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What is Encopresis?
Encopresis is the medical term used when a children soil their underwear with stool after the age they are expected to be toilet
trained, usually around 4 years of age. The underlying cause is almost always constipation and stool retention. The vast
majority (around 90%) of the children with soiling have significant underlying constipation. These children are the ones we see
most often in the Encopresis Treatment Center. Only a very small percentage of children who soil do not have constipation.
Often, emotional or behavioral concerns exist in these "non-retentive" encopretic children. Counseling is often needed
to help them overcome their problem.
What Causes It?
Encopresis is caused by a variety of factors with constipation the underlying cause for most children. The most common factors
are as follows:
1.A diet that is too low in fiber and too high in dairy products, especially too much milk and cheese. Inadequate fruit and
vegetable intake along with too little fluids can cause significant constipation.
2.Anxiety about stooling or fear of pain is also a common factor.
3.Medications also can cause constipation in some cases. Some medications for daytime wetting especially can cause difficulty
with hard stools and constipation severe enough that it leads to soiling.
4.Painful defecation due to hard, large diameter stool. This can lead to tiny tears in the anal tissue, which sometimes cause
bleeding, more pain, and increased stool retention due to anxiety about pain.
5.Anxiety about the toilet training process.
6.Power struggle with parents over toilet training, or too coercive training.
7.Refusal to use bathrooms away from home, or anxiety and lack of skill at self-wiping. Many children want their mom's to
help so they withhold stool until they are home and she is there to assist them.
These are just a few of the reasons children become constipated. A physician or ARNP should evaluate your child to assess,
identify contributing factors, and to rule out any medical problems that could cause constipation. The underlying cause, or
causes, must be ascertained if treatment is going to be successful. This requires a multi-faceted approach dealing with diet,
behavior, and the use of medications.
Why does constipation lead to soiling?
Uncorrected constipation can cause the rectum and lower colon to become "backed-up" with stool. The softer stool which
is higher up in the colon has to go somewhere, so it leaks around the large, hard ball of stool that has collected and distends
the rectum. Once the rectum is distended with stool, the child may be unable to pass the stool because of its size. The worse
the constipation, the more likely that there is going to be some "overflow" around the large ball of stool in the
rectum. It often takes 6 months to a year or even longer in some cases to shrink the colon back to its normal size and function.
During this time, treatment must be ongoing to prevent a relapse.
Does soiling always occur when constipation is severe?
Some children can experience very severe constipation, have very large stools, and still not soil. This is not the usual course,
but it does happen. Often these children are fighting all the time to keep from soiling. School can be exhausting for them as
they are constantly holding their buttocks and small anal muscles tight to prevent leaking stool. Their efforts sometimes
interfere with their ability to do well in school since all their energy is focused elsewhere. Stooling infrequency, very large
stools, blood on the stool or toilet paper are all signs that a problem exists, even with no soiling.
Is there a time that constipation and Encopresis is most likely to occur?
Toilet training is often a point when stool retention is first noted. Fear of falling into the toilet, of monsters in the drain,
or even the sound of flushing the toilet can cause a child to withhold stool or even sit on the toilet and have a bowel
movement. They ask for a puli-up instead, even though they may have successfully had a stool in the toilet previously. Another
common time for this problem is the start of day care or kindergarten. Some children in the 3 to 6 year old range, more or less,
refuse to use toilets away from home. Others do not know how to wipe their own bottom and have always had their parents do it
for them. They too will hold stool all day until they are safely home with mom or dad. Wetting with urine can occur because the
full rectum can press upon the bladder, causing it to leak urine without much warning. Children soon figure out that if they
urinate, the muscles surrounding the rectum also relax, making them more prone to losing ?control?, resulting in having some
stool expelled or soiling.
Why does my child deny that he has had an accident?
Even though it is extremely obvious (by odor or telltale stool noted in the underwear), the child is ashamed and will deny that
they have to go and that they have had an accident. They often will hide their underwear, fearing that they will be "found
out" and scolded. This furthers their embarrassment and shame. The unfortunate child who suffers from Encopresis is
commonly assumed to have a behavior problem--this belief is incorrect. Encopresis is a physical problem that is completely
treatable with the appropriate intervention.
How is Encopresis treated?
A variety of methods are used to manage this medical problem. Stool softeners and laxatives, both prescription and
over-the-counter medications, are often prescribed. Behavioral interventions are often a necessary part of successful treatment.
Educating the child and their parents to work together as a team to solve this problem takes away the feelings of guilt and
resentment shared by both the child and their parents. It then becomes a medical problem that can be "fixed" and the
child's burden of guilt and shame is lessened. The most important factor in successful treatment is that the colon must be
emptied at the start of treatment and then kept relatively empty thereafter. This allows the colon and rectum to shrink down to
normal size and allow the restoration of normal bowel function. It takes up to a year or longer at times to adequately treat
this condition effectively. The child must be cooperative and the parents diligent at giving the medications and following
recommendations. If anxiety or pain is a problem, that too must be addressed.
THE ENCOPRESIS TREATMENT CENTER? more...
The Encopresis Clinic at Children?s Hospital and Regional Medical Center (where we worked as nurse clinicians prior to its
closure) was a regional treatment center for this problem. With its closure, these families had nowhere to go for treatment. We
know what devastating effects Encopresis can have on a child and the repercussions experienced by their families. We opened the
new clinic in an effort to continue to serve the families and children who suffer from this difficult problem. More on the
history of the Encopresis Treatment Center on the Staff page.
The Encopresis Treatment Center is open Monday-Friday 9am-Spm. Children must be referred by their Physician or Nurse
Practitioner. Consultations with the nurses are available by appointment only.
Encopresis Treatment Center™
611 Main Street, Suite A
Edmonds,WA 98020
(425) 640-3227
Nancy Glass-Quattrin, RN, BSN, BCIAC
Notice: Due to the high volume of requests for information from all over the U.S. we are unable to personally return phone calls
out of state/country. The best place to find resources locally would be the nearest Children's Hospital, or hospital
affiliated with a university that has a pediatric department.
We know of just a few treatment centers that are university based and of course don't know which pediatrician in your area knows
how to treat encopresis properly so asking your physician for a referral to a local pediatric gastroenterologist might be of
some help.
Please note that we cannot recommend treatment for a child we are not treating.
! Note: Information on this page should not be relied
upon as medical advice and
is not intended to replace the advice of your child's physician.
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