7 Key Signs and Symptoms of Encopresis You Should Know

Encopresis is a medical condition characterized by the involuntary passage of stool, particularly in children who are old enough to be toilet trained (typically age 4 and older). This condition often develops as a result of chronic constipation, which leads to stool becoming impacted in the colon. As new stool continues to be produced, liquid stool may leak around the impacted mass, causing involuntary soiling. Understanding the symptoms of encopresis is crucial for early identification and management, as the condition can significantly impact a child’s emotional well-being, social interactions, and quality of life.

While encopresis can be distressing for both children and parents, recognizing the warning signs early can help families seek appropriate medical guidance. This article explores the key symptoms associated with encopresis, helping you understand what to look for and when to consult a healthcare professional.

1. Involuntary Stool Leakage or Soiling

The hallmark symptom of encopresis is the involuntary passage of stool into underwear or inappropriate places. This soiling typically occurs without the child being aware it is happening, and it is not intentional behavior.

Children with encopresis may experience:

• Frequent staining of underwear with small or large amounts of stool
• Soiling accidents that happen multiple times throughout the day
• Leakage that occurs during both daytime and nighttime hours
• Soft or liquid stool seepage rather than formed bowel movements

This involuntary leakage happens because hard, impacted stool creates a blockage in the rectum. Newer, softer stool and mucus can leak around this blockage, resulting in soiling that the child cannot control. Many children are genuinely unaware that they are soiling themselves because the rectum has become stretched and desensitized due to chronic constipation.

2. Chronic Constipation or Infrequent Bowel Movements

Most cases of encopresis develop as a consequence of chronic constipation. Children with this condition often have a history of difficult or infrequent bowel movements that may have been present for months or even years.

Signs of underlying constipation include:

• Having fewer than three bowel movements per week
• Passing very large, hard stools that may clog the toilet
• Straining excessively during bowel movements
• Experiencing pain or discomfort when trying to defecate
• Going several days without having a bowel movement

The constipation creates a cycle where the child avoids having bowel movements due to pain or discomfort, which leads to further stool accumulation, harder stools, and eventually, impaction. This impaction stretches the rectum and colon, reducing the child’s ability to sense when they need to have a bowel movement and leading to the overflow soiling characteristic of encopresis.

3. Abdominal Pain and Cramping

Children with encopresis frequently experience abdominal discomfort due to the accumulation of stool in their intestines. This pain can vary in intensity and may come and go throughout the day.

Characteristics of abdominal pain in encopresis include:

• Cramping sensations in the lower abdomen or around the belly button area
• Feeling of fullness or bloating in the stomach
• Pain that may worsen before or after meals
• Discomfort that improves temporarily after soiling episodes
• Tenderness when the abdomen is touched or pressed

The abdominal pain occurs because the colon becomes distended with accumulated stool, creating pressure and stretching of the intestinal walls. Some children may complain of stomach aches frequently, while others may not verbalize their discomfort clearly, especially younger children. Parents may notice their child holding their stomach, curling up in positions that provide pressure relief, or becoming irritable without an obvious cause.

4. Loss of Appetite

Many children with encopresis experience a decreased interest in food and reduced appetite. This symptom develops because the accumulated stool in the intestines creates a sensation of fullness, even when the stomach is empty.

Appetite-related symptoms include:

• Refusing meals or eating significantly smaller portions than usual
• Complaining of feeling full after eating very little
• Showing disinterest in favorite foods
• Skipping meals without showing signs of hunger
• Potential weight loss or failure to gain weight appropriately

The physical presence of impacted stool takes up space in the abdominal cavity, which can compress the stomach and reduce its capacity. Additionally, the general discomfort associated with the condition can make eating less appealing. Parents should monitor their child’s eating patterns and nutritional intake, as prolonged poor appetite can affect growth and development.

5. Behavioral Changes and Emotional Distress

Encopresis often has significant psychological and emotional impacts on children. The embarrassment and shame associated with soiling accidents can lead to noticeable changes in behavior and mood.

