Encopresis: A Medical and Family Approach

Deborah Padgett Coehlo, PhD, C-PNP CFLE

Disclosures

Pediatr Nurs. 2011;37(3):107-113. 

In This Article

Identified Causes of Chronic Childhood Stool Retention and Encopresis

The causes of chronic childhood stool retention with encopresis can usually be traced back to an event or events occurring during the early toilet training period in a child's life that caused a painful or unpleasant bowel movement. Other contributing factors include a) chronic, early constipation during infancy, b) low overall muscle tone and poor coordination, c) slow intestinal motility, d) atypical attention span, and e) male gender. Many children with encopresis have a history of an event that made having a bowel movement uncomfortable or frightening (Cox et al., 2003). This event can range from constipation with pain upon defecation or fear of a toilet flushing, to repeated sexual abuse. It is important to note that most children struggling with encopresis have not been victims of sexual abuse, but children with a history of early sexual abuse have a higher than average rate of encopresis. For those children not having an identifiable event or events, the cause may be attributed to low muscle tone with or without poor muscle coordination, short attention span or difficulty focusing, oppositional and conduct disorders, obsessive-compulsive disorders, and/or cognitive delays and learning disabilities. Other risk factors include eating a high-fat diet, high intake of sugary fluids (such as soda pop, juices), low intake of dietary fiber, low activity level, and/or chronic and/or recurrent stress, specifically an unstable or unpredictable daily routine. A small percentage of children with encopresis (less than 5%) have a history of bowel abnormalities (such as Hirsprung's disease) or neurological conditions (such as paralysis, spina bifida) (Borowitz et al., 2003; Feldman, 2009; Lewis & Rudolph, 1997). Table 1 summarizes the risk factors for encopresis for children 4 to 12 years of age. Table 2 summarizes the patterns of encopresis in most children.

Once a child withholds stool rather than passing stool, the colon begins to distend. This distention gradually stretches nerve fibers, and over time, the child has less and less sensation of the urge to pass stool. The stools become larger and larger, and the child becomes less able to feel or pass the stool voluntarily. The large stool becomes impacted, with loose, watery stool leaking around the impaction, causing the appearance of uncontrollable diarrhea. Eventually, if left untreated, the child cannot control when the large, impacted stool is passed, resulting in incontinence or soiling of large stools in the toilet or in socially unacceptable locations (see Table 2).

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