Encopresis is a complicated and distressing behavior that involves the passing of feces in places other than the toilet, such as in underwear, on the floor, or in other clearly unacceptable places. It occurs when a child resists having bowel movements, causing impacted stool to collect in the colon and rectum. When a child’s colon is full of impacted stool, liquid stool leaks around the impacted stool and out of the body, staining the child’s underwear. In most cases, encopresis is a symptom of chronic constipation. It may also be the result of developmental or emotional issues such as premature toilet training, adjusting to birth of a sibling, some other kind of trauma, or developmental delay. Encopresis may or may not be purposeful on the child’s part.

Encopresis is fairly common, but many cases are not reported due to the embarrassment of the child and/or the parents. Encopresis is estimated to affect 1% to 2% of kids under the age of 10, usually occurs after age 4, and after the child has already learned to use a toilet. It is 6 times more common in boys than in girls, with no clear reason for this gender disparity.

Some of the symptoms of encopresis are leakage of stool on a child’s underwear without illness, avoidance of bowel movements, loss of appetite, abdominal pain, loose, watery stools or constipation with dry, hard stools, scratching or rubbing the anal area due to irritation, decreased interest in physical activity, withdrawal from friends and family, and secretive behaviors associated with bowel movements.

Approximately 20% of children with encopresis are also at risk for other emotional problems that may require intervention and can include embarrassment, frustration, shame, anger, depression, and low self-esteem. Teasing by friends or peers can contribute significantly to these emotional issues, causing avoidance of social situations such as birthday parties or events that include sleepovers.

If you believe your child has encopresis, consult your child’s pediatrician first. A medical assessment is necessary to ensure a correct diagnosis. There are some medications that can help encopresis. If further help is needed, Silber Psychological Services offers behavioral techniques that help identify and treat the social and emotional issues in children with encopresis. Punishing or humiliating a child with encopresis will only make the situation worse. Our psychologists will work with both the child and the parents to address the problematic toileting behaviors with positive behavioral strategies and lifestyle changes to overcome the encopresis. Encopresis is a difficult problem with a high relapse rate. Our clinicians at Silber Psychological Services will utilize the most effective techniques to avoid relapse and bring about a positive outcome.