Common behavioral and emotional symptoms include:

• Withdrawal from social activities, playdates, or school events
• Reluctance to participate in sleepovers or overnight activities
• Increased anxiety, particularly around toilet use or in public settings
• Low self-esteem and feelings of shame or embarrassment
• Irritability, mood swings, or depression
• Defensive behavior or denial about soiling accidents
• Hiding soiled underwear rather than asking for help

Children with encopresis often feel deeply embarrassed about their condition, even though it is involuntary. They may face teasing or bullying from peers, which compounds their emotional distress. Some children may become secretive about their accidents, hiding soiled clothing or avoiding situations where their condition might be discovered. This emotional component is an important aspect of the condition that requires sensitive handling and support.

6. Fecal Odor That Persists

A persistent smell of feces on the child, their clothing, or in their immediate environment is a common and particularly distressing symptom of encopresis. This odor can occur even when there is no visible soiling.

Characteristics of this symptom include:

• Noticeable fecal smell that lingers on the child despite bathing
• Odor that others may detect, potentially leading to social difficulties
• Smell that persists on clothing even after washing
• The child may become desensitized to the odor and be unaware of it

The persistent odor occurs because small amounts of stool continuously leak and may be present on the child’s skin or clothing throughout the day. Because the child is constantly exposed to this smell, they often become “nose-blind” to it and genuinely do not realize that they have an odor. This can create social challenges, as peers and adults may notice and react to the smell, even when there is no visible soiling. This symptom can lead to social isolation and requires compassionate management to protect the child’s dignity.

7. Urinary Problems

Children with encopresis may also experience urinary symptoms due to the physical pressure that impacted stool places on the bladder and urinary tract structures.

Associated urinary symptoms include:

• Urinary frequency (needing to urinate more often than usual)
• Urinary urgency (sudden, strong need to urinate)
• Urinary incontinence or daytime wetting accidents
• Bedwetting (nocturnal enuresis) that may be new or worsening
• Urinary tract infections that occur repeatedly

The rectum and bladder are anatomically close to each other in the pelvis. When the rectum becomes distended with impacted stool, it can press against the bladder, reducing its capacity and interfering with normal bladder function. This pressure can make it difficult for the child to fully empty their bladder or to recognize bladder fullness signals properly. Some children may develop both bowel and bladder control issues simultaneously, a condition sometimes referred to as elimination disorder.

Main Causes of Encopresis

Understanding the underlying causes of encopresis is essential for addressing the condition effectively. The following are the primary factors that contribute to the development of encopresis:

Chronic Constipation

This is by far the most common cause of encopresis, accounting for the majority of cases. When a child experiences prolonged constipation, stool becomes hard and impacted in the colon and rectum. Over time, the rectum stretches to accommodate the large mass of stool, which reduces the child’s ability to sense when they need to have a bowel movement. Liquid or soft stool then leaks around the impaction, causing involuntary soiling.

Withholding Behavior

Many children develop a pattern of deliberately holding in bowel movements, which can lead to encopresis. Children may withhold stool for various reasons:

• Previous painful bowel movements that create fear of defecation
• Toilet training resistance or power struggles
• Being too busy playing and not wanting to stop for the bathroom
• Discomfort or anxiety about using unfamiliar toilets (such as at school)
• Stressful life events or changes in routine

Emotional and Psychological Factors

Stress, anxiety, and emotional difficulties can contribute to the development or persistence of encopresis. Factors such as family conflict, school problems, trauma, or major life transitions (like divorce, moving, or the birth of a sibling) can affect bowel function and toilet habits.

Dietary Factors

A diet low in fiber and high in processed foods, dairy products, and constipating foods can contribute to chronic constipation that leads to encopresis. Insufficient fluid intake can also worsen constipation and increase the risk of developing this condition.

Physical or Medical Conditions

In rare cases, encopresis may be associated with underlying medical conditions such as:

• Hirschsprung’s disease (a condition affecting nerve cells in the colon)
• Spinal cord abnormalities
• Anatomical problems with the rectum or anus
• Metabolic or endocrine disorders
• Developmental delays or neurological conditions

Prevention Strategies

While not all cases of encopresis can be prevented, there are several strategies that can significantly reduce the risk of developing this condition or help manage it if constipation begins to develop:

Establish Healthy Bowel Habits Early

Encourage regular toilet routines from an early age. Have children sit on the toilet at consistent times each day, particularly after meals when the natural gastrocolic reflex makes bowel movements more likely. Make toilet time relaxed and pressure-free, ensuring the child has adequate time without feeling rushed.

