Introduction

Encopresis is the soiling of the underwear with stool by children who are past the age of toilet training. Because each child achieves bowel control at his or her own rate, medical professionals do not consider stool soiling to be a medical condition unless the child is at least 4 years old. This stool or fecal soiling usually has a physical origin and is involuntary—the child does not soil on purpose. A large amount of hard stool is in the intestine, and stool leaks around this mass and out through the anus.

When to Seek Medical Care

Any of the following warrants a visit to your child's primary care provider:

1. Severe, persistent, or recurrent constipation
2. Pain when passing bowel movements
3. Reluctance to pass bowel movements, including straining to hold stool in
4. Soiling in a child who is at least 4 years old

Self-Care at Home

Although parents will be following a regimen recommended by the child’s health care provider, most of the work of treating encopresis is done at home.

It is very important that parents and other caregivers keep a complete record of the child’s medication use and bowel movements during the treatment period. This record can be very helpful in determining whether the treatment is working.

Other Therapy

Fiber supplements and certain foods, such as fruit juices and prunes, can have a laxative effect. These foods and juices function as osmotic laxatives. They all contain various sugars that are not efficiently absorbed by the intestinal lining, thus increasing the amount of water in the colon. Given in large enough doses, all of these foods and juices are very effective laxatives. However, most children are not willing to take in enough of these fruits and juices day in and day out for many months to serve as primary treatment for encopresis. Eaten in large enough quantities to ensure 2 soft bowel movements a day, these foods and juices often cause bloating and gas.

1. There is little evidence that eating a high-fiber diet significantly improves encopresis once it is established, although it may help prevent constipation in the first place.
2. Drinking plenty of fluid helps keep stools soft and may help prevent constipation in the first place.
3. Children with encopresis rarely need surgery. However, surgery may be used in extremely chronic and refractory cases.

Follow-up

The extent of follow-up needed for encopresis varies by situation. Your child’s health care provider will probably want to see the child at least once after treatment is well under way to ensure that the treatment is working or to alter treatment if necessary.

Prevention

The best way to prevent encopresis is to prevent constipation in the first place. Make sure the child gets a varied diet with plenty of fruits and vegetables and whole grain breads and cereals. The child should drink water and other fluids frequently and be physically active every day. Finally, make sure the child has a regular time every day when he or she sits on the toilet. After a meal is the best time for this.

Outlook

Generally, the outlook is excellent for children who undergo the treatment regimen outlined here. Many children who do not undergo treatment are able to resolve the problem on their own as they grow up, but this can take many years. The problem can persist into adulthood.