Materiały źródłowe

• #1 Soiling (Encopresis) (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/encopresis.html

  If your child has bowel movements (BMs) in places other than the toilet, you know how frustrating it can be. […] But many kids beyond the age of toilet teaching (generally older than 4 years) who soil their underwear have a condition known as encopresis (en-kah-PREE-sis). They have a problem with their bowels that dulls the normal urge to go to the bathroom. So they can’t control the accidents that usually follow. […] Encopresis isn’t a disease. It’s a symptom that may have different causes. […] Most encopresis cases are due to constipation. Stool (poop) is hard, dry, and difficult to pass when a person is constipated. Many kids „hold” their BMs to avoid the pain they feel when they go to the bathroom, which sets the stage for having a poop accident. […] When a child holds in BMs, the poop starts building up in the rectum and may back up into the colon and a frustrating cycle begins.

• #2 Encopresis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560560/

  Encopresis or fecal incontinence is defined as the involuntary passing of stool into inappropriate places such as the underwear in children older than four years of age. It represents severe psychological distress on children and their families. […] The encopresis of fecal incontinence also called soiling or fecal overflow incontinence. […] In the absence of organic causes, encopresis is secondary to overflow, and therefore results from the presence of constipation. Withholding of stool creates a vicious circle of accumulation of feces and hardening of the fecal mass in the rectosigmoid colon. Finally, feces leak between the solid fecal mass and rectal wall and come out through the anal canal when the sphincter muscles are relaxed. […] Stool withholding may be an intentional behavior to avoid unpleasant sensations and associations with defecation. […] The overall pathophysiology of this pattern of encopresis is still unclear. […] Risk factors for functional encopresis are low socioeconomic background, unhygienic toilets, living in an urban area or war-affected zone, hospitalization of the child for another illness, and bullying at school.

• #3 Encopresis Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17849-encopresis-soiling

  Encopresis, also known as functional fecal incontinence or soiling, is when children pass stool (poop) into their underwear, in most cases accidentally. It occurs in children 4 years of age and older who have been toilet trained. The most common cause of encopresis is constipation. When a child experiences constipation, its difficult to have a bowel movement because their stool is dry and hard inside their colon and it can be painful to pass. When children withhold or delay going to the bathroom, stool builds up in their colon. This makes the childs colon grow larger, making it hard for them to feel when it is time to have a bowel movement. Liquid stool might leak out around harder stool, and parents might mistake this for diarrhea. […] Encopresis could be a symptom of an underlying medical condition. Possible conditions that have encopresis as a symptom include: Colonic inertia: The colon doesnt move stool as it should.

• #4 Soiling (Encopresis) | Dayton Children’s Hospital

  https://www.childrensdayton.org/kidshealth/a/encopresis

  If your child has bowel movements (BMs) in places other than the toilet, you know how frustrating it can be. […] But many kids beyond the age of toilet teaching (generally older than 4 years) who soil their underwear have a condition known as encopresis (en-kah-PREE-sis). They have a problem with their bowels that dulls the normal urge to go to the bathroom. So they can’t control the accidents that usually follow. […] Encopresis isn’t a disease. It’s a symptom that may have different causes. […] Most encopresis cases are due to constipation. Stool (poop) is hard, dry, and difficult to pass when a person is constipated. Many kids „hold” their BMs to avoid the pain they feel when they go to the bathroom, which sets the stage for having a poop accident. […] When a child holds in BMs, the poop starts building up in the rectum and may back up into the colon and a frustrating cycle begins.

• #5 Soiling (Encopresis) | Dayton Children’s Hospital

  https://www.childrensdayton.org/kidshealth/a/encopresis

  The colon’s job is to remove water from the poop before it’s passed. The longer the poop is stuck there, the more water is removed and the harder it is to push the large, dry poop out. […] In time, the rectum and lower part of the colon get so full that it’s hard for the sphincter (the muscular valve that controls the passage of feces out of the anus) to hold the poop in. Partial BMs may pass through, causing the child to soil their pants. […] Kids can’t prevent this soiling and sometimes dont know it’s happening because the nerves aren’t sending the signals that regulate pooping. […] Soiling and constipation are a top reason that kids go to see pediatric gastroenterologists (doctors who diagnose and treat disorders of the stomach and intestines). […] Encopresis is not a behavioral issue or a simple lack of self-control.

• #6 Encopresis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/encopresis/symptoms-causes/syc-20354494

  Encopresis (en-ko-PREE-sis), sometimes called fecal incontinence or soiling, is the repeated passing of stool (usually involuntarily) into clothing. Typically it happens when impacted stool collects in the colon and rectum: The colon becomes too full and liquid stool leaks around the retained stool, staining underwear. Eventually, stool retention can cause stretching (distention) of the bowels and loss of control over bowel movements. […] Encopresis usually occurs after age 4, when a child has already learned to use a toilet. In most cases, soiling is a symptom of long-standing constipation. Far less frequently it occurs without constipation and may be the result of emotional issues. […] 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.

