[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Behavioral science](https://durgical.com/en/behavioral-science/) › [Other mental disorders](https://durgical.com/en/behavioral-science/areas/disorders/) › Encopresis

# 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.

Updated Nov 13, 2026

## Key points

- Encopresis is most commonly caused by retentive constipation with overflow.
- Withholding stretches the rectum and alters its sensitivity; soft stool then passes around the impacted mass and can look like diarrhea.
- Remove blame from the child and avoid punishment; support works better than criticism.
- Treatment has phases: education, disimpaction, maintenance laxatives, scheduled toilet sitting after meals with rewards, and a slow taper.
- Encopresis can come with urinary incontinence, so ask about wetting.
- Soiling without constipation calls for a look at psychological problems; oppositional and conduct problems and sexual abuse are among the causes to consider.

## 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- Recovery takes time: one-year cure rates reach about 50%, and relapses often occur when the maintenance treatment is withdrawn.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](https://durgical.com/en/conditions/functional-constipation-in-children/) | Hard, painful stools; withholding; soiling around impacted stool | Disimpaction and maintenance treatment |
| [Hirschsprung disease](https://durgical.com/en/conditions/hirschsprung-disease/) | Delayed passage of meconium, distended abdomen | Anorectal manometry and rectal biopsy |
| [Spina bifida or tethered cord](https://durgical.com/en/conditions/spina-bifida/) | Sacral pit or hair tuft, reduced leg reflexes | Specialist assessment |
| [Hypothyroidism](https://durgical.com/en/conditions/congenital-hypothyroidism/) | Organic cause to keep in mind | TSH and T4 |
| [Celiac disease](https://durgical.com/en/conditions/coeliac-disease/) | Poor growth and weight gain | Celiac serology |
| [Anorectal malformations](https://durgical.com/en/conditions/anorectal-malformations/) | Abnormal anal position or opening, history of neonatal surgery | Surgical assessment |
| [Child sexual abuse](https://durgical.com/en/conditions/child-maltreatment/) | 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.

## Memory aid

Empty it, keep it soft, sit after meals, praise: encopresis is usually constipation in disguise.

## 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.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/behavioral-science/encopresis/)

## Elsewhere in DurgiPedia

- [Defecation and continence](https://durgical.com/en/physiology/defecation-and-continence/)
- [Bowel elimination: constipation, enemas and faecal impaction](https://durgical.com/en/nursing/bowel-elimination-constipation-enemas-and-faecal-impaction/)
- [Hirschsprung disease](https://durgical.com/en/general-pathology/hirschsprung-disease/)
- [Hirschsprung disease (congenital aganglionic megacolon)](https://durgical.com/en/embryology/hirschsprung-disease/)

## Connections

## Related 4

- [Operant conditioning: reinforcement and punishment](https://durgical.com/en/behavioral-science/operant-conditioning-reinforcement-and-punishment/)
- [Behavior therapy: exposure, desensitization, token economy and more](https://durgical.com/en/behavioral-science/behavior-therapy-exposure-desensitization-token-economy-and-more/)
- [Assessing children and adolescents in mental health](https://durgical.com/en/behavioral-science/assessing-children-and-adolescents-in-mental-health/)
- [Milestones from 4 years to school age](https://durgical.com/en/behavioral-science/milestones-from-4-years-to-school-age/)

## Related conditions 8

- [Nocturnal enuresis](https://durgical.com/en/conditions/nocturnal-enuresis/)
- [Functional constipation in children](https://durgical.com/en/conditions/functional-constipation-in-children/)
- [Hirschsprung disease](https://durgical.com/en/conditions/hirschsprung-disease/)
- [Coeliac disease](https://durgical.com/en/conditions/coeliac-disease/)
- [Congenital hypothyroidism](https://durgical.com/en/conditions/congenital-hypothyroidism/)
- [Spina bifida (myelomeningocele)](https://durgical.com/en/conditions/spina-bifida/)
- [Anorectal malformations (imperforate anus)](https://durgical.com/en/conditions/anorectal-malformations/)
- [Child maltreatment (physical abuse, abusive head trauma, neglect)](https://durgical.com/en/conditions/child-maltreatment/)

## In Pharmacology 1

- [Laxatives](https://durgical.com/en/pharmacology/classes/laxatives/)

[← All of behavioral science](https://durgical.com/en/behavioral-science/)

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](https://www.msdmanuals.com/professional/pediatrics/stool-incontinence-in-children/stool-incontinence-in-children) (MSD Manual Professional Edition, 2025); [Constipation in Children](https://www.msdmanuals.com/professional/pediatrics/symptoms-in-infants-and-children/constipation-in-children) (MSD Manual Professional Edition, 2025); [Encopresis](https://medlineplus.gov/ency/article/001570.htm) (MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine, 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/behavioral-science/encopresis/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/behavioral-science/encopresis/