Provide a Fiber-Rich Diet

Ensure your child eats a diet high in fiber, including:

• Fresh fruits and vegetables
• Whole grain breads and cereals
• Legumes and beans
• Nuts and seeds (age-appropriate)

Adequate fiber helps maintain soft, regular stools that are easier to pass, reducing the risk of constipation and withholding behavior.

Ensure Proper Hydration

Encourage your child to drink plenty of water throughout the day. Adequate fluid intake helps keep stools soft and easier to pass. Limit excessive consumption of constipating beverages like cow’s milk and sugary drinks.

Encourage Physical Activity

Regular physical activity helps stimulate normal bowel function. Encourage your child to engage in active play, sports, and movement throughout the day rather than prolonged sedentary activities.

Address Constipation Early

If your child begins to show signs of constipation, address the issue promptly before it becomes chronic. Consult with a healthcare provider if constipation persists despite dietary and lifestyle modifications.

Avoid Toilet Training Pressure

Approach toilet training with patience and without punishment or excessive pressure. Forcing toilet training before a child is ready or using negative reinforcement can create anxiety around bowel movements and contribute to withholding behavior.

Create a Supportive Bathroom Environment

Make sure your child has a comfortable, private bathroom experience. Use a footstool so their feet are supported when sitting on the toilet, which promotes proper positioning for bowel movements. Ensure the bathroom is warm and that the child feels safe and relaxed.

Frequently Asked Questions

What age does encopresis typically occur?

Encopresis most commonly occurs in children between the ages of 4 and 12 years old. It is more prevalent in boys than girls. The condition is diagnosed when a child who is old enough to be toilet trained (generally age 4 or older) has repeated episodes of involuntary stool passage.

Is encopresis a behavioral problem?

No, encopresis is not a behavioral problem or a sign of defiance. It is a medical condition, most often caused by chronic constipation and stool impaction. The soiling is involuntary and not something the child is doing intentionally. Children with encopresis often feel embarrassed and distressed about their symptoms.

Can encopresis resolve on its own?

Encopresis rarely resolves on its own without intervention. The condition typically requires medical evaluation and a comprehensive management approach that may include dietary changes, behavior modification, and establishing regular bowel routines. Early intervention generally leads to better outcomes.

How long does it take to treat encopresis?

The duration of management varies depending on the severity of the condition and how long it has been present. Some children show improvement within a few months, while others may require six months to a year or longer. The rectum and colon need time to return to normal size and function after being stretched by chronic constipation.

Should I punish my child for soiling accidents?

No, punishment is not appropriate and can be harmful. Encopresis involves involuntary soiling that the child cannot control. Punishment, shame, or blame can worsen the psychological impact of the condition, increase anxiety, and potentially make the problem worse. Instead, approach the situation with understanding, support, and patience while working with healthcare providers.

Will my child need to see a specialist?

Many cases of encopresis can be managed by a pediatrician or family doctor. However, some children may benefit from referral to a pediatric gastroenterologist, especially if the condition is severe, does not respond to initial management, or if there are concerns about underlying medical conditions. In some cases, consultation with a child psychologist may also be helpful to address emotional and behavioral aspects.

Can encopresis cause long-term problems?

With appropriate management, most children with encopresis recover completely without long-term physical complications. However, if left untreated, the condition can lead to ongoing bowel problems and may have lasting effects on a child’s emotional well-being and self-esteem. Early identification and appropriate management are key to preventing long-term issues.

Is encopresis related to autism or developmental disorders?

While encopresis can occur in any child, it may be more common in children with developmental delays, autism spectrum disorder, or attention deficit hyperactivity disorder (ADHD). However, most children with encopresis do not have these conditions. Each child should be evaluated individually to understand the specific factors contributing to their situation.

References:

• Mayo Clinic – Encopresis
• Stanford Children’s Health – Encopresis
• Boston Children’s Hospital – Encopresis
• National Institute of Diabetes and Digestive and Kidney Diseases
• American Academy of Pediatrics – Encopresis