Encopresis is a disorder that involves the repeated passage of feces in inappropriate places by a child. Usually, this behavior is involuntary and the physical result of chronic constipation, which over time results in the leakage of stool. However, it can also be deliberate and psychological in nature, especially in cases where a child struggles with an oppositional defiant disorder or conduct disorder.
An estimated 1 percent of 5-year-olds have encopresis, and the problem can persist in some children for years thereafter. This disorder is more common in males than in females, and it tends to run in families. Instances of encopresis may occur during the day or night.
Encopresis can take a heavy toll on a child’s mental health. Children with encopresis often feel ashamed and may seek to avoid situations where they could feel embarrassed, including going to school, attending camp, or participating in a sport or other physical activity.
For a diagnosis of encopresis, according to the DSM-5:
- A child passes feces—involuntarily or on purpose—into clothing, on the floor, or in other inappropriate places.
- This occurs at least once a month for more than three months.
- The child is at least 4 years old (or at an equivalent level of development).
- This behavior must not be attributable to a substance's physiological effects or another medical condition.
Encopresis can be further classified according to two subtypes: with constipation and overflow incontinence and without them.
With constipation and overflow incontinence:
- There is evidence of constipation.
- Leakage may or may not occur frequently.
- Episodes happen mostly during the day.
Without constipation and overflow incontinence:
- There is no evidence of constipation.
- Soiling is intermittent.
- Feces may be left in a prominent place.
- The behavior may coincide with the presence of oppositional defiant disorder or conduct disorder.
In cases where the passage of feces is not intentional, it often results from constipation, which may, in turn, stem from the avoidance of defecation due to anxiety or other forms of psychopathology. Constipation can also result from dehydration or certain physiological dispositions related to defecation.
When the passage of feces is intentional, the child may also have features of another disorder (e.g., oppositional defiant disorder or conduct disorder) that involves socially unacceptable behavior more generally.
Painful defecation and some medications (such as anticonvulsants or cough suppressants) may contribute to the development of encopresis, according to the DSM-5. Inadequate toilet training and stress may also make encopresis more likely.
Scientists have found a second or "backup brain" in the gut that can influence people’s moods and behavior. Known as the enteric nervous system (ENS), this second brain processes information from throughout the body. As a result, anxiety, depression, and other distressing emotions can contribute to or exacerbate physical conditions related to the gut and digestive processes, such as encopresis.
Encopresis can be both a contributing factor and a symptom of depression in childhood and adolescence. Parents will want to keep an eye out for any behavior that is inappropriate for their child’s age and developmental level. Examples can include constipation, soiling, bed-wetting, and changes in bowel habits, particularly if they’re sudden.
A health care provider will perform a physical examination and perhaps run additional tests to help make a diagnosis of encopresis. Treatment, which should be administered by a physician, may include measures such as providing laxatives, enemas, or stool softeners and introducing a high-fiber diet. If necessary, a pediatric gastroenterologist may employ additional techniques to help overcome encopresis. A "maintenance" phase that involves scheduled toilet times and regular laxative use may last a couple of months or longer, according to the American Academy of Pediatrics.
A psychotherapist may help a child with encopresis cope with its negative psychological effects, such as shame or decreased self-esteem. In the absence of constipation, a psychiatric evaluation may help identify an underlying cause for the behavior.
Sometimes, children may deliberately soil themselves. This occurs more frequently with children who have a co-occurring disorder, like conduct disorder or oppositional defiant disorder (ODD). One sign is when a child’s feces are discovered in a prominent location, intended to be displayed. A trained therapist can help these children deal with encopresis and any related mental health issues.
Children whose encopresis goes unrecognized or untreated may not be able to resolve their symptoms on their own for many years. In some cases, they may experience problems into adulthood. In general, it’s best not to assume that encopresis will simply go away on its own; instead, seek treatment as early as possible to achieve a more positive outcome for the child.
In addition to following a physician’s treatment recommendations, parents can make some simple lifestyle changes at home to help their child deal with encopresis. For example, they can set a regular bathroom time (e.g., after meals). Parents can also encourage a child to drink plenty of water to prevent dehydration and eat a diet rich in fiber, fruits, and vegetables. It may help parents to keep a diary of their child’s eating and toilet habits so that they can notice and record improvements.