• #7 Encopresis – Wikipedia

  https://en.wikipedia.org/wiki/Encopresis

  Encopresis (from Ancient Greek, enkprsis) is voluntary or involuntary passage of feces outside of toilet-trained contexts (fecal soiling) in children who are four years or older and after an organic cause has been excluded. Children with encopresis often leak stool into their undergarments. […] Encopresis is commonly caused by constipation in children, by reflexive withholding of stool, by various physiological, psychological, or neurological disorders, or from surgery (a somewhat rare occurrence). […] The colon normally removes excess water from feces. If the feces or stool remains in the colon too long due to conditioned withholding or incidental constipation, so much water is removed that the stool becomes hard, and becomes painful for the child to expel in an ordinary bowel movement. A vicious cycle can develop, where the child may avoid moving his/her bowels in order to avoid the „expected” painful toilet episode. This cycle can result in so deeply conditioning the holding response that the rectal anal inhibitory response (RAIR) or anismus results. The RAIR has been shown to occur even under anesthesia and when voluntary control is lost. The hardened stool continues to build up and stretches the colon or rectum to the point where the normal sensations associated with impending bowel movements do not occur. Eventually, softer stool leaks around the blockage and cannot be withheld by the anus, resulting in soiling. The child typically has no control over these leakage accidents, and may not be able to feel that they have occurred or are about to occur due to the loss of sensation in the rectum and the RAIR. Strong emotional reactions typically result from failed and repeated attempts to control this highly aversive bodily product. These reactions then in turn may complicate conventional treatments using stool softeners, sitting demands, and behavioral strategies.

• #8 Soiling (Encopresis) (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/encopresis.html

  The colon’s job is to remove water from the poop before it’s passed. The longer the poop is stuck there, the more water is removed and the harder it is to push the large, dry poop out. […] In time, the rectum and lower part of the colon get so full that it’s hard for the sphincter (the muscular valve that controls the passage of feces out of the anus) to hold the poop in. Partial BMs may pass through, causing the child to soil their pants. […] Kids can’t prevent this soiling and sometimes dont know it’s happening because the nerves aren’t sending the signals that regulate pooping. […] Soiling and constipation are a top reason that kids go to see pediatric gastroenterologists (doctors who diagnose and treat disorders of the stomach and intestines). […] Encopresis is not a behavioral issue or a simple lack of self-control.

• #9 Encopresis (Fecal Soiling) – Harvard Health

  https://www.health.harvard.edu/a_to_z/encopresis-fecal-soiling-a-to-z

  Encopresis is when a child who is toilet trained passes stool (bowel movements) into his or her underwear. […] In most children, encopresis is related to chronic constipation. […] When stool needs to be passed, it collects in the lower bowel (rectum). There, it stretches the bowel wall. […] However, if the bowel wall is stretched for long periods without passing a bowel movement, the rectum loses its normal muscle tone and feeling. This makes it harder and harder to pass the hard stool collecting in the rectum. […] As newer stool continues to be made in the intestines, it leaks around the large chunk of hard stool. It passes out of the rectum, and soils the child’s underpants. […] Chronic constipation that turns into encopresis can have many different causes. […] No matter what the initial cause of a child’s chronic constipation, the end result is the same. A large chunk of stool builds up and stretches the rectum until it loses its normal tone and feeling. This makes it more difficult for the rectum to push out the stool. So, more and more stool builds up.

• #10 Encopresis Symptoms, Causes, Treatments, & More

  https://www.webmd.com/digestive-disorders/encopresis

  As more and more stool collects in the child’s lower intestine (colon), the colon slowly stretches (sometimes called megacolon). […] As the colon stretches more and more, the child loses the natural urge to pass a bowel movement. Eventually, looser, partly formed stool from higher up in the intestine leaks around the large collection of harder, more formed stool at the bottom of the colon (rectum) and then leaks out of the anus (the opening from the rectum to the outside of the body). […] Over time, the child with encopresis may also develop incoordination of the muscles used to pass bowel movements. In many children, the anal sphincter contracts rather than relaxes when they are trying to push out bowel movements. This disturbed coordination of muscle function, which causes fecal retention, is a key to the diagnosis and is also called anismus or paradoxic contraction of the pelvic floor to defecation.

• #11 Encopresis

  https://phoenixchildrens.staywellsolutionsonline.com/Search/90,P01992

  Encopresis is when your child leaks stool into their underwear. It’s also called stool soiling. It’s most often because of long-term (chronic) constipation. Encopresis happens to children ages 4 and older who have already been toilet trained. […] In most cases, encopresis happens because a child has long-term (chronic) constipation. […] When a child is constipated, they have fewer bowel movements than normal. Bowel movements can then become hard, dry, and difficult to pass. Your child may stay away from going to the bathroom because it hurts. Then stool becomes backed up (impacted) in the rectum and the large intestine (colon). The stool cant move forward. The rectum and intestine become enlarged because of the hard, impacted stool. […] Over time, liquid stool can start to leak around the hard, dry, impacted stool. This soils your child’s clothing.

• #12 Encopresis – Kids Tummies Website

  https://kidstummies.org/encopresis/

  Encopresis, also known as fecal soiling is the soiling of underwear with stool by children who are pass the age of toilet training and are at least 4 years old or older. Encopresis in most cases is involuntary which means they have no control over soiling their underwear. […] In the vast majority of cases, encopresis is the result of chronic (long-standing) constipation. […] When children hold in their poop in, their lower bowel begins to fill up. As they continue to do this, their lower bowel stretches out of its normal shape and the poop gets larger and harder. This makes pooping even more painful. When children hold their poop in repeatedly the muscles they used to push the poop out become stretched and as a result do not work well. Hard poop can get stuck and only liquid can pass around the hard poop. The stretched nerves become less sensitive and the child does not feel the leaking poop.

• #13

• #14 About Encopresis – Department of Pediatrics

  https://med.virginia.edu/pediatrics/clinical-and-patient-services/patient-tutorials/chronic-constipation-encopresis/about-encopresis/

  When somebody suffers from encopresis it means that he or she cant control their bowel movements and pass bowel movements in their underwear. Soiling and fecal incontinence mean the same thing. […] In most cases, encopresis develops as a result of long-standing constipation. The vast majority of of children suffering from encopresis have a history of constipation or a history of passing large and/or painful bowel movements. […] With constipation and painful bowel movements, children may not completely empty themselves when they go to the bathroom. Over a long period of time the large intestine slowly fills with stool and stretches out of shape. As the large intestine stretches larger and larger, liquid stool from the small intestine begins to leak around the more formed stool in the colon.

