Encopresis:  Involuntary Bowel Movements

Encopresis is a disorder that affects children between the ages of 4 to 17 years of age.  Although it is not very common, it is also not rare.  This disorder can be frustrating for parents and especially stressful for children.  This article will talk about what Encopresis is, symptoms and how to get help.

Encopresis What Does It Mean?

Encopresis is defined as “the repetitive, voluntary or involuntary, passage of stool in inappropriate places by children 4 years of age and older, at which time a child may be reasonably expected to have completed toilet training and to exercise bowel control.”   In other words, Encopresis happens when a child becomes constipated for an extended amount of time.  When the bowel backs up into the intestines, liquid leaks from the bowels and causes it to stain a child’s underwear.  

Stats: How Many Suffer from this Disorder?

Approximately 4% of children, between the ages of 4 and 17 years old, develop Encopresis due to chronic constipation.  This disorder is diagnosed after the age of 4 and is rarely diagnosed in the absence of constipation.  

What Causes Encopresis?

Encopresis is caused by constipation.  Constipation can be caused by a number of factors.  Below are reasons why a child may be constipated for a lengthy amount of time:

  • Withholding stool because they are afraid of using the toilet (such as when a child is away from home or out of their comfort area) or because having a bowel movement is too painful.
  • Not wanting to stop what they are doing or playing to go to the bathroom.
  • Not eating enough fiber.
  • Not drinking enough water or fruit juice.
  • Drinking too much milk (cow’s milk), and sometimes having a milk intolerance.

Signs and Symptoms of Encopresis 

Signs and symptoms of encopresis may include:

  • Liquid stool on underwear, which can be mistaken for diarrhea or leakage that comes from the bowels.
  • Constipation with dry, hard stool
  • Passing of large stool that clogs or almost clogs the toilet,
  • Avoiding having bowel movements.
  • Long periods of time in between the child having bowel movements.
  • Lack of appetite.
  • Stomach pain.
  • Problems with bedwetting or wetting clothes during the day.
  • Repeated bladder infections, typically in girls.

What are the Common Behaviors/Characteristics?

Common characteristics of Encopresis are chronic constipation.  If you notice that your child is constipated far more often than not, you should consider taking them to the doctor to discuss options so that the condition doesn’t develop into something more serious.  

Testing: What are the Diagnostic Criteria Per the DSM 5?

According to DSM-5, there are 4 features that must be present to support a diagnosis of encopresis:

  1. Patient’s chronological age must be at least 4 years;
  2. A repeated passage of feces into inappropriate places, e.g., clothing or floor. This can be either intentional or involuntary;
  3. At least one such event must occur every month for at least 3 months;
  4. The behavior is not attributable to the effects of a substance, e.g., laxative, or another medical condition, with the exception of a mechanism involving constipation.

Encopresis is usually diagnosed by a medical doctor with the above being present.

Encopresis and Other Conditions

Encopresis can be similar to other conditions on the surface but there is big difference in their symptoms and causes.  The conditions below explain the differences.

Encopresis vs Enuresis

Unlike Encopresis, Enuresis is the continued inability to control their urination.  While Encopresis deals with the bowel movements, Enuresis deals with urination.  Encopresis can also be voluntary, unlike Enuresis which is involuntary.

Encopresis vs Fecal Incontinence

Fecal incontinence differs from Encopresis in that it is something that cannot be controlled.  Fecal incontinence is often caused by a medical condition or some sort of muscle or nerve damage.  Sometimes people can also have fecal incontinence after surgery.  This is not something that someone knowingly does and is completely out of their control.  

Related Conditions 

Encopresis should not be confused with any bowel incontinence or bowel excretion that is not caused by constipation. Encopresis is caused solely by constipation, although the reasons for constipation will vary.

Encopresis In Adults/Children

In order for someone to be diagnosed with Encopresis, it must be present between the ages of 4 and 17 years old, therefore, Encopresis is a diagnosis specifically given to children.  

Example Case of Encopresis

The following is a case of Encopresis:

A 6 year old boy, George who lives with his mom, is removed from his home and placed in foster care following abuse and neglect charges.  The boys is sent to live with a foster family and deals with trauma from the move as well as some malnutrition from his biological family.  After being in the foster family for two weeks, he develops stomach pains, loss of appetite and becomes lethargic.  He is taken to the hospital and given an x-ray where is it determined that he is constipated and has probably been constipated since the being at the foster home.  The foster family states that they have noticed that George has had bowel movements in his underwear but was afraid to tell his foster family that he is unable to use the bathroom.  After talking with the family, a process of elimination, and further testing, it is determined that George has Encopresis.  The doctor uses an enema to help to relieve George’s constipation and the family is referred to a nutritionist and mental health professional to talk about prevention, dietary changes, and coping skills for George.  

How to Deal/Coping With Encopresis

Children with Encopresis are at risk for isolation, feelings of shame and guilt, and possible depression.  It is important to seek medical treatment as early as possible as well as mental health treatment to assist with coping.  With treatment, this condition can be resolved successfully and a child can have normal bowel movements.  

Look out for These Complications/Risk Factors

Every child who develops Encopresis, develops it for different reasons, but it should be noted that the persons with the following conditions may be more likely to develop Encopresis:

  • Abuse or neglect; when a child does not feel safe in their environment, they may be more likely to hold their bowel.
  • Living in a house with chaos or an environment that is unstable can lead to involuntarily not having a bowel movement due to stress.
  • Fear of, or not wanting to use a public bathroom can cause a child to develop Encopresis because they are training their bowels to not release.
  • Having a neurological impairment.
  • Having a history of constipation or having pain when having a bowel movement.
  • Developmental or cognitive delays such as autism or mental retardation.
  • Having obsessive compulsive disorder.
  • ADHD or difficulty focusing.
  • Learning disabilities. 

