Encopresis
- Disorder
Repeated passing of stool in clothes or other wrong places by a child aged 4 or older, most often because of long-standing constipation.
What it is
Encopresis is the repeated passage of stool in inappropriate places, such as clothing, by a toilet-trained child over 4 years of age, whether on purpose or not. It affects about 2 to 5 in 100 children aged 4 and is much more common in boys. It is most commonly caused by retentive constipation with overflow; when there is no retention, psychological problems should be considered. It is treatable, but relapses are common.
Key facts
- Common triggers are painful stools or an anal fissure, toilet training and the start of school.
- Because the stretched rectum loses sensitivity, the child cannot control the overflow.
- Diagnosis is clinical: history, examination and, in cooperative children, a gentle digital rectal examination.
- An abdominal X-ray helps when the diagnosis is unclear or the child does not respond to treatment.
- Red flags for an organic cause: delayed passage of meconium, poor growth and weight gain, reduced leg reflexes and a sacral pit or hair tuft.
- Recovery takes time: one-year cure rates reach about 50%, and relapses often occur when the maintenance treatment is withdrawn.
Step by step
- Educate the family: explain the physiology, remove blame from the child and expect a long course.
- Disimpact the bowel with oral or rectal treatment until the fecal mass is cleared.
- Keep stools soft every day with a maintenance laxative, alongside more water, fruit and dietary fiber.
- Schedule toilet sitting 5 to 10 minutes after each meal to use the gastrocolic reflex.
- Reward sitting and cooperation with stickers or a chart.
- Refer to a child psychologist or behavioral therapist if home methods fail or emotional problems are present.
- Withdraw the laxative slowly while keeping the routine; relapses often occur during withdrawal.
Soiling: functional constipation and the causes not to miss
| Cause | Clue | Next step |
|---|---|---|
| Functional constipation with overflow | Hard, painful stools; withholding; soiling around impacted stool | Disimpaction and maintenance treatment |
| Hirschsprung disease | Delayed passage of meconium, distended abdomen | Anorectal manometry and rectal biopsy |
| Spina bifida or tethered cord | Sacral pit or hair tuft, reduced leg reflexes | Specialist assessment |
| Hypothyroidism | Organic cause to keep in mind | TSH and T4 |
| Celiac disease | Poor growth and weight gain | Celiac serology |
| Anorectal malformations | Abnormal anal position or opening, history of neonatal surgery | Surgical assessment |
| Child sexual abuse | Stool retention or soiling without another cause | Safe interview and reporting |
Clinical notes
- Relieve the impaction before starting the maintenance phase.
- Ask about urinary incontinence, diet, stressors and behavior at home.
- Look for and address shame, guilt and low self-esteem, which can also make friendships harder.
- Refer for specialist assessment when red flags are present or when standard treatment fails.
Test yourself
Think of the answer, then tap the question to see it.
What is the most common type of encopresis?
Retentive encopresis: constipation with overflow incontinence.
Why do children with retentive encopresis often not notice the soiling?
Withholding stretches the rectum and alters its sensitivity, so overflow passes around the impacted stool without control.
Why is toilet sitting scheduled after meals?
To use the gastrocolic reflex, which increases colonic movement after eating.
Which history point suggests Hirschsprung disease rather than functional constipation?
Delayed passage of meconium, often with a distended abdomen.
Elsewhere in DurgiPedia
- Defecation and continence
- Bowel elimination: constipation, enemas and faecal impaction
- Hirschsprung disease
- Hirschsprung disease (congenital aganglionic megacolon)
Connections
In Pharmacology1
Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.
Sources: Stool Incontinence in Children (MSD Manual Professional Edition, 2025); Constipation in Children (MSD Manual Professional Edition, 2025); Encopresis (MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine, 2026).
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Representative model, for educational purposes only.