What are the Primary Causes of Encopresis?

Encopresis which in common terms is known as fecal soiling is a condition seen in children associated with functional constipation. Encopresis is mostly seen in children between the ages of three and seven. Fecal soiling is usually preceded by prolonged constipation or episodes where the child does not defecate when the need arises. Encopresis is a condition which is often at times diagnosed much later than it has already started. This is because parents might take soiling of undergarments as a one off episode and do not pay much attention to it^[1].

There have been some cases where encopresis has been accompanied by urinary incontinence and even urinary tract infection. To manage encopresis, the first step is to increase awareness among parents and inform them to discourage children from not defecating whether in school or at home. This is then followed by removal of the stool either through a procedure or manually until the entire rectum is empty^[1].

Additionally, stool softeners are given to the child to prevent the stools from accumulating again. Toilet training then starts for the child with appropriate rewards for going when needed. Encopresis is a condition which can relapse but about 50% of children tend to outgrow the problem or respond positively to treatment within a year of treatment^[1].

It is perfectly understandable for the parents to get frustrated of their child has bowel movements at places other than the restroom especially in social environments. This article highlights some of the common causes of encopresis^[2].

Majority of the cases of encopresis occur as a result of constipation. When a child is constipated, it becomes very hard to pass stools as they become very hard. This is the reason why many children refrain from using the restroom when they feel an urge to defecate so as to avoid the pain that it causes. This is what sets up an “accident” where the child soils his clothes^[2].

On an average, a child has one to two bowel movements in a day but this count is quite variable as some kids may only have two to three bowel movements a week. A child cannot be called constipated if he or she passes stools every three days and the quality of the stool is soft^[2].

However, if the child passes stool that is hard and causes pain when defecating then it comes under constipation. There are many reasons for a child to get constipated. An unhealthy diet, infections, inadequate intake of fluids during the day, avoidance of going to the restroom when there is an urge due to fear, and not having enough access to the restroom all can cause constipation in a child^[2].

Some children become constipated due to stress such as when being abused or parents getting divorced. Some of the rare causes of constipation and resultant encopresis include medical conditions like Hirschsprung Disease and spina bifida syndrome^[2].

The question is what can be done for kids who are constipated and suffer from episodes of encopresis. The treatment is done in three stages. The first stage involves eliminating all stools that has been accumulated in the rectum. This is done by medications, laxatives, and stool softeners. At times, enemas are also given to treat constipation. It should be noted that enemas and laxatives should only be given under physician supervision^[2].

The next step towards treating encopresis involves training the child to have regular bowel movements. This can be done by utilizing stool softeners. The function of the stool softeners is to decrease the hardness of the stools so that they can be passed away without any pain or discomfort^[2].

Timed voiding is the next step towards treating encopresis. The child should be asked to go to the restroom after meals as this is when the bowels get stimulated in children. The child should sit for about 10 minutes. By doing this, the child will get into the habit of knowing the urge and going to the toilet on time and prevent soiling the clothes^[2].

As and when the bowel movements regularize and the child is able to go to the restroom by his or her own volition the medications and stool softeners should be cut down and stopped gradually^[2].

In conclusion, encopresis is quite a common problem that arises when the child is either not able to identify the urge to defecate or refrains from defecating in public places such as a school and soils clothes. Constipation is the primary cause of encopresis. There can be multiple causes of constipation like dietary habits and lack of fluid intake^[2].

Addressing issues such as constipation along with timed voiding and encouraging the child to pay attention to the urge to defecate is recommended. Additionally, discouraging the child from refraining to go to the restroom when required all plays a vital role in helping parents cope up with encopresis^[2].

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Also Read:

• What is Fecal Soiling or Encopresis & How is it Treated?