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Encopresis

Encopresis is the repeated passage of feces in inappropriate places by a child. It is often the result of chronic constipation, which over time results in the leakage of stool. Typically, this behavior is involuntary. Children with encopresis often feel ashamed and may seek to avoid entering situations where they could feel embarrassed.

An estimated 1 percent of 5-year-olds have encopresis, and this disorder is more common in males than in females.

Symptoms

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 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, except through a mechanism involving constipation

Encopresis can be further classified according to two subtypes:

  • With constipation and overflow incontinence: There is evidence of constipation; leakage may or may not occur frequently and happens 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; may coincide with the presence of oppositional defiant disorder or conduct disorder.
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Causes

In cases where the passage of feces is not intentional, it often results from constipation that may in turn stem from the avoidance of defecation due to anxiety or other forms of psychopathology. The constipation can also result from dehydration or certain physiological dispositions related to defecation.

When the passage is intentional, the child may also have features of another disorder (e.g., oppositional defiant disorder or conduct disorder) that involves social 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.

Treatment

Physical examination and tests by a health care provider can help make a diagnosis. 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.

References
American Academy of Pediatrics  
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
U.S. National Library of Medicine
Last updated: 02/07/2019