Encopresis is a disorder seen after the age of 4. It results in a fecal emission, generally involuntary, in inappropriate places (clothing, ground…). Once the cause has been identified, encopresis can be treated to restore normal bowel movements.

Definition of encopresis

Encopresis is a medical term designating the regular emission of feces in inappropriate situations and / or places (clothing, ground…). This is usually unintentional / uncontrolled but can sometimes be intentional. To be diagnosed as such, an encopresis must last for at least 3 months with an inappropriate stool frequency at least once a month.

We speak of encopresis only after the age of 4 years. Before this age, it is considered that the child may not yet have acquired toilet facilities. Potty training can take time for some children. It often takes place between 2 and 4 years old.

Types d’encoprésies

It is possible to distinguish:

• primary encopresis when it appears in children over 4 years of age who have not acquired cleanliness;
• secondary encopresis when it occurs in a clean child for at least 1 year.

This disorder can also be defined as follows:

• retentional encopresis, the most frequent form (95% of cases), which is characterized by functional constipation leading to an accumulation of feces and incontinence with overflow;
• non-retentional encopresis that is not associated with constipation.

Causes of encopresis

Several causes of encopresis have been identified. They are different depending on whether or not there is functional constipation.

In the context of retentional encopresis, constipation of organic or psychological origin is observed. Possible causes include:

• a megacolon;
• an organic digestive pathology such as Hirschsprung’s disease;
• an organic neurological disease such as spina bifida;
• an organic endocrine pathology such as hypothyroidism;
• refusal of the pot as opposed to parents before the age of 4;
• too rigid or too early learning to clean;
• difficult access to toilets as an unsanitary condition;
• a history of pain on defecation such as fissures;
• a phobia including in particular the phobia of defecation;
• etc.

Conversely, retentional encopresis is not associated with constipation. The origin is only psychological. It requires special medical attention because it can be due to:

• a behavioral disorder;
• family or school difficulties;
• psychiatric pathology;
• etc. 

Diagnosis of encopresis

The diagnosis of encopresis is based on:

• a clinical examination supported by an interrogation whose objective is in particular to know the date of the first symptoms and the frequency of the disorder;
• additional examinations to confirm and / or deepen the diagnosis, in particular through a neurological examination, an examination of the anal region or an X-ray of the intestine.

People affected by encopresis

Encopresis is mainly seen in children. It is estimated to affect between 1 and 4% of children. It mainly affects boys.

Factors favoring encopresis

It was found that several factors could promote encopresis in children:

• social difficulties in the family or at school;
• too rigid toilet training;
• substandard housing.

• Stool Leakage: The typical sign of encopresis is stool leakage, that is, the release of feces in inappropriate situations and / or places. These leaks usually occur during the day but can also occur at night.
• Constipation: In the majority of cases, encopresis is said to be retentional. This means that it is characterized by functional constipation.
• Abdominal Pain: Constipation is usually accompanied by bloating and abdominal pain.

In some cases, other symptoms may be noted:

• oozing watery stools;
• anal fissures.

Treatment for encopresis depends on its type and origin. It can be based on:

• educational support to explain the physiological mechanisms involved and facilitate the child’s adherence to care;
• a drug treatment based on laxatives to cleanse the colon and empty the rectal bulb;
• a natural treatment generally based on a diet rich in insoluble fiber and liquids;
• psychological and / or child psychiatric care.

The treatment is long-term, generally between 6 and 24 months.

Some cases of encopresis can be avoided by:

• the establishment and maintenance of appropriate hygiene and dietetic rules for children;
• regular medical monitoring of the child, in accordance with the doctor’s recommendations;
• progressive and flexible toilet training, with patience and pedagogy;
• attention paid to the social difficulties experienced by the child, so that these do not have an impact on his development.