Encopresis: Symptoms, Causes, and Treatment
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What is encopresis?
Encopresis is repeated stooling into clothing by a toilet-trained child, usually caused by constipation that stretches the bowel. [1] [2] The child is not doing it on purpose; once the colon is stretched and full, leakage usually cannot be controlled. [2] [4] Treatment clears impacted stool and rebuilds bowel habits with fiber, fluids and scheduled toilet time, and it is usually successful. [1] [2]
What the research says
According to PubMed:
Adding behavior modification to laxatives helped. A Cochrane review of 21 randomized trials (1,371 children, nearly all with functional fecal incontinence) found that in one small trial, adding behavior modification to laxative therapy significantly reduced soiling episodes at 3 months (OR 0.14, 95% CI 0.04 to 0.51) and at 12 months (OR 0.20, 95% CI 0.06 to 0.65). (Brazzelli et al., Cochrane Database Syst Rev, 2011, DOI) [7]
Biofeedback added no benefit. In the same review, combined results of nine trials showed no benefit from adding biofeedback to conventional treatment (OR 1.11, 95% CI 0.78 to 1.58 for persisting symptoms up to 12 months). (Brazzelli et al., Cochrane Database Syst Rev, 2011, DOI) [7]
Stool withholding and pain on defecation are the most commonly reported behaviors. A systematic review of 67 studies on children with functional defecation problems found that stool withholding and pain when passing stool were the most commonly reported defecation-specific behaviors. (Beaudry-Bellefeuille et al., Perm J, 2017, DOI) [8]
Study details are from PubMed abstracts.
What encopresis is
Encopresis is the medical term for repeated passing of stool into clothing in a child who has already learned to use the toilet. It is also called fecal incontinence or soiling. In most cases, the child cannot control it. [1] [2]
The condition usually appears after age 4. It typically shows up when stool collects in the colon and rectum until the colon is simply too full. At that point, liquid stool leaks around the retained stool and stains the child's underwear. [2] [6]
Over time, the retained stool stretches (distends) the bowel. The stretching affects the nerves that normally signal it is time to use the toilet. The result is a loss of control over bowel movements. [2]
A crucial point for parents: in most cases, encopresis is a symptom of long-standing constipation, not misbehavior. Very rarely, it happens without constipation, and emotional issues may be the cause. [2]
Symptoms
The main sign is leakage of stool or liquid stool onto the underwear. Parents sometimes mistake this leakage for diarrhea, because the leaked material is liquid. [1] [2]
Other signs and symptoms include:
Constipation with dry, hard stool
Passing stool that is so large it clogs or almost clogs the toilet
Avoiding going to the bathroom to have a bowel movement
Long periods between bowel movements
Lack of appetite
Belly (abdominal) pain
Daytime wetting or bedwetting (enuresis)
Repeated bladder infections, typically in girls [2]
Symptom | What parents may notice |
Stool leakage | Stains on underwear, sometimes mistaken for diarrhea |
Large hard stools | Stools that clog or nearly clog the toilet |
Avoidance | Skipping or holding in the urge to go |
Belly pain | Stomachaches tied to stool buildup |
Wetting | New or repeated bedwetting and daytime wetting |
Bladder infections | Repeated urinary tract infections, usually in girls |
When to see a doctor
If a child who has been toilet trained starts showing signs of encopresis, contact the child's healthcare team. This is the recommended first step even when the symptoms seem mild. [2]
Causes
Constipation (most cases)
In most children with encopresis, the underlying cause is constipation. When stool is hard and dry, passing it is painful. The child then avoids the toilet, and the problem gets worse. [1] [2]
The longer stool stays in the colon, the harder it becomes to push out. The colon stretches. The nerves that normally signal "toilet time" are affected. And because the colon is simply too full, stool or liquid stool leaks out. [1] [2]
Several things can start or worsen constipation: [2]
Constipation trigger | How it contributes |
Withholding stool | Fear of the toilet away from home or of painful passing |
Interrupting play | The child does not want to stop playing to go to the bathroom |
Too little fiber | Diet low in fruits, vegetables, and whole grains |
Not enough fluids | Stool hardens when the child drinks too little |
Too much cow's milk | May contribute to constipation in some children; research is conflicting |
Emotional issues
Stress can also play a role, especially in the rarer cases where constipation is not the cause. Emotional stressors linked to encopresis include: [2]
Toilet training that began too early or was forced or conflict-filled
Life changes such as dietary changes, toilet training itself, starting school, or schedule changes
Family stress such as a parent's divorce or the birth of a sibling [2]
Risk factors
Encopresis is more common in boys than in girls. [2] [5] [6] Other factors that raise the risk include:
Risk factor | Notes |
Sex | More common in boys than girls |
Constipating medicines | For example, some cough suppressants |
ADHD | Attention-deficit/hyperactivity disorder |
Autism spectrum disorder | Higher risk of constipation-related soiling |
Anxiety or depression | Emotional factors can contribute |
Complications
The main complications of encopresis are emotional rather than physical. Children may feel embarrassment, frustration, shame, or anger about the accidents. [2]
Teasing by peers, or punishment from adults, can lead to depression and low self-esteem. [1] [2] This is one reason the guidance for parents is always encouragement, never blame.
