Signs of Encopresis (Stool holding)

Encopresis (Stool Holding)

Description

Encopresis is also called stool holding. It usually occurs in children older than 4 and results from a resistance to have a bowel movement. With time stool backs up in the large intestine and rectum and can become lodged (impacted) at the rectum. The child then experiences involuntary passage of liquid stool around the blockage which stains the underwear. The most common cause is constipation, but emotional and psychological problems can also result in the disorder.

Symptoms

Involuntary leaking of stool, passing stool in inappropriate places (in the child's clothes), avoidance of bowel movements, secretive behavior associated with bowel movements, constipation, hard stools, occasional passage of very large stool, abdominal pain.

Tests

A history and physical exam will be performed. Digital examination of the rectal area may show a fecal impaction. An abdominal x-ray may confirm impacted stool in the colon.

Standard Workup

X-Ray

Treatment

Therapy is aimed at relieving the rectal stool blockage (impaction) and then directed toward preventing a recurrence. A finger may be inserted into the rectum to remove the stool followed by enemas to remove further stool higher up the large intestine. Encouraging good bowel habits, going to the bathroom as soon as the urge to defecate is sensed, increasing the bulk in the diet, and laxatives can usually prevent a recurrence of the disorder. At times psychotherapy is needed as well especially if there is no evidence of constipation.