Encopresis (excessive fecal leaking)

Description Encopresis is fecal...

Description

Encopresis is fecal soiling that occurs sometime after a child is toilet trained, usually in children older than 4. The most common cause is a resistance to have a bowel movement. With time stool backs up in the large intestine and rectum and can become lodged (impacted) in the lower part of the colon or rectum. The impaction is painful to pass. The child becomes constipated and reluctant to use the bathroom. The child then experiences involuntary passage of liquid stool around the blockage which stains the underwear. Emotional and psychological factors may contribute to the problem.

Symptoms

Involuntary leaking of stool, passing stool in inappropriate places (in the child's clothes), avoidance of bowel movements, secretive behavior associated with bowel movements, constipation, hard stools, occasional passage of very large stool, abdominal pain.

Tests

Common tests used for diagnosis and treatment

Workup:
A history and physical exam will be performed. Digital examination of the rectal area may show a fecal impaction. An abdominal x-ray may confirm impacted stool in the colon.

Tests:
X-ray

Specialists:
Pediatrics, Family Practice, Pediatric Gastroenterology, Colon and Rectal Surgery

Treatment

Therapy is aimed at relieving the rectal stool blockage (impaction) and then directed toward preventing a recurrence. A finger may be inserted into the rectum to remove the stool followed by enemas to remove further stool higher up the large intestine. Encouraging good bowel habits, going to the bathroom as soon as the urge to defecate is sensed, increasing dietary fiber, and making sure the child drinks plenty of fluids will usually help. Psychologic counseling and/or behavioral therapy may be advised.