Encopresis occurs when your child resists having bowel movements, causing impacted stool to collect in the colon and rectum. When your child's colon is full of impacted stool, liquid stool can leak around the impacted stool and out of the anus, staining your child's underwear. Encopresis may also be called stool holding.

Encopresis usually occurs after age 4, when your child has already learned to use a toilet. In most cases, encopresis is a symptom of chronic constipation. Less frequently, it may be the result of developmental or emotional issues.

Encopresis can be frustrating for you — and embarrassing for your child. However, with patience and positive reinforcement, treatment for encopresis is usually successful.

Signs and symptoms of encopresis may include:

• Leakage of stool or liquid stool on your child's underwear. If the amount of leakage is large, you may misinterpret it as diarrhea.
• Constipation with dry, hard stool.
• Passage of large stool that clogs or almost clogs the toilet.
• Avoidance of bowel movements.
• Lack of appetite.
• Abdominal pain.

When to see a doctor
Call your doctor if your child is older than age 4, is toilet trained and is exhibiting one or more of the symptoms listed above.

In encopresis, stool collects in your child's colon and rectum and becomes impacted. When the colon is full of this impacted stool, some liquid stool may leak out of the anus, staining your child's underwear.

There may be two 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's time to go to the toilet. When the colon becomes too full, soft or liquid stool may leak out.
• Emotional issues. Emotional stress also may trigger encopresis. A child may experience stress from premature toilet training or an important life change — for instance, the divorce of a parent or the birth of a sibling.

The following risk factors may increase your child's chances of having encopresis:

• Sex. Encopresis is more common in boys.
• Chronic constipation. This may cause your child to avoid passing stool.
• Not drinking enough fluids. This aggravates existing constipation.

A child who has encopresis may experience a range of emotions, including embarrassment, frustration, shame and anger. If your child is teased by friends or chastised by adults, he or she may feel depressed or have low self-esteem.

Early treatment, including spending time with a mental health professional, can help prevent the social and emotional impact of encopresis.

Because appointments can be brief and there's often a lot of ground to cover, it's a good idea to be prepared for your child's appointment. Write down a list of your child's symptoms — including how long they've been occurring. Also write down any questions you want to ask your child's doctor. For instance, if your child is embarrassed, depressed or experiencing other psychological problems related to encopresis, you may want to ask your child's doctor to recommend a mental health professional.

What to expect from your doctor
Your child's doctor will have questions for you, too. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• How long has your child been toilet trained?
• Does your child have hard, dry stools that sometimes clog the toilet?
• Does your child take any medications? If so, which ones?
• Does your child regularly resist the urge to use the toilet?
• Does your child experience painful bowel movements?
• How often do you notice stains or fecal matter in your child's underwear?
• Have there been any significant changes in your child's life? For instance, has he or she started a new school, moved to a new town, or experienced a death or divorce in the family?
• Is your child embarrassed or depressed by this condition?
• How have you been managing this issue?

What you can do in the meantime
Avoid feeding your child anything that will worsen constipation. Instead, give your child high-fiber foods, such as fruits and vegetables, and encourage him or her to drink plenty of liquids.

Your child's doctor will ask about the symptoms. The doctor also may conduct a physical examination, including a digital rectal examination to check for impacted stool. During this exam, the doctor inserts a lubricated, gloved finger into your child's rectum while pressing on his or her abdomen with the other hand.

Your child's doctor also may recommend an abdominal X-ray to confirm the presence of impacted stool.

If the cause of encopresis is not a physical issue related to the colon, the doctor may recommend a psychological evaluation to help determine the cause.

Treatment of encopresis focuses on clearing the colon of retained, impacted stool and encouraging healthy bowel movements. This includes training your child to go to the toilet as soon as reasonably able when the urge to defecate occurs.

There are several methods for clearing the colon and relieving constipation. Your child's doctor will likely recommend one or more of the following:

• Stool softeners, such as lactulose
• Colon lubricants, such as mineral oil
• Rectal suppositories
• Enemas
• More fluids

Your child's doctor may recommend abdominal X-rays to check the progress of the colon clearing.

Once the colon has been cleared, it's important to encourage your child to have regular bowel movements. In addition to recommending self-care measures such as a high-fiber diet, your child's doctor may recommend the use of stool softeners for six to 12 months.

Psychotherapy
If your child feels shame, guilt, depression or low self-esteem related to encopresis, psychotherapy can be helpful. A psychologist can help your child deal with these feelings and may also give you techniques for teaching your child not to hold stool. Ask your child's doctor for a recommendation.

Once your child has been treated for encopresis, it's important that you take steps to encourage softer stools and regular bowel movements. The following tips can help:

• Focus on fiber. Feed your child a diet that includes plenty of fruits, vegetables and foods high in fiber. Offer whole grains, which are brown — not white — in color.
• Push fluids. Encourage your child to drink plenty of water.
• Limit dairy products and fats. These can inhibit bowel movements.
• Set a schedule. Adopt regular mealtimes and bedtimes.
• Arrange bathroom time. Have your child spend three minutes alone on the toilet after one meal each day trying to have a bowel movement. This applies only to children who are toilet trained and are at least 4 years old.
• Stick with the program for several months. The relapse rate for encopresis is high.

As you help your child overcome encopresis, be patient and use positive reinforcement. Don't blame, criticize or punish your child if he or she has an accident. Instead, offer your unconditional love and support.

Educate yourself on effective toilet training techniques. Avoid starting too early or being too forceful in your methods. Wait until your child is ready, and then use positive reinforcement and encouragement to help him or her progress. Most children are not ready for toilet training until after their second birthdays.

Help your child avoid constipation by providing a diet high in fiber and encouraging your child to drink plenty of water.