Fact Sheet: Encopresis in Children and Adolescents

Encopresis is the voluntary or involuntary passage of stools in places other than toilets. To qualify for a diagnosis of encopresis, the patient must be repeatedly passing feces into inappropriate places (such as clothing or on the floor) at least once per month over a three-month period. The child must be chronological age of at least 4 (or equivalent developmental level). The behavior must not be due exclusively to the direct physiological effect of a substance (e.g., laxatives or stool softeners) or a general medical condition except through a mechanism involving constipation. There are two subtypes of encopresis: primary in which the child has never been toilet trained and secondary where the child was toilet trained and accident free, usually for a period of at least 6 months, prior to starting the soiling.

Prevalence and Course

The prevalence of encopresis in the child population has been estimated to range from approximately 4 percent of 4-year-olds and 1.6 percent of 10 year old children, affecting boys three to six times more often than girls. The two primary groups of children presenting with fecal soiling or encopresis include children with functional constipation with overflow incontinence and children with functional nonretentive fecal incontinence. As many as 95 percent of children referred for the treatment of encopresis present with functional constipation. 

Health and Psychosocial Consequences

The most serious and most common health based consequence of encopresis involves urinary tract infections from the contamination of the urinary tract with feces from the child’s underwear. The most serious social consequence of encopresis is teasing and ridicule from peers, classmates, friends and siblings.

Evidence-based Assessment

One of the available general parent and teacher rating scales (BASC, CBCL, Connors CBRS) is recommended to identify comorbidities such as Oppositional Defiant Disorder and Attention Deficit/Hyperactivity Disorder which may interfere with the parents’ ability to implement treatment recommendations.

Culture, Diversity, Demographic and Developmental Factors

Studies have not found associations between encopresis and socioeconomic status, family size, child’s position in the family or parental age. Unfortunately, population based studies on the prevalence of encopresis in children are scarce, especially beyond American populations.  

Evidence-based Interventions

The treatment approach with the best outcome data is usually referred to as Medical-Behavioral.  Typically, this consists of the use of medication to address the child’s constipation (either oral medications or rectal). The second stage in the treatment of encopresis is maintenance of regular and healthy bowel functioning and preventing the child from getting constipated again. The Clinical Practice Guidelines recommend including diet management (including reduction of intake of dairy products when indicated). Numerous reports by psychologists have reported successful interventions when dietary recommendations and exercise have been included. Regardless of the treatment approach, there seems to be general agreement that treatment that prevents or postpones the reappearance of constipation is necessary. 

References

Christophersen, E.R., & Friman, P.C. (2010). Elimination disorders in children and adolescents.  Cambridge, MA: Hogrefe. 

Clinical Practice Guideline: Evaluation and treatment of constipation in infants and children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. (2006). Journal of Pediatric Gastroenterology and Nutrition, 43, e1-e13.

DiLorenzo, C., & Benninga, M.A. (2004). Pathophysiology of pediatric fecal incontinence. Gastroenterology, 126(Suppl 1), SS33-40.  

Har, A.F., & Croffie, J.M. (2010). Encopresis. Pediatrics in Review, 31, 368-374.