• #15 Encopresis Symptoms, Causes, Treatments, & More

  https://www.webmd.com/digestive-disorders/encopresis

  Establishing regular soft and painless bowel movements is mostly a matter of helping your child to learn to give up the habit of retaining stool. This is accomplished by giving them laxatives every day to produce soft bowel movements. The laxative must be given in doses large enough to produce one or two soft bowel movements every day. The soft stool will pass easily and painlessly, which will encourage your child to have regular bowel movements rather than holding their stool in. Remember that fecal retention and soiling go together. So, as long as your child retains stool in their rectum, soiling will persist. […] The final step is working with your child to develop regular bowel habits. This step is just as critical as the first two steps and must not be abandoned just because the soiling has improved after the previous steps.

• #16 Pediatrics and Pelvic Health: Skid marks, Poop Accidents, Constipation

  https://fusionwellnesspt.com/blog/pediatrics-and-pelvic-health-encoporesis-skid-marks-poop-accidents-and-constipation

  Constant straining with bowel movements will cause the muscles of the pelvic floor to spasm or become weak. If your child’s constipation triggers pelvic floor weakness or spasm, these muscle holding patterns can stay around as they get older, and for some, these issues persist into adulthood. […] The ultimate goal is to help the child to be able to fully relax the pelvic floor and have a complete bowel movement without strain or pain.

• #17 Encopresis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/encopresis/symptoms-causes/syc-20354494

  The longer the stool remains in the colon, the more difficult it is for the child to push stool out. The colon stretches, ultimately affecting the nerves that signal when it’s time to go to the toilet. When the colon becomes too full, soft or liquid stool may leak out around the retained stool or loss of control over bowel movements may occur. […] Emotional stress may trigger encopresis. A child may experience stress from: […] Early treatment, including guidance from your child’s doctor or mental health professional, can help prevent the social and emotional impact of encopresis. Regular follow-up visits with your doctor can help identify ongoing or recurring problems so that adjustments in treatment can be made as needed.

• #18 Soiling | EBSCO Research Starters

  https://www.ebsco.com/research-starters/health-and-medicine/soiling

  Soiling refers to the involuntary passage of small amounts of semisolid feces, often associated with chronic constipation in children. […] The underlying cause is often rectal distention, resulting from infrequent and large bowel movements that can reduce the sensory awareness of impending bowel actions. […] Soiling is caused by chronic constipation in school-aged children. […] The size of these bowel movements is evidence of distention of the rectum as a result of long-standing constipation, which is the basis of this disorder. […] Persistent rectal distention (megacolon) as a result of chronic constipation results in decreased sensitivity of the rectum to acute rectal distention. […] In soiling children, the rectum functions as a storage organ, and does so rather poorly. […] Since soiling results from rectal distention (megacolon), effective therapy should empty the rectum (catharsis) and keep it empty (maintenance), allowing reversal of the rectal distention and return of normal rectal sensitivity. […] The goal of therapy is resolution of the fecal soiling, since this is the only symptom that causes the child to suffer. […] Even with no treatment, soiling resolves spontaneously around the time of puberty as the underlying constipation resolves.

• #19 Encopresis (Fecal Soiling) – Harvard Health

  https://www.health.harvard.edu/a_to_z/encopresis-fecal-soiling-a-to-z

  This unhealthy cycle can only be broken when the bowel is completely cleared of stool. At that point, the bowel can return to its normal size. Then a child can learn how to empty his or her bowel on a more regular schedule. […] If your child has encopresis because of chronic constipation, treatment is a three-step process. It involves: […] Clearing the bowel of the large chunk of stool. This usually can be done with medications (laxatives) taken by mouth. […] Preventing the return of constipation. For six months or more, the child may need to take a stool softener to allow bowel movements to pass more easily and comfortably. […] Teaching normal bowel habits. The child will need to sit on the toilet for 10 to 15 minutes at regular times during the day, including after every meal. This will allow the bowel muscles to respond normally to the urge to pass stool. […] Most children with encopresis either outgrow the problem or respond to treatment. Treatment may involve changes in diet, medication and motivational therapy.

• #20 Soiling (Encopresis) | Dayton Children’s Hospital

  https://www.childrensdayton.org/kidshealth/a/encopresis

  Treatment happens in three phases: Emptying the rectum and colon of the hard poop. […] Keep in mind that relapses are normal, so don’t get discouraged. […] Patience is the key to treating encopresis. It can take several months to a year for the stretched-out colon to return to its normal size and for the nerves in the colon to become effective again. […] Successful treatment of encopresis depends on the support a child gets.

• #21 Soiling (Encopresis) – Kidshealth | Akron Children’s

  https://www.akronchildrens.org/kidshealth/en/parents/encopresis.html

  Treatment happens in three phases: Emptying the rectum and colon of the hard poop. […] Helping your child begin having regular BMs. […] Reducing use of the stool medicines. […] Keep in mind that relapses are normal, so don’t get discouraged. […] Patience is the key to treating encopresis. It can take several months to a year for the stretched-out colon to return to its normal size and for the nerves in the colon to become effective again. […] Successful treatment of encopresis depends on the support a child gets. Some parents find that positive reinforcement helps to encourage the child throughout treatment.

