Encopresis is the involuntary discharge of feces (ie, fecal incontinence). The behavioral difficulties associated with encopresis are most likely the result of the condition rather than its cause. In the vast majority of cases, encopresis develops as a consequence of chronic constipation with resulting overflow incontinence. Many children with encopresis have a remote history of constipation or painful defecation or demonstrate incomplete evacuation during defecation on physical examination or radiographic assessment. Chronic constipation due to irregular and incomplete evacuation results in progressive rectal distention and stretching of both the internal anal sphincter and the external anal sphincter (EAS). As the child habituates to chronic rectal distention, he or she no longer senses the normal urge to defecate. Soft or liquid stool eventually leaks around the retained fecal mass, resulting in fecal soiling.