Health A-Z

Medical Content Created by the Faculty of the
Harvard Medical School

Encopresis (Fecal Soiling)

What Is It?

Encopresis is when a child who is toilet trained passes stool (bowel movements) into his or her underwear. To have encopresis, the child must be at least four years old, the age by which most children can control bowel movements. Encopresis is also called fecal incontinence.

In most children, encopresis is related to chronic constipation. Constipation is when bowel movements don't occur often enough. Also, the stool is hard and dry.

When stool needs to be passed, it collects in the lower bowel (rectum). There, it stretches the bowel wall. This feeling of the bowel being stretched is what normally makes us realize we have to go to the bathroom.

However, if the bowel wall is stretched for long periods without passing a bowel movement, the rectum loses its normal muscle tone and feeling. This makes it harder and harder to pass the hard stool collecting in the rectum. Also it becomes more difficult for your child to know when stool is ready to be passed.

As newer stool continues to be made in the intestines, it leaks around the large chunk of hard stool. It passes out of the rectum, and soils the child's underpants. In almost all children with encopresis caused by constipation, this is not done on purpose. In fact, many children do not even realize that the stool has leaked out. The first clue that the child has a problem may come when someone notices that the child smells bad.

Chronic constipation that turns into encopresis can have many different causes. These include:

• Tension and anxiety because of problems during toilet training

• A diet that is low in fiber, found in:

  • Fruits

  • Vegetables

  • Whole grains

• A diet that is high in foods that tend to cause constipation, such as:

  • Whole milk

  • Cheese

  • White rice

  • White bread

• Not drinking enough liquids

• An inactive lifestyle with too little exercise (exercise stimulates the intestines to move)

• Fear and anxiety about using an unfamiliar bathroom (for example, at school)

• Not paying attention to the feeling (urge) that it's time to have a bowel movement: Some children do not go to the bathroom when they have the urge to do so. They might be too busy playing a game, watching television or doing some other engaging activity. At school, they may be afraid to ask for permission to leave class to use the bathroom.

• A fissure. When a child with constipation finally passes a bowel movement, the abnormally large stool may injure the skin of his or her rectum. This can produce a painful tear in the skin called a fissure. Because of this painful fissure, the child may become more and more anxious about having a bowel movement for fear of pain.

• Hypothyroidism. Having low levels of thyroid hormones can make a child's digestive system function more slowly than normal. This can lead to constipation.

No matter what the initial cause of a child's chronic constipation, the end result is the same. A large chunk of stool builds up and stretches the rectum until it loses its normal tone and feeling. This makes it more difficult for the rectum to push out the stool. So, more and more stool builds up.

This unhealthy cycle can only be broken when the bowel is completely cleared of stool. At that point, the bowel can return to its normal size. Then a child can learn how to empty his or her bowel on a more regular schedule.

In rare cases, encopresis is related to:

• Medical problems involving the nerves in the spine or the bowel wall

• Psychological issues, such as:

  • Anger

  • Abnormally impulsive behavior

  • Grief over the death of a loved one

  • Some other stress or history of trauma

Boys have encopresis more often than girls.