• #22

  https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Fecal-Soiling.aspx

  Fecal soiling, referred to medically as encopresis in children over four years of age, affects about 1.5 percent of young school children, with boys outnumbering girls by a ratio of six to one. […] In most cases, however, fecal soiling is not voluntary, but occurs when emotional stress, resistance to toilet training, or physical pain during bowel movements causes a child to resist having bowel movements. This resistance, or stool retention, leads to constipation, which in turn leads to involuntary leakage or soiling when the pressure becomes too great. If this continues to happen, the muscles involved in stool ejection may begin to stretch, and nerve sensations in the area diminish, making it more difficult for the child to feel the need to defecate. The intestines may lose their ability to contract, making bowel movements even more of a challenge and fecal soiling more likely.

• #23 Encopresis: Symptoms, Mental Health, and Treatment

  https://psychcentral.com/disorders/encopresis-symptoms

  When a child is soiling themselves, either on purpose or by accident, its known as encopresis. […] Encopresis, also known as soiling or fecal incontinence, usually happens in children. It refers to passing stool in places other than the toilet. […] The root cause of encopresis is chronic constipation. Chronic constipation can happen for several reasons, including because a child holds their bowel movements in. They may hold their stool consciously or unconsciously. […] Some things that may cause encopresis include: having painful bowel movements, which might encourage children to hold it; stressful events, like going to a new school; having a tough time with toilet training. […] Your child may begin to hold their stool, creating a cycle of constipation and overflow incontinence because they have an unusually painful bowel movement, have an anal fissure, have an infection, don’t want to use the toilet in a specific environment, like at school, or don’t want to stop doing what they’re doing to use the bathroom.

• #24 Encopresis: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/encopresis

  Encopresis is also known as fecal soiling. It occurs when a child (usually over the age of 4) has a bowel movement and soils their pants. This problem is most often linked to constipation. […] Fecal matter can become hard and difficult to pass if your child doesn’t get enough fiber, water, or exercise, or if they hold in a bowel movement. This can cause bowel movements to be painful. Liquid fecal matter or a soft bowel movement can then leak around the hard stool in the rectum and into a child’s underpants. The child can’t consciously control this soiling. […] Just because encopresis is associated with psychological causes doesn’t mean that the symptoms are under your child’s control. They’re most likely not soiling themselves on purpose. The problem may begin because of controllable situations, such as fear of using a public toilet or not wanting to be toilet trained, but it becomes involuntary over time.

• #25 Encopresis – My top tips to help stop your kids pooing in their pants – NatureDoc

  https://naturedoc.com/encopresis-top-tips-to-help-stop-your-kids-pooing-in-their-pants/

  Encopresis is a condition where a child repeatedly soils their underwear with poo, often past the age when gastric control over bowel habits is typically expected. […] There are several causes of encopresis, including chronic constipation, impacted stool, undigested food in the stool, slow peristalsis, poor core strength and psychological factors such as stress and anxiety. […] Withholding poo can all start during the potty-training stage when some kids are reluctant to have a bowel movement anywhere other than their nappy. […] This can mean they try to hold it in all day as they fear or strongly dislike the act of doing a poo and some only poo in a nappy at night when they are most relaxed. […] One of the key things to remember with encopresis is for the child to realise that it is not their fault, and these accidents rarely happen due to intended behaviour or attention seeking.

• #26 Encopresis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560560/

  Encopresis or fecal incontinence is defined as the involuntary passing of stool into inappropriate places such as the underwear in children older than four years of age. It represents severe psychological distress on children and their families. […] The encopresis of fecal incontinence also called soiling or fecal overflow incontinence. […] In the absence of organic causes, encopresis is secondary to overflow, and therefore results from the presence of constipation. Withholding of stool creates a vicious circle of accumulation of feces and hardening of the fecal mass in the rectosigmoid colon. Finally, feces leak between the solid fecal mass and rectal wall and come out through the anal canal when the sphincter muscles are relaxed. […] Stool withholding may be an intentional behavior to avoid unpleasant sensations and associations with defecation. […] The overall pathophysiology of this pattern of encopresis is still unclear. […] Risk factors for functional encopresis are low socioeconomic background, unhygienic toilets, living in an urban area or war-affected zone, hospitalization of the child for another illness, and bullying at school.

• #27 Faecal incontinence, soiling or encopresis | Raising Children Network

  https://raisingchildren.net.au/school-age/health-daily-care/toileting/faecal-incontinence

  Constipation and faecal incontinence are more common in children with attention deficit hyperactivity disorder (ADHD) and autistic children. […] The main symptom of faecal incontinence is pooing in places other than the toilet, usually in underwear. This can range from skid marks to larger bits of poo. […] Because the most common cause of faecal incontinence is constipation, you might see symptoms of constipation in children with faecal incontinence. These include pain when doing a poo, large or hard poos, or less frequent poos. […] The treatment for faecal incontinence depends on its cause.

• #28 Autism, PDD-NOS & Asperger’s fact sheets | Toilet training for children with Autism Spectrum Disorders

  http://www.autism-help.org/behavior-soiling-encopresis.htm

  Soiling (encopresis) occurs when a child does not reliably use the toilet for a bowel motion. […] A poor diet can lead to constipation. Severe constipation causes the bowel to be blocked with hard poo. The child finds it painful to pass this, and so becomes more constipated. Liquid faeces then leak around the blockage, staining clothes. […] It helps to understand the underlying reasons before attempting to change soiling behavior. There may be a sensory issue involved, whether it is the sight, sound, smell or feel of the toilet, or actual poo. Understanding the sensory issues may make it easier to encourage the appropriate behavior. […] Children with autism or Aspergers find it difficult to change existing routines. Learning to use the toilet instead of diapers will usually take longer than with neurotypical children. […] Communication issues exist as well. It will be common for children to have trouble grasping a verbal message. It can also help to use pictures, and also model the desired behavior.