Encopresis Treatment

Treatment for encopresis may include:

  • Removing the impacted stool.
  • Keeping bowel movements soft, by changing diet or using stool softeners, so the stool will pass easily.
  • doctors may try retraining the intestine and rectum to get control of the bowel movements.

Punishing a child with Encopresis is never the answer as it will only cause a child to be more emotionally stressed and continue to complicate the situation.

Often, making changes in your child’s diet will help constipation. Consider the following suggestions:

  • Increase the amount of fiber your child eats by adding fruits and vegegetable.
  • Add more whole grain cereals and breads that are high in fiber.
  • Give your child more fruit juice and cut out soft drinks such as soda.
  • Encourage your child to drink more water.
  • Limit fast foods and junk foods that are usually high in fats and sugars, and offer more well-balanced meals and snacks.
  • Limit caffeine such as coffee or tea.
  • Limit whole milk to two glasses a day for a child 2 years old and younger, but don’t eliminate milk altogether unless directed by a doctor.  Children need calcium from milk to help their bones grow strong.
  • Give your child meals on a regular schedule. Eating a meal will usually stimulate a bowel movement within 30 minutes to an hour. Feed your child breakfast early so that they don’t have to rush and will have time to have a bowel movement if needed.
  • Keep your child as active as possible. Exercise aids digestion by helping the normal bowel movements the intestines to push food forward as it is digested. People who don’t move a lot tend to have more constipation. 

Following good bowel habits and getting your child used to having regular bowel movements is key to overcoming this disorder.  Here are some suggestions to lead to good bowel habits:

  1. Have your child sit on the toilet at least twice a day for at least 10 minutes, preferably shortly after a meal. 
  2. Make this time pleasant for your child by not criticizing them or stressing them about having a bowel movement. 
  3. Giving a child stickers or other small rewards and making posters that chart your child’s progress can help your child want to have a bowel movement and put them at ease.  Rewards should be given for effort as well as after having a bowel movement.  

Until the rectum and intestines regain their muscles control, it is common for a child to have accidents.  Young children can wear pull ups to help them until they no longer need them.  This can be a very difficult and stressful time for your child, so it is important to make it as normal as possible for them.  For older kids, taking a change of underwear and clothes would be helpful.  

Possible Medications for Encopresis

Your doctor may prescribe an enema to assist in removing the bowel from the intestines.  An enema is a liquid that is placed in the rectum to loosen the stool and make it come out.  Never give your child an enema at home.  An enema should only be given under doctor’s care and will most likely take place in a hospital.  A stool softener may also be given to a child to soften the bowel movement.  This should also not be given to a child unless they are under a doctor’s care and the doctor has recommended it.  

Home Remedies to help Encopresis

Many treatments for Encopresis can be done with things at home, such as changing your child’s diet and exercising more. Some parents also turn to probiotics for help with digestive issues that can help with having regular bowel movements.  There has been controversy surrounding using probiotics so you should research the possibility and discuss it with your primary care doctor.  

Living with Encopresis

Encopresis is a condition that will more likely cause a great deal of stress to the parents and child alike.  Children run the risk of feeling embarrassed, succumb to teasing, and may even before isolated from friends.  Parents may feel anger and stress due to not knowing what is causing the disorder and wanting their child to control themselves.  It is important to seek support from family, friends and professionals to help with dealing with this disorder.  Children need to feel safe so that they can get through this as well as parents need to feel understood as well.  

Insurance Coverage for Encopresis

Encopresis is a medical condition that requires medical attention and is covered by most insurances.  Contact the number on the back of your insurance card of consult with your primary care doctor to find out the exact coverage by your insurance.  

How to Find a Therapist

Seeking a therapist could be very beneficial in learning to cope with this disorder.  You can find a therapist by going online to www.psychologytoday.com and searching for a therapist that will help with the stress of caring for a child with this disorder.  You can also search for a child therapist that could assist your child with dealing with stress, shame, and coping skills.  

What Should I be Looking for in a LMHP?

When searching for a therapist, you want to find someone that has experience with treating children and/or experience in treating families that are caring for a child with a chronic illness.  Finding the right fit may take some time but if you do your research and ask the right questions, you should find someone that you feel comfortable with rather quickly. 

Questions to Ask a Potential Therapist

The following questions should be asked to a potential therapist:

  1. How familiar are you with Encopresis?
  2. Have you treated children or families dealing with Encopresis?
  3. How do you treat families and/or children that are dealing with Encopresis?

Encopresis Resources and Support Helpline

There aren’t many resources for dealing with Encopresis, however finding a good primary care doctor or pediatrician would be the first step in getting help for your child.  Getting support from family and friends is important in helping your child to deal with this disorder.  

While Encopresis is more common than most people know, it is something that isn’t talked about often.  Its important to gather as much information on this disorder as possible and equip yourself with treatment that works for your child.  Being patient and understanding with your child will be key in helping them to overcome this condition so that they can begin to have normal bowel movements and a healthier life.  

author avatar
Angel Rivera
I am a Bilingual (Spanish) Psychiatrist with a mixture of strong clinical skills including Emergency Psychiatry, Consultation Liaison, Forensic Psychiatry, Telepsychiatry and Geriatric Psychiatry training in treatment of the elderly. I have training in EMR records thus very comfortable in working with computers. I served the difficult to treat patients in challenging environments in outpatient and inpatient settings
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