The research article When the Going Gets Tough: Pediatric Constipation and Encopresis discusses assessment of children with constipation and encopresis, what to look for and what to expect from physicians.  The article describes a seven year old with a three year history of fecal soiling.  The child passed hard stools and had large bowel movements that often clogged the toilet about once every two weeks. His parents reported that when younger, the child would often hold onto a table and stiffen his body to avoid using the toilet.  He would rarely sit independently to defecate and the parents admitted frustration and belief that if he would just use the toilet this would get better.   The child admitted holding his stool so it wouldn’t hurt and so he wouldn’t have accidents, however he had abdominal pain that would get better when he pooped.  He was also teased by his siblings. Treatments tried were over the counter laxatives, rewards and punishments.

This type of situation is commonly seen in pediatric gastroenterology clinics.  Research indicates that encopresis occurs in 2.8% of 4-year-olds, 1.9% of 6-year-olds, and 1.6% of 10- to 11-year-olds.  It occurs in boys more often than girls and the amount of time from when symptoms first start to the time of diagnosis can be one to five years or longer. Encopresis is a result of long-standing constipation and is involuntary.

For parents and caregivers discussing encopresis with their child’s physician, all of the following are things to consider: age when symptoms started, size of poops, frequency of poops and painful poops, when the child has accidents, the child’s school and public toilet use, and if there is withholding behavior.  Other issues to potentially discuss are urinary accidents (including bed wetting), weight loss, vomiting, bleeding or hemorrhoids.  Parents should be aware that a number of assessment tools may be useful and necessary in determining the cause for the encopresis as well as to educate families about what is going on with the child’s body.  An abdominal examination should be done to assess for gas and stool, as well as inspection of the perianal area for fissures, hemorrhoids, prolapse and position of the anus.   Abdominal x-rays can help determine the amount of poop in the colon.  Rectal examination is recommended at least once for determining amount, consistency and location of stool, size and tone of the rectum, and voluntary contraction and relaxation of the external sphincter.  These and other specific tests may be recommended by the child’s physician to be sure there is no evidence of an organic cause and to accurately determine the course for treatment.  Although many parents may believe there is an underlying serious health condition causing the child’s encopresis, 95% of encopresis cases are functional meaning there is not an underlying disease process that is the cause.