• #29 Encopresis |Understanding & Managing Encopresis In Children

  https://www.childpsychologist.com.au/resources/encopresis-soiling-in-school-aged-children

  Biological factors: Functional constipation (persistent constipation with incomplete defecation without evidence of a structural or biochemical explanation) is one of the main causes of encopresis, accounting for 90% of cases amongst children (Har Croffle, 2010). […] Psychological factors: Overall 30-50% of children with encopresis have a comorbid emotional or behavioural disorder (von Gontard, 2012). […] Family and social factors: Children may develop delays in toileting due to unsuccessful toilet training as a toddler and intrusive toilet training. […] In western cultures, bowel control is established in 95% of children by age 4 in 99 % of children aged 5 (von Gontard, 2013). […] Encopresis can have a severe effect on the child, family and school environment. […] Studies have shown that encopresis children experience a greater amount of anxiety and depression symptoms, difficulties with attention, more social problems, disruptive behaviours and lower levels of academic performance (Mosca Schatz, 2014).

• #30 Encopresis: Symptoms, Mental Health, and Treatment

  https://psychcentral.com/disorders/encopresis-symptoms

  Children with encopresis also commonly experience other mental health conditions like depression, anxiety, oppositional behavioral disorders, aggression, and social withdrawal. […] A combination of medication and behavioral therapy is often the most successful treatment for encopresis. […] Treatment for constipation may include oral or rectal medications, such as stool softeners to flush out the bowels. […] Behavioral treatment helps encourage healthy bowel movements. […] It’s important for parents and caregivers not to punish children for soiling themselves. This can backfire and make the problem worse. […] Behavioral training usually involves being clear with the child that the situation isn’t their fault. It may also include educating the family and child about typical defecation and what causes constipation. […] In rare cases, medication or behavioral interventions may not help with encopresis. Surgery may be necessary to ease the symptoms and help your child.

• #31 Encopresis Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17849-encopresis-soiling

  Encopresis, also known as functional fecal incontinence or soiling, is when children pass stool (poop) into their underwear, in most cases accidentally. It occurs in children 4 years of age and older who have been toilet trained. The most common cause of encopresis is constipation. When a child experiences constipation, its difficult to have a bowel movement because their stool is dry and hard inside their colon and it can be painful to pass. When children withhold or delay going to the bathroom, stool builds up in their colon. This makes the childs colon grow larger, making it hard for them to feel when it is time to have a bowel movement. Liquid stool might leak out around harder stool, and parents might mistake this for diarrhea. […] Encopresis could be a symptom of an underlying medical condition. Possible conditions that have encopresis as a symptom include: Colonic inertia: The colon doesnt move stool as it should.

• #32 Fecal Incontinence (Soiling): Causes, Treatment and Prognosis | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/fecal-incontinence

  While surgical repair can help restore bowel function, it cannot always insure bowel control. […] Bowel issues can also be triggered by how fast the colon pushes feces through to the rectum before it reaches the sphincter muscles. […] Hypomotility: In patients where the colon pushes stool slowly, feces tends to gather in the rectum which is larger than normal in most such patients. […] The issue can also develop in children who dont have any malformations and have never had surgery. In this case, the soiling due to idiopathic (unknown cause) constipation is called encopresis. […] For some children who have had surgery to correct an anorectal malformation, a repeat procedure may help improve their potential for bowel control. […] For certain patients who have borderline bowel control, a new technology called sacral nerve stimulation (SNS) may eliminate the need for enemas. SNS uses a device to send a small electrical signal to help modulate nerves that control continence.

• #33 Soiling and Functional Fecal Retention: How to Help – About Kids GI

  https://aboutkidsgi.org/lower-gi/childhood-defecation-disorders/soiling-and-functional-fecal-retention/

  Encopresis (or fecal soiling) is usually associated with constipation. […] Functional fecal retention is the most common problem in children that come to see a pediatric gastroenterologist. It is defined by passage of big, hard stools at infrequent intervals, days or weeks apart; and by the child trying to avoid having a bowel movement by stiffening and straightening his or her legs and buttocks. […] Functional fecal retention is most often due to frightening or painful defecation experiences, which result in voluntary avoidance of passing stools. Repeated retention of feces causes an increase in size of stools leading to more painful defecation experiences and further attempts at avoidance. […] We understand what causes the soiling. Even though the child is able to hold back the stool for days or weeks, he still needs to pass gas many times each day, like everyone else. When he relaxes his bottom to let out the gas, liquid that has seeped around the retained stool may also leak out and soil the underclothes.

• #34 Fecal Incontinence (Soiling): Causes, Treatment and Prognosis | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/fecal-incontinence

  Fecal incontinence (accidentally having bowel movements) is a very common problem in children. It can be caused by medical conditions like chronic constipation or congenital conditions that may disrupt bowel control, including: spina bifida, anorectal malformations and Hirschsprung disease. […] Fecal incontinence can be caused by medical conditions like chronic constipation or congenital conditions that may disrupt bowel control, including: spina bifida, anorectal malformations and Hirschsprung disease. […] Children with true fecal incontinence lack the ability to voluntarily have a bowel movement, so they require daily interventions to empty the colon of stool. However, there are two different types of true fecal incontinence and treatment for each varies: […] These conditions may have prevented their bodies from developing normal bowel structures or control of those structures.

