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</a><h1 class="with-also" itemprop="name">Encopresis</h1>
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</noscript></div><div class="main"><div id="ency_summary"><p>If a child over 4 years of age has been toilet trained, and still passes stool and soils clothes, it is called encopresis. The child may or may not be doing this on purpose.</p></div><section><div class="section"><div class="section-header"><div class="section-title"><h2>Causes</h2></div><div class="section-button"><button type="submit" aria-controls="section-1" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-1"><p>The child may have <a test="test" href="./003125.htm">constipation</a>. The stool is hard, dry, and stuck in the colon (called <a test="test" href="./000230.htm">fecal impaction</a>). The child then passes only wet or almost liquid stool that flows around the hard stool. It may leak out during the day or night. </p><p>Other causes may include:</p><ul><li>Not toilet training the child</li><li>Starting toilet training when the child was too young</li><li>Emotional problems, such as <a test="test" href="./001537.htm">oppositional defiant disorder</a> or <a test="test" href="./000919.htm">conduct disorder</a></li></ul><p>Whatever the cause, the child may feel shame, guilt, or low self-esteem, and may hide signs of encopresis.</p><p>Factors that may increase the risk of encopresis include:</p><ul><li>Chronic constipation</li><li>Low socioeconomic status</li></ul><p>Encopresis is much more common in boys than in girls. It tends to go away as the child gets older.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Symptoms</h2></div><div class="section-button"><button type="submit" aria-controls="section-2" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-2"><p>Symptoms can include any of the following:</p><ul><li>Being unable to hold stool before getting to a toilet (bowel incontinence)</li><li>Passing stool in inappropriate places (as in the child's clothes)</li><li>Keeping bowel movements a secret</li><li>Having constipation and hard stools</li><li>Passing a very large stool sometimes that almost blocks the toilet</li><li>Loss of appetite</li><li>Urine retention</li><li>Refusal to sit on toilet</li><li>Refusal to take medicines</li><li>Bloating sensation or pain in the abdomen</li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Exams and Tests</h2></div><div class="section-button"><button type="submit" aria-controls="section-3" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-3"><p>The health care provider may feel the stool stuck in the child's rectum (fecal impaction). An <a test="test" href="./003815.htm">x-ray of the child's belly</a> may show impacted stool in the colon.</p><p>The provider may perform an examination of the nervous system to rule out a spinal cord problem.</p><p>Other tests may include:</p><ul><li><a test="test" href="./003579.htm">Urinalysis</a></li><li><a test="test" href="./003751.htm">Urine culture</a></li><li><a test="test" href="./003444.htm">Thyroid function tests</a></li><li><a test="test" href="./000233.htm">Celiac screening tests</a></li><li><a test="test" href="./003477.htm">Serum calcium test</a></li><li><a test="test" href="./003462.htm">Serum electrolytes test</a></li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Treatment</h2></div><div class="section-button"><button type="submit" aria-controls="section-4" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-4"><p>The goal of treatment is to:</p><ul><li>Prevent constipation</li><li>Keep good bowel habits </li></ul><p>It is best for parents to support, rather than criticize or discourage the child.</p><p>Treatments may include any of the following:</p><ul><li>Giving the child laxatives or enemas to remove dry, hard stool.</li><li>Giving the child stool softeners, such as magnesium hydroxide, lactulose, or polyethylene glycol powder, as recommended by the provider.</li><li>Having the child eat a diet high in fiber (fruits, vegetables, whole grains) and drink plenty of fluids to keep the stools soft and comfortable.</li><li>Taking flavored mineral oil for a short period of time. This is only a short-term treatment because mineral oil interferes with the absorption of calcium and vitamin D.</li><li>Seeing a pediatric gastroenterologist when these treatments are not enough. The doctor may use biofeedback, or teach the parents and child how to manage encopresis.</li><li>Seeing a psychotherapist to help the child deal with associated shame, guilt, or loss of self-esteem.</li></ul><p>For encopresis without constipation, the child may need a psychiatric evaluation to find the cause.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Outlook (Prognosis)</h2></div><div class="section-button"><button type="submit" aria-controls="section-5" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-5"><p>Most children respond well to treatment. Encopresis often recurs, so some children need ongoing treatment.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Possible Complications</h2></div><div class="section-button"><button type="submit" aria-controls="section-6" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-6"><p>If not treated, the child may have low self-esteem and problems making and keeping friends. Other complications may include:</p><ul><li>Chronic constipation</li><li>Urinary Incontinence</li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>When to Contact a Medical Professional</h2></div><div class="section-button"><button type="submit" aria-controls="section-7" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-7"><p>Contact your provider for an appointment if a child is over 4 years old and has encopresis.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Prevention</h2></div><div class="section-button"><button type="submit" aria-controls="section-8" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-8"><p>Encopresis can be prevented by:</p><ul><li>Toilet training your child at the right age and in a positive way.</li><li>Talking to your provider about things you can do to help your child if your child shows signs of constipation, such as dry, hard, or infrequent stools.</li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Alternative Names</h2></div><div class="section-button"><button type="submit" aria-controls="section-Alt" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Alt"><p>Soiling; Incontinence - stool; Constipation - encopresis; Impaction - encopresis</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>References</h2></div><div class="section-button"><button type="submit" aria-controls="section-Ref" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Ref"><p>Marcdante KJ, Kliegman RM, Schuh AM. Digestive system assessment. In: Marcdante KJ, Kliegman RM, Schuh AM, eds.<em> Nelson Essentials of Pediatrics</em>. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 126.</p><p>Noe J. Constipation. In: Kliegman RM, Toth H, Bordini BJ, Basel D, eds. <em>Nelson Pediatric Symptom-Based Diagnosis</em>. 2nd ed. Philadelphia, PA: Elsevier; 2023:chap 19.</p><p>Roy D, Akriche F, Amlani B, Shakir S. Utilisation and safety of polyethylene glycol 3350 with electrolytes in children under 2 years: A Retrospective Cohort. <em>J Pediatr Gastroenterol Nutr</em>. 2021;72(5):683-689. PMID: 33587408 <a href="https://pubmed.ncbi.nlm.nih.gov/33587408/" target="_blank">pubmed.ncbi.nlm.nih.gov/33587408/</a>.</p></div></div></section>
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