Prevention
Three habits can lower the risk of encopresis before it starts.
A balanced, high-fiber diet with plenty of water helps avoid constipation in the first place. [2] Fruits, vegetables, and whole grains keep stool soft. [1] [6]
Effective toilet training also matters. Parents are advised not to start training too early or to make it forceful. Waiting until the child is ready, and using positive reinforcement, helps. [2]
Finally, early treatment makes a real difference. If soiling starts, guidance from a medical or mental health professional plus regular follow-up appointments can keep the problem from becoming entrenched. [2]
How doctors diagnose encopresis
The diagnosis usually begins with a physical exam. The doctor will discuss the child's symptoms, bowel movement habits, and eating habits. [1]
A digital rectal exam is often part of the workup. The doctor inserts a lubricated, gloved finger into the rectum and presses on the belly to feel for retained stool. [1] [5]
If emotional issues seem to be contributing, a psychological evaluation may be recommended as well. [1]
Treatment
Treatment works best when it starts early. It has two main steps: first, clear the colon of impacted stool, and then encourage healthy bowel movements. [1] [5] Sometimes psychotherapy is also part of the plan. [6]
Step 1: Clearing the colon
The retained stool must be removed before anything else can work. Options include:
This step requires close follow-up with the healthcare team. [5]
Step 2: Encouraging healthy bowel movements
Once the colon is clear, the focus shifts to building lasting habits:
Strategy | Purpose |
More fiber and fluids | Keeps stool soft and easy to pass |
Laxatives, gradually stopped | Used until the bowel returns to typical function, then tapered |
Toilet on urge | Training the child to go as soon as the urge happens |
Cow's milk trial | A short trial off cow's milk, or a check for intolerance, if indicated |
Behavior modification
A medical or mental health professional can teach behavior modification, sometimes called bowel retraining. This programs regular toilet habits into the child's day. [5]
Psychotherapy may be recommended if emotional issues are related to the soiling, or if the child is dealing with shame, guilt, depression, or low self-esteem. [6]
Home care after treatment
Treatment does not end when symptoms stop. Maintaining results takes consistency over months. [1]
Focus on fiber. Fruits, vegetables, whole grains, and other high-fiber foods promote soft stools. [1] [6] Encourage water so stool does not harden, while keeping an eye on calories in other drinks.
Arrange toilet time. Have the child sit on the toilet for five to ten minutes at regular times each day. The best time is after meals, when the bowel is more active. Praise the child for sitting and trying. [1] [5]
Use a footstool. A small stool near the toilet adds comfort, and the leg position puts more pressure on the abdomen, making bowel movements easier.
Stick with the program. It can take months for the bowel to regain typical sensation and function. Consistency reduces the chance of relapse. [1] [4]
Be encouraging. Do not blame, criticize, or punish the child for accidents. Love and support are part of the treatment. [1] [4]
One important caution: do not give the child any enema or laxative, including herbal or homeopathic products, without talking to the healthcare team first. If the team recommends limiting cow's milk, ask how much dairy the child still needs for nutrition.
The constipation cycle
Understanding the cycle helps explain why encopresis develops and why it can take months to undo.
The cycle starts when stool is hard, dry, and painful to pass. The child begins to avoid the toilet. Stool then builds up inside the colon, stretching it. The stretched colon loses its ability to signal properly, and liquid stool leaks out around the retained mass. [1] [5]
Breaking the cycle takes clearing the colon, then patiently rebuilding each step of the cycle in reverse.