• #35 Fecal Incontinence | Children’s Mercy Kansas City

  https://www.childrensmercy.org/departments-and-clinics/colorectal-center/fecal-incontinence/

  Because constipation is most often the underlying reason for fecal incontinence, symptoms include 2 or fewer bowel movements per week, at least 1 episode of incontinence or stool leaking unexpectedly per week (if the child is toilet trained), a history of not pooping, painful or hard bowel movements, presence of a fecal mass in the rectum, and large diameter stools that stop up the toilet. […] There are a number of other medical conditions that also can cause FI, including cerebral palsy, spina bifida, thyroid disorders and anorectal malformation, or imperforate anus. Hirschsprung disease is the most common cause of lower intestinal obstruction in infants. […] The short answer is that it is not (especially after a child with typical anatomy has been toilet trained). […] If there is an underlying condition that causes differences in anatomy, we will discuss if diet and medications, enemas or surgery will work best to help regain control of bowel movements.

• #36 Encopresis – Help For Your ChildVisit our FacebookVisit our YouTube channelsearchcrosslinkedinfacebookpinterestyoutubersstwitterinstagramfacebook-blankrss-blanklinkedin-blankpinterestyoutubetwitterinstagram

  https://helpforyourchild.com/encopresis/

  Three to six times more common in boys, encopresis isn’t a disease, but rather a symptom that may have different causes. To understand encopresis, it’s important to understand constipation. […] The colon’s job is to remove water from the poop before it’s passed. The longer the poop is stuck there, the more water is removed – and the harder it is for the child to push the large, dry poop out. […] Eventually, the lower part of the colon becomes so full that it’s difficult for the sphincter (the muscular valve that controls the passage of feces out of the anus) to hold the poop in. Partial BMs may pass through, causing the child to soil his or her pants. […] Although rectal surgery or birth defects such as Hirschsprung disease and spina bifida can cause constipation or encopresis without constipation, these are uncommon.

• #37 Encopresis

  https://phoenixchildrens.staywellsolutionsonline.com/Search/90,P01992

  Other health problems may cause chronic constipation. These include diabetes, hypothyroidism, Hirschsprung disease, and inflammatory bowel disease. […] Encopresis can cause both physical and emotional problems. […] Stool that is backed up (impacted) in the intestine can cause belly (abdominal) pain. It can also cause a loss of appetite. Some children may get bladder infections. […] Children with encopresis often feel upset by the accidents they have when they soil their clothes. In most cases, they cant control this stool leakage. This can affect how they feel about themselves, or their self-esteem. […] You may help prevent stool soiling if you prevent any emotional upsets while your child is toilet training. Children who have a negative experience using the toilet may avoid going to the bathroom. This leads to constipation and, over time, encopresis. […] You can also help your child have regular bowel movements by making some diet and lifestyle changes. Give your child high-fiber foods and limit high-fat and high-sugar foods. Make sure your child drinks plenty of fluids, such as water. And keep your child physically active.

• #38 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content?contenttypeid=90&contentid=P01992

  Other health problems may cause chronic constipation. These include diabetes, hypothyroidism, Hirschsprung disease, and inflammatory bowel disease. […] Encopresis can cause both physical and emotional problems. […] Stool that is backed up (impacted) in the intestine can cause belly (abdominal) pain. It can also cause a loss of appetite. Some children may get bladder infections. […] Children with encopresis often feel upset by the accidents they have when they soil their clothes. In most cases they can’t control this stool leakage. This can affect how they feel about themselves, or their self-esteem. It can also affect how they deal with other people. Children are often ashamed or embarrassed by this problem. […] You may help prevent stool soiling if you avoid any emotional upsets while your child is toilet training. Children who have a negative experience using the toilet may avoid going to the bathroom. This leads to constipation and, over time, encopresis.

• #39 Soiling in Children: A Guide to Understanding and Support

  https://readykids.com.au/soiling/

  Soiling can also happen when a child is in the process of being toilet trained. Some kids may hold in their stool because they don’t want to use the toilet. This can lead to constipation and soiling. […] Soiling or encopresis can also be a result of abuse or neglect. Kids who are neglected or abused may not have access to proper hygiene, which can lead to soiling. […] There are some medical conditions that can lead to soiling or encopresis. These include neurological conditions, Hirschsprungs disease, spinal cord abnormalities, cystic fibrosis, and so on. Soiling or encopresis can also be a side effect of certain medications. Often, it can be a sign of a more serious underlying health condition such as Crohns disease, ulcerative colitis, or celiac disease. […] In some cases, soiling can be caused by an underdeveloped anal sphincter. This is a muscle that controls the release of poop. If this muscle is not fully developed, it can cause soiling. […] Soiling can cause low self-esteem or anxiety in children. Also, it can be a way for kids to express anxiety or stress. For children who have experienced trauma or abuse, it can also be a coping mechanism for dealing with those experiences.

• #40 Soiling: Understanding Encopresis in Children – DoveMed

  https://www.dovemed.com/health-topics/focused-health-topics/soiling-understanding-encopresis-children

  Diagnosing encopresis involves ruling out medical conditions and evaluating the child’s medical history. […] The treatment of encopresis typically involves a multifaceted approach: Laxatives and Stool Softeners: Healthcare providers may prescribe laxatives or stool softeners to help clear fecal impaction and soften stools, making bowel movements less painful. […] Preventing encopresis involves: Early Intervention: Address constipation and toilet training difficulties promptly to prevent chronic issues. […] Soiling, or encopresis, can be distressing for both children and parents. It often results from chronic constipation, emotional stressors, or toilet training difficulties. Timely intervention, including medical treatment, behavioral therapy, and dietary changes, can help children overcome this condition and regain control of their bowel movements.

