence are characteristically poorly formed, and leakage occurs mostly during the day and rarely during sleep. Only part of the feces is passed during toileting, and the incontinence resolves after treatment of the constipation. The secondary subtype has no evidence of constipation on physical examination or by history. Feces are likely to be of normal form and consistency, and soiling is intermittent. Feces may be deposited in a prominent location. This is usually associated with the oppositional defiant disorder or conduct disorder.
