Pathophysiology: Encopresis, also called stool holding or soiling, occurs when your child resists having bowel movements, causing impacted stool to collect in the colon and rectum. When your child's colon is full of impacted stool, liquid stool can leak around the impacted stool and out of the anus, staining your child's underwear. Encopresis usually occurs after age 4, when your child has already learned to use a toilet. In most cases, encopresis is a symptom of chronic constipation. Less frequently, it may be the result of developmental or emotional issues. Signs and symptoms of encopresis may include: • Leakage of stool or liquid stool on your child's underwear. If the amount of leakage is large, you may misinterpret it as diarrhea. • Constipation with dry, hard stool. • Passage of large stool that clogs or almost clogs the toilet. • Avoidance of bowel movements. • Long periods of time between bowel movements, possibly as long as a week. • Lack of appetite. • Abdominal pain. • Repeated urinary tract infections. Statistics: It is estimated that 1-2% of children younger than 10 years have encopresis. In a study of 482 children aged 4-17 years who were observed over a 6-month period in a primary care pediatric clinic in Iowa, 4.4% of the subjects experienced fecal incontinence at least once per week. Nearly all of the few published population-based studies examining the prevalence of encopresis have been conducted in North America and Europe.
In one such study conducted in the Netherlands, 4.1% of children aged 5-6 years and 1.6% of children aged 11-12 years experienced fecal soiling at least once per month. Studies conducted in Sweden and the United Kingdom reported similar numbers. Boys are much more commonly affected than girls. In most series, approximately 80% of affected children are boys. Treatment: There are several methods for clearing the colon and relieving constipation. Your child's doctor will likely recommend one or more of the following: • Stool softeners, such as lactulose • Colon lubricants, such as mineral oil • Rectal suppositories • Enemas • More oral fluids Your child's doctor may recommend abdominal X-rays to check the progress of the colon clearing. Once the colon has been cleared, it's important to encourage your child to have regular bowel movements. In addition to recommending self-care measures, such as a high-fiber diet and drinking lots of fluids, your child's doctor may recommend the use of stool softeners for six months or more. Psychotherapy If your child feels shame, guilt, depression or low self-esteem related to encopresis, talk therapy (psychotherapy) can be helpful. A psychologist can help your child deal with these feelings and may also give you techniques for teaching your child not to hold stool. Ask your child's doctor for a recommendation.