Encopresis

Constipation, or hard, difficult to pass stools, affects nearly everyone at some point. But when constipation lasts a long time, called chronic constipation, it can cause serious issues. One of those issues is encopresis.

At UVA Health Children’s, we offer help and support for parents whose children have constipation and encopresis.

What Is Encopresis?

Encopresis is a condition where liquid stool leaks out, leading to soiling. Liquid stool is passing around the harder stool. At first, this leakage might just look like stained underwear. Many parents just assume their child needs to wipe better.

But as the large intestine or colon  stretch more, larger accidents happen. More liquid stool from further up in the colon slides around the hard stool and escapes out, leading to a smelly, sticky mess. Children often do not realize what has happened until they feel the wetness on their clothing, or when someone else mentions the smell. They are not doing this on purpose, and they can’t feel that it is happening. This can lead to a lot of anxiety

What Causes Encopresis?

The most common cause of encopresis is chronic constipation. But there are other causes.

• Nerve damage
• Emotional stress or fear
• Rectal tearing or infection
• Hirschsprung disease
• Inflammatory bowel disease

Other medical conditions like hypothyroidism and diabetes can cause constipation, which can lead to encopresis.

Who Gets Encopresis?

While anyone can get encopresis, there are several risk factors that make it more likely.

Age Encopresis is usually diagnosed after 4, or when a child is routinely able to use the toilet.

Gender Boys get encopresis more often than girls.

Neurodevelopmental Differences Children with ADHD or autism spectrum disorder (ASD) are more likely to get encopresis.

How Is Encopresis Treated?

Encopresis involves both short-term and long-term treatments. First, we’ll focus on getting your child to move their bowels. But because encopresis is caused by chronic stretching of the colon from constipation, we’ll work on reversing that process as well.  We’ll also work on establishing healthy bathroom habits to prevent this from happening again.

Short-Term Treatment

The first, and most immediate, is helping your child go now. Your provider will work with you to find the best way to remove the stool.

Depending on the severity, this could include a laxative or a short-term diet designed to help your child go. Often, an enema is prescribed.

An enema is fluid that goes into the rectum and helps soften and move the stool that’s already there.

Long-Term Treatment

The other part of treatment focuses on giving your child’s colon  time to return to its normal size. Your child will most likely be prescribed a stool softener. It’s important to keep up this process as things start to get better. This will help your child’s gut fully heal.

During this time, treatment may include:

• Stool softeners
• Sitting on the toilet at scheduled times
• Increasing fiber intake (fluid supplementation or food)
• Drinking more fluids

Dietary Needs

Many children with encopresis also struggle with sensory aversions that may make a balanced diet difficult. Our dietitians can help your family with finding options that are gut and child friendly.

Ongoing Care

Around 1% of children develop encopresis at some point. And for most, it’s a short-lived condition with no lasting impacts.

If there is another condition causing your child’s encopresis, we’ll help diagnose and treat that.

We can also recommend mental health support for children whose encopresis has created lasting emotional impacts. Embarrassment, shame, and even anger is not uncommon.