Encopresis (Constipation and Soiling)
What is constipation?
When your child's bowel movements are very hard, difficult or painful to pass, and/or occur less often than every 3 days, it is called constipation. This may happen if your child doesn’t eat enough fiber, doesn’t get enough exercise, or doesn’t drink enough liquids (especially water). It can also happen if your child ignores the urge to poop because they are embarrassed to use the public bathroom, or don't want to stop playing. Constipation can make pooping painful, so that your child may hold their poop in to avoid a painful bowel movement. Functional constipation means that the constipation is not due to an underlying disease process.
What is soiling?
Soiling, overflow incontinence, or fecal incontinence, is when liquid or formed poop leaks into the child's underwear. The child has no control over this leakage. It usually happens when a big, hard blockage of poop from constipation is blocking the rectum. This is called an impaction. When a child has an impaction, poop can leak around the blockage into the underwear.
What is encopresis?
Encopresis is overflow soiling that happens because of constipation. In children with encopresis, formed, soft, or liquid poop leaks from the anus around a mass of poop that is stuck in the lower bowel. The bowel can get so stretched that your child can no longer feel the urge to poop, and the anal sphincter (the muscle around the anus that holds the poop in) can get very weak. Sometimes the poop takes up so much room that your child's bladder doesn't have enough space. This can cause bedwetting.
How common are constipation and encopresis?
About 16-37% of school-aged kids have to deal with constipation. Constipation with overflow (encopresis) soiling affects at least 4% of preschool kids and 1-2% of school-aged kids. In school-aged kids, encopresis is most likely to affect boys.
How do I know when to see the doctor?
If you feel there may be a problem with your child’s bowel function, don’t delay. Talk to your pediatrician. Current studies show that children do better with early diagnosis and treatment.
You should call your child's doctor if:
- You are worried about constipation in your child.
- Any constipation symptoms last longer than one week.
- You see blood on the stool (poop), or worry about small skin tears at the anus.
- Your child has hemorrhoids.
- Normal pushing is not enough to get the poop out.
- Your child’s bowel movements are painful.
- Liquid or soft poop leaks out between bowel movements.
- Your child is constipated and vomiting.
- Your child has a swollen belly.
- You are concerned about your child’s growth and weight gain.
How does the doctor tell if my child has encopresis?
The doctor will need to talk to you and your child. The doctor may need to do a finger exam of your child's rectal vault to feel whether it is full of impacted poop, and may need your child to get an abdominal x-ray and/or barium enema. Keep a "bowel movement monitoring sheet" (scroll down on this page to reach the monitoring sheet) of your child's pooping patterns, and bring it to your doctor appointment. This will help the doctor and you figure out what is going on.
What kind of treatment will my child need?
Only a doctor should start treatment for your child. Never give laxatives, suppositories, enemas or other bowel medication to a child without your child's doctor's instructions to do so.
Treatment may include:
- Starting with a “clean-out” to clear the impaction from the rectal vault. Your doctor may prescribe a high dose of mineral oil, enemas, or a combination of things.
- Changing your child's diet to include more fluids (especially water) and fiber-rich foods.
- Making sure your child gets lots of exercise
- Behavioral training--which includes having your child sit on the toilet several times a day, and using rewards for sitting and for pooping. Keep the tone positive. Never try to embarrass or punish your child.
- Giving your child medicines by mouth to help soften the stools.
- Following up with your doctor on a regular schedule to make sure the impaction does not happen again.
Remember: it is very important to use both the medicines and the behavior training. You are the key to helping your child solve this problem. Consistency is important. Get your child's school to work with you on the program.
How do I work with my child's school?
Talk with your child's teacher, principal and school nurse, to make sure they know what is going on. They will need to be involved with making sure that your child gets enough fluids during the school day, and can get to the toilet often and on time. School personnel may also need to help with your child's clean-up if they soil themselves. Teachers have an important role to play in making sure your child can take care of the problem privately, and avoid being teased by the other kids. Here is an example of a note your child's doctor might send to your child's school.
How can I find out more?
- Read and become familiar with this handout: Functional Constipation and Soiling in Children . (Also available in Spanish.) The handout covers all the basics of encopresis, including how common it is, what causes it, and how to treat it with medicines, behavior modification, and diet (with a list of common foods and their fiber contents). Included is a "bowel movement monitoring sheet" so you can keep track of your child's patterns. Using the monitoring sheet will enable you and your child's doctor to better help your child.
- Visit the University of Virginia's website on constipation and encopresis in children. It includes a helpful picture of the intestine and rectum, to help you and your child picture what is going on in their body. Take your time exploring this excellent website, perhaps with your child.
- Learn all about the digestive system for more background information. Includes a glossary of digestive system terms.
- Stool Soiling in Children from the American Academy of Family Physicians is also available in Spanish (see below).
- More Spanish language information on Encopresis.
- Encopresis –this page includes good information about getting more fiber into your child's diet.
Related topics on YourChild:
What are some websites, books and videos for kids?
Kids' websites:
Kids' books:
- Clouds and Clocks: A Story for Children Who Soil, by Matthew Galvin
- Everyone Poops, by T. Gomi
Videos for young children:
- It's Potty Time, Learning Through Entertainment Video Distributors
- Once Upon a Potty, Barren's Home Video
Reference:
Felt B, Brown P, Coran A, Kochhar P, Opipari-Arrigan L, Marcus S. Guideline for clinical care: functional constipation and soiling in children. University of Michigan Health System; February 2003. Available at URL: http://cme.med.umich.edu/pdf/guideline/peds03.pdf. Accessed 9 January 2007.
Written and compiled by Kyla Boyse, R.N. Reviewed by faculty and staff at the University of Michigan
Updated April 2008