What parents should bring to the appointment
Appointments may involve a referral to a pediatric gastroenterologist, or to a mental health professional if the child is distressed. [1]
Before the visit, prepare the following:
A description of the child's symptoms and how long they have lasted
Key personal information, including recent stresses or life changes
A list of all medicines, including over-the-counter drugs, vitamins, herbs, and supplements, with doses
Information about the child's typical diet and fluid intake, including dairy
A list of questions to ask
Questions worth asking include: what is the most likely cause, are other causes possible, what tests are needed, how long will this last, what treatments are available and what are their side effects, are there alternatives, what dietary changes and physical activity are recommended, and is there printed material or recommended websites.
The doctor may also ask about the child's toilet training history, whether hard stools clog the toilet, how often bowel movements occur, what medicines the child takes, whether the child resists the urge to go, whether passing stool seems painful, whether stains appear in the underwear, what life changes have happened recently, whether the child seems embarrassed or depressed, how the family has managed the accidents, and how toilet training went with siblings.
Conclusion: patience turns the tide
Encopresis is distressing for children and families, but it is also highly treatable. In most cases, the root cause is constipation that went unaddressed for long enough to stretch the colon. The child is not misbehaving; the bowel has lost its normal signaling, and the leakage is out of the child's control.
The path forward is clear: clear the colon, rebuild healthy habits, and surround the child with encouragement rather than blame. Given patience and positive reinforcement, treatment is usually successful.
Talk to your healthcare team. If a toilet-trained child begins stooling in clothing, contact the healthcare provider. Early treatment leads to better results, and this is not a problem a child can solve alone.
Frequently asked questions
What is encopresis and what causes it?
Encopresis is the repeated passing of stool into clothing in a toilet-trained child, and it cannot usually be controlled. In most cases, it is caused by long-standing constipation: hard stool piles up, the colon stretches, and liquid stool leaks around the retained stool. [2]
Can a child control encopresis?
Generally, no. Once the colon is full and stretched, the leakage of liquid stool happens on its own. [2] [5] This is why blame and punishment are counterproductive.
Is encopresis a sign of emotional problems?
Sometimes, but not usually. In most cases it is a symptom of constipation. Emotional stressors, such as early or forceful toilet training, starting school, a parent's divorce, or a new sibling, can contribute, especially in the rarer cases without constipation. [2]
How do doctors diagnose encopresis?
Diagnosis typically involves a physical exam, a discussion of symptoms and bowel habits, a digital rectal exam to feel for retained stool, and sometimes an abdominal X-ray to confirm impaction. A psychological evaluation may be added if emotional issues seem to play a role. [1] [6]
How long does encopresis treatment take?
Treatment begins with clearing the impacted stool using laxatives, suppositories, or enemas, then rebuilds healthy bowel habits with fiber, fluids, scheduled toilet time, and bowel retraining. [1] [6] It can take months for the bowel to regain typical sensation and function, so sticking with the program is essential. [1] [4]
This article is for general education and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional about your individual situation.
Trusted external resources
References
Cleveland Clinic. Encopresis (Soiling). Cleveland Clinic. Last updated August 25, 2025. https://my.clevelandclinic.org/health/diseases/17849-encopresis-soiling
Mayo Clinic Staff. Encopresis: Symptoms and causes. Mayo Clinic. September 19, 2025. https://www.mayoclinic.org/diseases-conditions/encopresis/symptoms-causes/syc-20354494
National Institute of Diabetes and Digestive and Kidney Diseases. Bowel Control Problems (Fecal Incontinence). NIDDK. Last Reviewed July 2017. https://www.niddk.nih.gov/health-information/digestive-diseases/bowel-control-problems-fecal-incontinence
International Foundation for Gastrointestinal Disorders. Fecal Incontinence in Children. About Incontinence. Accessed October 14, 2026. https://aboutincontinence.org/what-is-incontinence/fecal-incontinence-in-children/
Yilanli M, Gokarakonda SB. Encopresis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated July 24, 2023. PMID 32809395. https://www.ncbi.nlm.nih.gov/books/NBK560560/
Kaneshiro NK. Encopresis. MedlinePlus Medical Encyclopedia. Review date July 16, 2024. https://medlineplus.gov/ency/article/001570.htm
Brazzelli M, Griffiths PV, Cody JD, Tappin D. Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children. Cochrane Database Syst Rev. 2011;2011(12):CD002240. PMID 22161370. https://doi.org/10.1002/14651858.CD002240.pub4
Beaudry-Bellefeuille I, Booth D, Lane SJ. Defecation-Specific Behavior in Children with Functional Defecation Issues: A Systematic Review. Perm J. 2017;21:17-047. PMID 29035187. https://doi.org/10.7812/TPP/17-047
Medical disclaimer
Medical content last reviewed October 2026. This article is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for diagnosis and treatment.
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