Question 1

Is encopresis the child's fault?

Accepted Answer

No. In most cases, encopresis results from chronic constipation that stretches the rectum and reduces the child's ability to feel when stool is leaking. The soiling is usually involuntary, and punishment typically makes the problem worse by increasing shame and avoidance.

Question 2

Why does my child hide soiled underwear instead of telling me?

Accepted Answer

Children hide soiled underwear out of shame and embarrassment. They often don't fully understand why the accidents happen and fear being punished or seen as babyish. This hiding behavior is very common and is not a sign of defiance—it's a sign of distress.

Question 3

Can a child really not feel the stool coming out?

Accepted Answer

Yes. When chronic constipation causes the rectum to stretch and become enlarged, the normal sensations that signal the need to have a bowel movement are diminished. Softer stool can then leak around the hard impacted stool without the child feeling it.

Question 4

Will my child grow out of encopresis on their own?

Accepted Answer

While some children do eventually resolve encopresis without treatment, waiting can prolong suffering and cause lasting psychological effects. Early treatment leads to faster resolution and prevents the shame and social problems that often accompany prolonged soiling.

Question 5

How is encopresis different from poor toilet training?

Accepted Answer

Encopresis is diagnosed only in children who are developmentally old enough to be toilet trained (age 4+). Many children with encopresis were successfully toilet trained before the problem developed. The issue is typically constipation-related, not a training failure.

Question 6

What's the difference between encopresis and enuresis?

Accepted Answer

Encopresis involves stool accidents while enuresis involves urine accidents (bedwetting or daytime wetting). They are both elimination disorders and can occur together in some children, but they have different underlying causes and treatments.

Question 7

Encopresis vs oppositional defiant disorder: how do you tell the difference?

Accepted Answer

In encopresis, children typically feel ashamed and try to hide accidents—they're not being defiant. Children with ODD show a broader pattern of angry, argumentative behavior across settings. A child who only 'misbehaves' around toileting likely has encopresis, not ODD.

Question 8

Encopresis vs irritable bowel syndrome in children: which is it?

Accepted Answer

IBS involves recurrent abdominal pain with changes in bowel habits (diarrhea, constipation, or both) but doesn't typically cause repeated soiling in inappropriate places. Encopresis specifically involves stool passage in clothing or other inappropriate locations, usually due to overflow from constipation.

Question 9

Retentive vs non-retentive encopresis: what's the difference?

Accepted Answer

Retentive encopresis (with constipation) is far more common—the child withholds stool, becomes impacted, and then overflow leakage occurs. Non-retentive encopresis (without constipation) is less common and may be more related to behavioral or emotional factors.

Question 10

Can stress or trauma cause encopresis?

Accepted Answer

Yes. Stressful events like a new sibling, moving, divorce, or starting school can trigger toileting regression or worsen withholding behaviors. Trauma can also contribute. However, even in stress-related cases, constipation often develops and becomes the maintaining factor.

Question 11

Why does my child only have accidents at school, not at home?

Accepted Answer

Many children avoid school bathrooms due to lack of privacy, cleanliness concerns, limited time, or fear of teasing. They hold their stool all day, leading to overflow accidents later. Addressing bathroom access and comfort at school is an important part of treatment.

Question 12

How do doctors treat encopresis?

Accepted Answer

Treatment typically involves three phases: 1) Initial cleanout with laxatives or enemas to clear impacted stool, 2) Maintenance with daily laxatives to keep stool soft and prevent re-impaction, and 3) Behavioral strategies like scheduled toilet sitting and positive reinforcement. Treatment often continues for months.

Question 13

Is medication necessary for encopresis?

Accepted Answer

For constipation-related encopresis (the most common type), laxatives are usually necessary to break the cycle. The rectum needs time to return to normal size, and keeping stool soft prevents the painful bowel movements that cause children to withhold. Dietary changes alone are often not sufficient.

Question 14

How long does encopresis treatment take?

Accepted Answer

Treatment typically takes several months to a year or longer. The rectum needs time to return to normal size and sensitivity. Stopping treatment too early is a common cause of relapse. Patience and consistency are essential.

Question 15

Should I punish my child for encopresis accidents?

Accepted Answer

No. Punishment increases shame and anxiety, which often worsens withholding and avoidance. A supportive, matter-of-fact approach works best. Help your child clean up without shaming, maintain the treatment plan, and praise efforts and successes.

Question 16

Can encopresis cause permanent damage?

Accepted Answer

When treated appropriately, encopresis does not cause permanent physical damage. The stretched rectum returns to normal size over time. However, prolonged untreated encopresis can cause significant psychological harm, including low self-esteem, social isolation, and anxiety.

Question 17

What dietary changes help with encopresis?

Accepted Answer

Increasing fiber (fruits, vegetables, whole grains) and fluids (especially water) helps keep stool soft. Reducing constipating foods like dairy, processed foods, and bananas may help. However, diet alone usually isn't enough—laxatives are typically needed during active treatment.

Question 18

Why does encopresis affect boys more than girls?

Accepted Answer

Encopresis is about 3-6 times more common in boys than girls, though the exact reason isn't fully understood. Boys may be more likely to ignore urges, have later developmental readiness for toilet training, or be more affected by the conditions that lead to withholding.

Question 19

Can encopresis come back after successful treatment?

Accepted Answer

Yes, relapse is common, especially if treatment is stopped too soon or if stressful events occur. Maintaining good bowel habits, adequate hydration, fiber intake, and addressing constipation early can prevent recurrence. Some children need occasional maintenance treatment.

Question 20

When should I be concerned about something more serious?

Accepted Answer

Seek immediate evaluation if your child has: sudden onset of soiling after being fully trained for years (especially with other changes), weight loss, vomiting, blood in stool, fever, or neurological symptoms like leg weakness. These could indicate a medical condition requiring different treatment.

Encopresis

Overview

Description

Prevalence

Age of Onset

DSM-5 Code

ICD-10 Code

Overview

Real-Life Signs

Stories

Causes & Risk

Diagnosis

Treatment

Related Conditions

For Parents

FAQs

Seeking Help for Encopresis?

Encopresis

Overview

Description

Prevalence

Age of Onset

DSM-5 Code

ICD-10 Code

Overview

Real-Life Signs

Stories

Causes & Risk

Diagnosis

Treatment

Related Conditions

For Parents

FAQs

Seeking Help for Encopresis?