When somebody suffers from encopresis it means that he or she can’t control their bowel movements and pass bowel movements in their underwear. “Soiling” and “fecal incontinence” mean the same thing.
What causes encopresis?
In most cases, encopresis develops as a result of long-standing constipation. The vast majority of of children suffering from encopresis have a history of constipation or a history of passing large and/or painful bowel movements. In many cases, the child or the parents do not recall the constipation since it was so long ago.
With constipation and painful bowel movements, children may not completely empty themselves when they go to the bathroom. Over a long period of time the large intestine slowly fills with stool and stretches out of shape. As the large intestine stretches larger and larger, liquid stool from the small intestine begins to “leak” around the more formed stool in the colon. In the beginning, this leakage is usually small amounts that streak or stain the underwear and most parents just assume the child isn’t wiping very well.
As the intestine stretches further, the amount of leakage increases so that eventually children begin having “accidents” — they pass whole bowel movements in their underwear! Because these stools are “leaking” through the intestine and not getting completely digested, they are usually very dark and sticky, smell very badly, and have to be scraped off the skin and clothes.
Children don’t usually feel these “accidents” happening — they just seem to happen. Accidents tend to occur more often during the daytime when the child is active and moving around, and only rarely do they occur at night while the child is asleep.
In most cases, encopresis is not primarily a behavioral problem. Children do not have these accidents out of spite or because they are lazy. Instead, many behavioral problems develop because of the encopresis, and once the encopresis is treated, many of the behavioral problems may resolve.
Treatment of Encopresis
Since most cases of childhood encopresis result from constipation, treatment is similar. It is important to remember that although most encopresis begins with constipation, by the time soiling develops, most children are no longer experiencing lots of pain with bowel movements. In children with encopresis, avoidance of the toilet is often a habit that began long ago. Also, children with encopresis often don’t have the normal urge to go to the bathroom.
Abrahamian FP, Lloyd-Still JD. Chronic constipation in childhood: a longitudinal study of 186 patients. J Ped Gastro Nutr 1984;3:460-467.
Borowitz SM, Brooks R, Koratchev B, et al. Constipation in Early Childhood: precipitating factors and treatment outcome. Pediatric Research 1999;45:109A.
Borowitz SM, Sutphen JL, Link WL, Cox DJ. Lack of Correlation of Anorectal Manometry with Symptoms of Chronic Childhood Constipation and Encopresis, Diseases of the Colon and Rectum 1996; 39:400-405.
Borowitz SM, Cox DJ, Sutphen JL. Differences in toileting habits between children with chronic encopresis, asymptomatic siblings, and asymptomatic non-siblings, Journal of Developmental and Behavioral Pediatrics, 1999; 20:145-149.
Borowitz SM, Cox DJ, Sutphen JL, Kovatchev B. Treatment of childhood encopresis: a randomized trial comparing three treatment protocols. Journal of Pediatric Gastroenterology and Nutrition 2002; 34:378-384.
Borowitz SM, Cox DJ, Tam A, Ritterband LM, Sutphen JL, Penberthy JK. Precipitants of constipation during early childhood. Journal of the American Board of Family Medicine 2003; 16:213-218.
Borowitz SM, Cox DJ, Kovatchev B, Ritterband LM, Sutphen JL. Treatment of childhood constipation by primary care physicians: efficacy and predictors of outcome. Pediatrics 2005; 115:873-877.
Cox DJ, Sutphen JL, Ling W, Quillian W, Borowitz S. Relative Efficacy of Laxative, Toilet Training, and Biofeedback Therapies in the Treatment of Pediatric Encopresis, Journal of Pediatric Psychology 1996; 21:659-670.
Cox DJ, Sutphen JL, Borowitz SM., Ling, W. Contribution of behavior therapy and biofeedback to laxative therapy in the treatment of pediatric encopresis, Annals of Behavioral Medicine 1998; 20:1-7.
Gallagher B, West D, Puntis JW. Characteristics of children under 5 referred to hospital with constipation: a one-year prospective study. Int J Clin Pract 1998;52:165-7.
Gattuso JM, Kamm MA. Adverse effects of the drugs used in the management of constipation and diarrhoea. Drug Safety 1994;10:47-65.
Iacona G, Cavataio F, Montalto G, et al. Intolerance of cow’s milk and chronic constipation in children. N Engl J Med 1998; 3990:1100-4
Ling WD, Cox DJ, Sutphen JL, Borowitz S: Psychological factors in encopresis: comparison of patients to nonsymptomatic siblings. Clinical Pediatrics 1996; 35:427-8.
Lloyd B, Halter RJ, Kuchan MG, et al. Formula tolerance in postbreastfed and exclusively formula-fed infants. Pediatrics 1998; 103:E77
Loening-Baucke V. Chronic constipation in children. Gastroenterology 1993;105:1557-1564.
Loening-Baucke V. Biofeedback training in children with functional constipation – a critical review. Dig Dis Sciences 1996; 41:65-71.
Muller-Lissner AA. Adverse effects of laxatives: fact and fiction. Pharmacology 1993;47 Suppl 1:138-145
Parker PH To do or not to do? That is the question. Ped Ann 1999;28:283-290.
Partin JC, Hamill SK, Fischel JE, et al. Painful defecation and fecal soiling in children. Pediatr 1992;89:1007-9.
Ritterband LM, Cox DJ, Walker LS, Kovatchev B, McKnight L, Patel K, Borowitz S, Sutphen J. An internet intervention as adjunctive therapy for pediatric encopresis. Journal of Consulting and Clinical Psychology 2003; 71:910-917.
Rockney RM, McQuade WH, Days AL, et al. Encopresis treatment outcome: long-term follow-up of 45 cases. J Dev Behav Pediatr 1996; 17:380-385.
Schiller LR. Clinical pharmacology and use of laxatives and lavage solutions. Journal of Clinical Gastroenterology 1999 Jan;28(1):11-8
Sprague-McRaie JM, Lamb W, Homer D. Encopresis: a study of treatment alternatives and historical and behavioral characteristics. Nurse Practitioner 1993; 18:52-63.
Staiano A, Adreotti MR, Greco L, et al. Long term follow-up of children with chronic idiopathic constipation. Dig Dis Sci 1994;39:561-564.
Sutphen JL, Borowitz SM, Hutchison RL, et al. Long-term follow-up of medically treated childhood constipation. Clin Pediatr 1995;34:576-580.
Swenson O, Sherman JO, Fisher JH. Diagnosis of congenital megacolon: an analysis of 501 patients. J Ped Surg 1973;8:587-594.
Taubman B, Buzby M. Overflow encopresis and stool toileting refusal during toilet training: a prospective study on the effect of therapeutic efficacy. J Pediatr 1997; 131:768-771.
Van der Plas RN, Benninga MA, Taminiau JA, Buller HA. Treatment of defaecation problems in children: the role of education, demystification, and toilet training. Eur J Pediatr 1997; 156:689-692.
Van der Plas RN, Benninga WL, Redekop WK, Taminiau JA, Buller HA. Randomized trial of biofeedback training for encopresis. Arch Dis Child 1996; 75:367-374.