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Encopresis is a problem that children age four or older can develop due to long-term constipation. Children have fewer bowel movements than normal when they are constipated, and the bowel movements they do have can be hard, dry and difficult to pass. Because of this, some children may avoid using the bathroom to avoid discomfort. Stool can become impacted in the rectum and large intestine and unable to move forward. The rectum and intestine become enlarged due to the hard, impacted stool. Eventually, the rectum and intestine have problems sensing the presence of stool, and the anal sphincter (the muscle at the end of the digestive tract that helps hold stool in) does not control the stool correctly. Liquid stool can start to leak around the hard, dry, impacted stool, soiling a child’s clothing.

Which children are at risk for encopresis?

Any child with chronic constipation may develop encopresis. Some of the situations that lead to constipation include the following:

  • Eating a high-fat, high-sugar, “junk-food” diet
  • Not drinking enough water
  • Lack of exercise
  • Reluctance to use public bathrooms
  • Stress in the family, with friends or at school
  • Too busy playing to take time to use the bathroom
  • Change in bathroom routine, such as when a child starts a new school year and bathroom breaks are less frequent than they were over the summer.

For unknown reasons, boys develop encopresis six times more than girls. Family stress can be linked to constipation, but there does not seem to be any association between developing encopresis and how many children are in a family, a child’s birth order, a child’s age or the family’s income.

Why is encopresis of concern?

Encopresis can cause both physical and emotional problems.

  • Impacted stool in the intestine can cause abdominal pain, as well as loss of appetite. Some children may develop bladder infections.
  • Other health problems may cause chronic constipation, including diabetes, hypothyroidism, Hirschsprung’s disease and inflammatory bowel disease.
  • Children with encopresis usually do not have control of this leakage of stool and may become upset, ashamed or embarrassed when leakage occurs and they soil their clothes. Their self-esteem and interactions with other people can be affected, and they may avoid going to school, playing with friends or spending the night away from home. Parents may feel guilt, shame or anger because of their child’s encopresis.

What are the symptoms of encopresis?

The following are the most common symptoms of encopresis. However, each child may experience symptoms differently. Symptoms may include:

  • Loose, watery stools
  • Involuntary stooling, or needing to have a bowel movement with little or no warning, which may soil underwear when a child cannot get to the bathroom in time
  • Scratching or rubbing of the anal area due to irritation by watery stools
  • Withdrawal from friends, school and/or family
  • Hiding their underwear.

Symptoms of encopresis may look like other conditions or medical problems. Please consult your child’s doctor for a diagnosis.

How is encopresis diagnosed?

Your child’s doctor will examine your child and obtain a medical history. Imaging tests may also be done to evaluate the intestine and rule out other health problems. These tests may include:

  • Abdominal X-ray. A diagnostic test to evaluate the amount of stool in the large intestine. Barium enema. An X-ray test that examines the organs of the lower part of the digestive system: the terminal ileum, colon and anus. Barium or another form of contrast is given through the anus as a controlled enema. This test is used to evaluate the anatomy and movement of the intestine. It may show strictures (narrowed areas) and obstructions (blockages) of the large intestine. It is does not show abnormalities in the lining of the intestine, and sedation is not used for this test.

Learn more about X-rays.

What is the treatment for encopresis?

Specific treatment for encopresis will be determined by your child’s doctor based on the following:

  • The extent of the problem
  • Your child’s age, overall health and medical history
  • The opinion of the health care providers involved in the child’s care
  • The family’s opinion or preference.

Treatment for encopresis may include:

  • Removing the impacted stool
  • Keeping bowel movements soft so the stool will pass easily
  • Retraining the intestine and rectum to gain control over bowel movements.


An enema may be prescribed by your child’s doctor to help remove the impacted stool. An enema is a liquid that is placed in your child’s rectum and helps loosen the hard, dry stool. (DO NOT give your child an enema without the approval of a doctor or other health care provider.)

Your child’s doctor will often prescribe medications to help keep your child’s bowel movements soft for several months. This will help prevent stool impaction from occurring again. Please do not give your child stool softeners without the approval of a doctor.

Dietary Changes

Changes in your child’s diet will help constipation, and may include:

  • Increasing the amount of fiber in your child’s diet by adding more fruits and vegetables or adding more whole grain cereals and breads. Learn more about good sources of fiber.
  • Offering your child fruit juice instead of soft drinks.
  • Encouraging your child to drink more fluids, especially water.
  • Limiting fast foods and junk foods that are usually high in fats and sugars while offering more well-balanced meals and snacks.
  • Limiting drinks with caffeine, such as cola drinks and tea.
  • Limiting whole milk to 16 ounces if your child is 2 years of age and older, but do not eliminate milk altogether. Children need the calcium in milk to help their bones grow strong.
  • Planning to serve your child’s meals on a regular schedule. Eating a meal will often stimulate a bowel movement within 30 minutes to an hour. Serve breakfast early so your child does not have to rush off to school and miss the opportunity to have a bowel movement.

Increase Exercise

Increasing the amount of exercise your child gets can also help with constipation. Exercise aids digestion by helping the normal movements the intestines make push food forward as it is digested. People who do not move around much are often constipated. Encourage your child to go outside and play rather than watch TV or engage in other indoor activities.

Proper Bowel Habits

Have your child sit on the toilet at least twice a day for at least 10 minutes, preferably shortly after a meal. Make this time pleasant; do not scold or criticize the child if they are unable to have a bowel movement. Giving stickers or other small rewards, and making posters that chart your child’s progress can help motivate and encourage him or her.

If these methods do not help, or if your doctor notices other problems, he or she may recommend laxatives, stool softeners or an enema. These products should ONLY be used with the recommendation of your child’s doctor. DO NOT use them without consulting your child’s doctor first.

Until the intestine and rectum regain their muscle tone, children may still have “accidents” and soil their underwear on occasion. Preschool children may be able to wear a disposable training pant until they regain bowel control. Taking a change of underwear and/or pants to school can help minimize your child’s embarrassment and improve his or her self-esteem as bowel control improves.

Good Sources of Fiber for Children

Making sure a child is getting enough fiber and water can help relieve your child’s chronic constipation. Here are some great sources of fiber for children.

Foods Moderate Fiber High Fiber
Bread Whole wheat bread, granola bread, wheat bran muffins, whole-grain waffles, popcorn
Cereal Bran cereals, shredded wheat cereals, oatmeal, Mueslix, granola, oat bran High bran cereals
Vegetables Beets, broccoli, Brussels sprouts, cabbage, carrots, corn, green beans, green peas, acorn and butternut squash, spinach, potato with skin, avocado
Fruits Apples with peel, dates, papayas, mangos, nectarines, oranges, pears, kiwis, strawberries, applesauce, raspberries, blackberries, raisins Cooked prunes, dried figs
Meat Substitutes Peanut butter, nuts Baked beans, black-eyed peas, garbanzo beans, lima beans, pinto beans, kidney beans, chili with beans, trail mix