Encopresis

Encopresis may also be called stool withholding. In most cases, encopresis is not a disease but rather a symptom of chronic constipation. Less frequently, it may be related to developmental or emotional issues. Encopresis usually occurs more commonly in boys after age 4, when a child has already learned to use a toilet.

There are three main causes of encopresis:

• Constipation. Most cases of encopresis are the result of chronic constipation. In constipation, the child's stool is hard, dry and may be painful to pass. As a result, the child avoids going to the toilet, making the problem worse. The longer the stool remains in the colon, the more difficult it is for the child to push out. The colon stretches, ultimately affecting the nerves that signal when it is time to go to the toilet. When the colon becomes too full, soft or liquid stool may leak out.
• Motility. Motility is the ability of the colon to pass stool. Some children are born with physical conditions, such as Hirschsprung's disease or anorectal malformations, in which their colon does not function properly, causing them to be predisposed to constipation.
• Emotional issues. Emotional stress such as premature toilet training or an important change in the child's life—for instance, the divorce of a parent or the birth of a sibling—also may trigger encopresis.

Symptoms of encopresis include:

• Abdominal pain
• Avoidance of bowel movements
• Constipation and dry, hard stool
• Lack of appetite
• Passage of large stool that clogs or almost clogs the toilet
• Stool leakage

Children with encopresis often experience leakage of stool or liquid stool on their underwear when they are not sick. If the amount of leakage is large, parents may misinterpret this as diarrhea.

Diagnosis of Encopresis

If your child is experiencing symptoms of encopresis, a pediatric gastroenterologist can perform the following exams and tests to help make a diagnosis:

• Physical exam. A pediatric gastroenterologist will ask about your child's symptoms and complete a general examination of your child’s body.
• Rectal exam. A physical exam may include a rectal exam to check for impacted stool. During this exam, the doctor inserts a lubricated, gloved finger into your child's rectum.
• X-ray. The pediatric gastroenterologist may recommend an abdominal X-ray to confirm the presence of impacted stool.
• Psychological evaluation. If the cause of encopresis is unclear, the doctor may recommend a psychological evaluation to help determine the cause.
• Motility test. A motility test called anorectal manometry uses small balloons to test the function of the anal muscles. The test can be conducted under general anesthesia. More extensive studies can be conducted in cooperative children while they are awake.