• #41 Encopresis |Understanding & Managing Encopresis In Children

  https://www.childpsychologist.com.au/resources/encopresis-soiling-in-school-aged-children

  Encopresis (or faecal soiling) is one of the most frustrating difficulties of middle childhood, affecting approximately 1.5% of young school children (von Gontard, 2013). […] According to the Diagnostic Statistical Manual (DSM-V) (American Psychiatric Association, 2013) encopresis (or otherwise known as Elimination Disorder) is essentially the repeated passing of stools into inappropriate places, after the age at which toilet training is expected to be accomplished. […] There are two basic categories of encopresis i) primary encopresis-which refers to children who have never attained bowel control, ii) secondary encopresis-which refers to soiling after successfully attaining toilet control usually brought upon by entering a stressful environment (such as family conflict). […] Parents of children with encopresis often feel frustrated as they often believe that their children play an active role in controlling their bowel movements. While in some cases, soiling may be intentional, in other cases it may be involuntary and beyond the child’s control.

• #42 Encopresis – Help For Your ChildVisit our FacebookVisit our YouTube channelsearchcrosslinkedinfacebookpinterestyoutubersstwitterinstagramfacebook-blankrss-blanklinkedin-blankpinterestyoutubetwitterinstagram

  https://helpforyourchild.com/encopresis/

  If you think your child has encopresis, it’s extremely important to call your child’s doctor immediately. That’s because the longer you wait, the harder it is to treat. […] Successful treatment of encopresis depends on the support the child receives. […] Various terms have been used to describe this problem, including functional encopresis, primary nonretentive encopresis and stool toileting refusal. […] While the treatment of retentive encopresis has progressed substantially in the past 20 years, less attention has been paid to the 5 to 20 percent of cases in which constipation is not contributory, or where a child „refuses” the toilet-training process. […] Once the reason for a child’s resistance is identified, specific interventions can be initiated. […] Many children with fecal soiling have a history of painful defecation, toilet „phobia” or toilet refusal behavior.

• #43

  https://link.springer.com/article/10.1007/s00787-018-1162-8

  To examine prospective associations between psychosocial problems and childhood constipation and soiling. […] Psychosocial problems in early childhood are risk factors for constipation and soiling at school age. […] Constipation and soiling are common in childhood and the majority of cases are functional. […] Soiling is a common consequence of chronic constipation, but an estimated 20% of children experience soiling with no underlying constipation. […] Psychosocial factors are also thought to play a role, since clinicians often observe that children with constipation and/or soiling suffer from psychological problems and stress. […] Very little is known about the aetiology of non-retentive soiling, but psychological disturbance is thought to be a contributing factor. […] It is possible that early psychological distress is a manifestation of the pain and discomfort associated with constipation.

• #44 SOILING AND WETTING IN CHILDREN – Family Doctor

  https://www.familydoctor.co.nz/categories/childrens-health/soiling-and-wetting-in-children/

  When should soiling (the medical term is encopresis) be regarded as a problem that needs to be dealt with, rather than as a developmentally normal behaviour? The answer to this question depends partly on how often the soiling occurs, and how much is passed, but so-called „accidents” (other than skid-marks) should be a rare event after the age of 4. If a child is still occasionally passing substantial amounts into their pants, or frequently passing small amounts over the age of 4, then it is a problem which needs to be addressed. The approach to be taken will depend on the particular type of soiling problem. […] Most of this group suffer from chronic constipation, which leads to the forming of a hard faecal mass in the colon, with overflow of softer material around it. The constant stretching of the colon with packed faeces actually causes it to become distended, with some loss of control and sensation, which makes it difficult to establish a normal toileting routine. These children may need a brief hospital stay to clear their bowels, and take the first steps towards a normal toileting pattern with the help of appropriate diet and medication, but it takes some months for the colon to regain its normal shape and function.

• #45 Encopresis and Constipation: Information for Primary Care : Ottawa-Carleton, ON : eMentalHealth.ca

  https://primarycare.ementalhealth.ca/index.php?m=fpArticle&ID=22927

  Encopresis means (usually) involuntary leaking of stool into clothes or passing stools in the wrong place (eg. not in the toilet). Encopresis typically starts after a period of acute constipation, in which the child experiences a painful bowel movement. […] As the child withholds, more stool accumulates in the colon. The stool becomes harder, drier and bulkier, resulting in an impaction. […] As this stool accumulates, there is leakage of stool around the impaction leading to soiling of underwear (sneaky poo). […] Note that due to loss of sensation, the child is likely unaware if small amounts of stool have leaked and does not have control over this leakage caused by pressure within the rectum. […] As it becomes too painful to force out the impacted stool, it becomes a vicious circle with the child ignoring the urge to defecate, in an attempt to avoid what will eventually be another painful bowel movement.

• #46 Encopresis and Constipation: Information for Primary Care : Ottawa-Carleton, ON : eMentalHealth.ca

  https://primarycare.ementalhealth.ca/index.php?m=fpArticle&ID=22927

  Initially, there is overflow soiling with release of large stools within 5-7 days. […] Over time, the bowel movements become less frequent, but with large bowel movements and chronic overflow, abdominal pain and social withdrawal. […] Eventually, the child loses the ability to sense the need to defecate or feel the leakage around the impaction, nor notice the extremely unpleasant smell of feces that others notice. This is typical and not on purpose.

• #47 Encopresis | Phoenix Children’s Hospital

  https://phoenixchildrens.org/specialties-conditions/encopresis

  Encopresis can cause both physical and emotional problems. […] Stool that is backed up (impacted) in the intestine can cause belly (abdominal) pain. It can also cause a loss of appetite. Some children may get bladder infections. […] Children with encopresis often feel upset by the accidents they have when they soil their clothes. In most cases, they cant control this stool leakage. This can affect how they feel about themselves, or their self-esteem. […] You may help prevent stool soiling if you prevent any emotional upsets while your child is toilet training. Children who have a negative experience using the toilet may avoid going to the bathroom. This leads to constipation and, over time, encopresis. […] Making changes in your childs diet and activity level may help prevent constipation and stool soiling. But solving encopresis may be harder for some children. […] If your child soils their underwear, dont get angry or punish your child.

