Doctor's Notes on Encopresis
Encopresis is the soiling of the underwear with stool who are past the age of potty training (at least 4 years of age and older). Signs and symptoms may include children with constipation and/or painful defecation, sometimes for years. Most children say they have no urge to pass stool before they soil their underwear, soiling usually occurs in the daytime, especially in the afternoon when the child returns from school. Some pass stool in the bathtub, shower or swimming pool and many have stretched-out colons and produce very large stools; often very dark, sticky and foul smelling.
Rarely, encopresis is caused by an anatomic abnormality or disease but the vast majority are caused by constipation (infrequent stools that are hard and may cause pain when expelled and over time may stretch the colon). Usually, constipation develops long before encopresis and makes the child want to hold in the stool. Eventually, stool leaks out; because the child has been avoiding bowel movements, the bowel is stretched out and signals to defecate and relax sphincter tone are depressed. Although some physicians suggest the constipation is due to lack of good hydration and/or fiber intake, no clear cause has been established.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.