Fecal Incontinence (Encopresis)

Fecal incontinence, also known by its medical term as encopresis, is the repeated passing of stool (usually involuntarily) into clothing. It is a common issue in children with chronic constipation. While it can be frustrating and embarrassing for both children and parents, it is important to understand that it is a medical problem, not a behavioral one. The child is not doing it on purpose.

How Does Constipation Lead to Encopresis?

Encopresis is most often caused by chronic constipation. When a child is constipated, a large, hard mass of stool builds up in the colon and rectum. Over time, the rectum stretches, which can dull the nerves that signal the need to have a bowel movement. As the rectum remains stretched, liquid stool from higher up in the colon can leak around the hard stool mass and out of the anus, soiling the child's underwear. The child often has no sensation of this leakage and cannot control it.

According to the Rome IV criteria, at least one episode of fecal incontinence per week is one of the diagnostic criteria for functional constipation in children over 4 years of age.

What are the Signs of Encopresis?

The most obvious sign of encopresis is soiled underwear. Other signs may include:

• Secrecy or hiding soiled underwear.
• A smell of stool that the child may not be aware of.
• Stool leakage that can range from small stains to large amounts.
• Constipation symptoms, such as infrequent, hard bowel movements.

It is crucial to approach this issue with patience and understanding. Punishing or shaming a child for soiling will only increase their anxiety and will not solve the underlying problem. Treatment for encopresis focuses on treating the chronic constipation that is causing it. This typically involves a combination of laxatives to clear the impacted stool and then a maintenance plan to prevent it from happening again, along with behavioral strategies like scheduled toilet sits.