• #48 Encopresis in Children and Adolescents – Society of Pediatric Psychology

  https://pedpsych.org/fact_sheets/encopresis/

  Encopresis is the voluntary or involuntary passage of stool in places other than toilets. To receive a diagnosis of encopresis, the child must pass feces into inappropriate places (such as clothing or on the floor) at least once per month for three months or more. Passage of stool into inappropriate places is also known as soiling or fecal incontinence. […] The most serious and common health-based consequence of encopresis is urinary tract infections from the contamination of the urinary tract with feces from the child’s underwear. […] The treatment approach with the best outcome data is usually referred to as Medical-Behavioral. Typically, this consists of the use of medication to address the child’s constipation (either oral medications and/or rectal) and implementation of behavioral modification strategies to promote and maintain appropriate defecation. […] There is no empirical evidence to support the use of punishment in the treatment of encopresis. Punishment of soiling may lead to more behavioral challenges and further delay of bowel control.

• #49 Encopresis – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/topic/default?id=encopresis-90-P01992

  Encopresis is when your child leaks stool into his or her underwear. It is also called stool soiling. It is most often because of long-term (chronic) constipation. […] In most cases encopresis happens because a child has long-term (chronic) constipation. […] Over time, liquid stool can start to leak around the hard, dry, impacted stool. This soils your child’s clothing. […] Encopresis can cause both physical and emotional problems. […] It can be very embarrassing for your child. […] It is most often because of long-term (chronic) constipation.

• #50 Toileting troubles in teenagers and young people – Bladder & Bowel UK

  https://www.bbuk.org.uk/toileting-troubles-in-teenagers-and-young-people/

  Many bodily functions are considered private and not for discussion. Top of the list of the not to be talked about is toileting! […] Problems that teenagers may have with their bladder and bowels include: […] Soiling when poo leaks into the underwear, either because it gives no warning it needs to come out or because you dont know it is there. […] At Bladder Bowel UK we know that having a problem with your bladder and/or bowel (continence problems), causes distress to young people. […] Continence problems, if discovered might result in teasing or bullying. They impact on self-esteem. They reduce opportunities of those affected such as avoiding school trips and sleepovers. In extreme cases they can cause symptoms of depression.

• #51 Encopresis (Fecal Soiling) in Children Guide: Causes, Symptoms and Treatment Options

  https://www.drugs.com/health-guide/encopresis-fecal-soiling-in-children.html

  This unhealthy cycle can only be broken when the bowel is completely cleared of stool. At that point, the bowel can return to its normal size. […] If your child has encopresis because of chronic constipation, treatment is a three-step process. It involves: Clearing the bowel of the large chunk of stool. […] Preventing the return of constipation. […] Teaching normal bowel habits. […] Most children with encopresis either outgrow the problem or respond to treatment. Treatment may involve changes in diet, medication and motivational therapy.

• #52 Soiling (Encopresis) | Rady Children’s Hospital

  https://www.rchsd.org/health-article/soiling-encopresis/

  The Importance of Diet and Exercise […] Diet and exercise are very important in keeping stools soft and BMs regular. Make sure your child gets plenty of fiber-rich foods. Serve fresh fruits, dried fruits like prunes and raisins, dried beans, vegetables, and high-fiber bread and cereal. […] What Else Should I Know? […] Successful treatment of encopresis depends on the support a child gets. Some parents find that positive reinforcement helps to encourage the child throughout treatment. For instance, put a star or sticker on the poop calendar for having a BM (or even for trying to), sitting on the toilet, or taking medicines. […] Dont blame or yell it will only make your child feel bad and it wont help manage the condition. With lots of love, support, and reassurance that theyre not the only one in the world with this problem, your child can overcome encopresis.

• #53 Encopresis |Understanding & Managing Encopresis In Children

  https://www.childpsychologist.com.au/resources/encopresis-soiling-in-school-aged-children

  While encopresis is a chronic and complex problem amongst many families, it is treatable. […] The first step to treating encopresis is to identify the cause behind the condition and seek medical advice from a pediatrician or GP. […] Behavioural modification with the assistance of a Psychologist is an integral treatment component for encopresis. […] Comorbid emotional and behavioural disorders should be treated separately according to evidence-based recommendations (von Gontard, 2013).

• #54 What Is Encopresis? – Child Mind Institute

  https://childmind.org/article/what-is-encopresis/

  One of the major roles of the colon is to remove water from your poop before it passes through the anus. And the longer a bowel movement stays in the colon, the dryer it becomes. This makes it harder to push out. The build-up of poop also causes the colon to stretch, weakening the sphincter — the muscle valve that passes feces out of the anus — and damaging the nerves that alert a child when it’s time to pass a bowel movement. […] As new stool inevitably enters the colon but has nowhere to go, it can become watery and begin to leak out of the anus. And because of the nerve damage, the child can’t feel this happening. So, they’re often unaware that they’ve soiled their pants. […] While encopresis is not constipation, it is most commonly caused by chronic constipation. This can happen when a child repeatedly holds in their bowel movements and poop starts to build up and harden in their rectum and colon, causing watery poop to leak out of the anus.

• #55

  https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Soiling-Encopresis.aspx

  Encopresis is a chronic, complex but solvable problem. However, the longer it exists, the more difficult it is to treat. […] The treatment goals will probably be four fold: To establish regular bowel habits in the child, To reduce stool retention, To restore normal physiological control over bowel function, To defuse conflicts and reduce concerns within the family brought on by the child’s symptoms. […] To accomplish these goals, attention will be focused not only on the physical basis of encopresis but also on its behavioral and psychological components and consequences.

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