Encopresis

Diagnosis

To diagnose encopresis, a healthcare professional may perform several evaluations to determine the cause and rule out underlying issues.

• Physical examination and history:
The doctor will assess your child’s symptoms, bowel habits, and diet to identify any patterns and rule out physical causes of constipation or soiling.

• Digital rectal exam:
A lubricated, gloved finger is gently inserted into the rectum to check for impacted stool, while the abdomen is pressed to feel for blockages.

• Abdominal X-ray:
This imaging test helps confirm the presence and extent of stool buildup in the colon.

• Psychological evaluation:
If emotional or behavioral factors are suspected, a mental health evaluation may be recommended to assess stress, anxiety, or other emotional triggers that contribute to symptoms.

Treatment

Early treatment of encopresis improves outcomes significantly. The main goals are to clear the colon of retained stool and encourage regular bowel movements. In some cases, psychological support is also essential.

Clearing the colon of impacted stool:
The first phase of treatment involves removing the hardened stool causing blockage. Recommended methods include:

• Laxatives to soften stool and promote bowel movement

• Rectal suppositories to stimulate bowel emptying

• Enemas to flush out impacted stool
  Close monitoring ensures the colon is completely cleared before moving to maintenance care.

Encouraging healthy bowel movements:
Once the colon is cleared, steps are taken to maintain regularity and prevent recurrence:

• Dietary changes with increased fiber intake and adequate hydration

• Gradual reduction of laxatives once normal bowel function resumes

• Toilet training to help the child use the toilet promptly when the urge arises

• Cow’s milk elimination trial if milk intolerance is suspected

Behavior modification:
Behavioral therapy or bowel retraining helps children establish consistent toileting habits and overcome fear or resistance to bowel movements.

Psychotherapy:
If emotional distress contributes to encopresis, counseling or psychotherapy may be advised. This helps address shame, guilt, anxiety, or low self-esteem, and supports both the child and family in managing the condition effectively.