Encopresis is a condition in which children fail to have normal and regular bowel movements and instead eliminate feces into inappropriate places (e.g., their bed). The exact definition of encopresis varies slightly among experts, but it can generally be defined as fecal incontinence in children who are at least 4 years old (or the developmental equivalent of that age) and past the normal age for toilet training. When adults are unable to control their bowels, it is known simply as fecal incontinence.

Encopresis that is present from birth is called primary encopresis. Secondary encopresis occurs when a child has an established period of fecal continence that is then interrupted by incontinence.

Most cases of encopresis result from chronic constipation that causes stool to become impacted in the child’s colon. Passing this type of stool in a bowel movement can be painful. To avoid such pain, the child may intentionally avoid going to the bathroom. This tends to exacerbate the situation. In a small number of cases, there is no evidence that constipation is causing a child’s encopresis. Experts suspect that lack of proper toilet training (e.g., the child is forced or rushed into toilet training) or behavioral problems are at the root of these cases of encopresis.

Children with encopresis may experience abdominal pain and a loss of appetite (anorexia). In addition, their attempts to resist having bowel movements may be evident when they cross their legs, walk on their tiptoes or dance to prevent having to go to the bathroom. As stool builds up in the colon, it may leak from the anus and stain the underwear. This leakage may be runny or have the consistency of clay and it often smells very bad.

An excess of impacted stool may also stretch the colon, hindering the nerves’ ability to signal the need for a bowel movement. This may result in bowel movements that occur suddenly or at inappropriate times.

A physician will likely perform a digital rectal examination to look for the presence of excess stool in the colon. An imaging technique such as an abdominal x-ray may be used to confirm the presence of impacted stool. The physician will also rule out other medical conditions (e.g., spina bifida) before diagnosing encopresis.

The first goal of treating children with encopresis is to clean out the colon to eliminate impacted stool. Several different techniques may be used to achieve this. Once the impacted stool has been cleansed from the body, the physician and parents will work together on techniques to help encourage the child to develop a pattern of regular bowel movements.