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What Is Encopresis? - Definition, Causes & Treatment

Instructor: Marisela Duque

Marisela teaches nursing courses at the college level. She also works as a unit educator, teaching experienced nurses about changes in nursing practice.

Upon completion of this lesson, you will be able to describe the meaning of encopresis, identify causes of encopresis, and understand ways to treat and prevent encopresis.

Defining Encopresis

Encopresis is a medical term that describes the passage of stool in an inappropriate place (any place other than a toilet) in a child over 4 years of age that is already toilet trained. When a child has encopresis they most often have accidents in their underwear. This condition may be voluntary or involuntary, which I'll explain further below, and it can be a very challenging and frustrating condition for the child and their family.

Symptoms of encopresis include:

  • Passage of stool in inappropriate places (in the bed or clothes)
  • Inability to hold stool until reaching a toilet
  • Hiding bowel movements
  • Very large stools

What Causes Encopresis?

Boys, children with chronic constipation, and children who suffered abuse or neglect are more likely to develop encopresis. Boys are about 50% more likely than girls to suffer from this condition, but the exact reason for this is still a mystery. Some children may have fear of the toilet or a history of sexual abuse. It is important to know that most children with encopresis have not suffered any abuse or neglect, but the rate of encopresis among children with an abusive past is high.

Most often encopresis is caused by constipation. Feces that is hard and dry can get stuck in the colon causing constipation. This can mean that only liquid stool can pass through the hard mass. This hard fecal mass can become very large and painful to pass; therefore, the child may hold back from using the toilet to avoid the ordeal. Over time, the rectum (bottom part of the colon) can become stretched with feces that accumulates.

The nerves in the rectum that send messages to the brain when it is time to poop are always stimulated, so the child eventually loses the ability to recognize when he really needs to go. Think of it as living near an airport. At first, you hear all the planes as they pass over your home. After a while, you get used to the sound and you don't even notice them.

In about 20% of cases, the child voluntarily poops in an inappropriate place. Causes that may lead to voluntary encopresis include delayed potty training past 4 years of age, emotional problems and behavioral problems. If children are not toilet trained properly, then encopresis can occur from lack of knowledge of regular toilet habits. It is important to determine the exact reason for delayed toilet training (lack of skills needed to open bathroom door, fear of toilet, or inadequate teaching). Children with emotional and/or behavioral problems, such as aggressive behavior, severe temper tantrums or attention deficit disorders, may need assistance from a pediatric psychiatrist to be successful.

Treatment Options

Treatment for encopresis depends on the underlying cause, but it usually consists of a mix of both medical and psychological approaches. This is because there is a lot of emotional discomfort that accompanies this condition. Children will often feel ashamed after an accident and try to hide it from their caregivers. Caregivers should respond in an understanding and nonjudgmental way to prevent any emotional damage.

Treatment includes medication therapy, nutritional changes, incorporating exercise, and behavioral approaches:

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