17849 Encopresis Soiling

Overview

Encopresis is the medical word for soiling: when a child (or adult) leaks small amounts of stool into their underwear without meaning to. In most cases, it happens because a person has had constipation for a long time. Hard, dry stool builds up in the bowel, and liquid or soft stool leaks around it. Encopresis is not a behavior problem, and it is not done on purpose.

Yes, it is quite common. Around 1 to 2% of children experience encopresis at some point. It is one of the most common bowel problems in childhood.

It mostly affects children, especially between ages 3 and 7 when toilet training is happening. It can also happen in older children and teens. Less often, adults with severe constipation or certain nerve or muscle conditions can have similar overflow soiling.

Symptoms

Common symptoms

• Leaking small amounts of stool into underwear, often without noticing
• Thick, hard, or pellet-like poo (constipation)
• Pain or discomfort when passing poo
• Holding in poo (sitting in a corner, crossing legs, or hiding to stop the urge)
• Large poo that blocks the toilet
• A poor appetite or feeling full quickly

Symptoms in children

• Underwear stained with small, pasty or liquid poo
• Avoiding the toilet or hiding dirty underwear
• Having a low mood, feeling embarrassed, or getting upset about using the toilet
• Wetting in the daytime or at night (sometimes associated with urine)
• Soreness around the bottom

Symptoms in older adults

• Leaking liquid stool while having long-standing constipation
• Feeling the need to poo but only passing a small amount
• Not being aware of the need to poo
• Bloating or tummy discomfort

Causes

Main causes

• Ongoing constipation: when poo stays in the bowel, it becomes hard and dry and is painful to pass.
• Over-stretched bowel: the large bowel becomes stretched by the hard poo, and the muscles can no longer tell the brain when it is full.
• Overflow soiling: soft or liquid poo leaks around the hard, stuck poo.
• Withholding: a child may hold in poo because it hurts, because they are busy playing, or because they are worried about using the toilet.

Risk factors

• A low-fiber diet (not enough fruits, vegetables, and whole grains)
• Not drinking enough fluids
• Ignoring or delaying the urge to poo
• Stressful toilet training or pressure to be clean
• Fear of the toilet (e.g., at school or at night)
• Lack of physical activity
• Certain medicines that can cause constipation (ask your doctor or pharmacist)

When to see a doctor

See a doctor urgently if:

• See a doctor the same day if there is severe belly pain, repeated vomiting, a swollen belly, or if the person cannot pass poo at all.
• Also seek same-day advice if you see bright red blood in the poo, or if the soiling is combined with fever.

Book a routine appointment if:

• Make a routine appointment if soiling lasts for more than a few weeks.
• Talk to a doctor if your child is avoiding the toilet, hiding underwear, or feeling very embarrassed.
• Adults with ongoing constipation and soiling should speak with a general practitioner to find the cause.

Diagnosis

A doctor will listen to you and your child describe the symptoms. They will ask about poo patterns, diet, fluids, and toilet habits. They may gently press on the belly to check for hard stool. In some cases, they may talk about a digital rectal examination, which is a quick internal check, but this is usually only done when needed.

Tests that may be done

• A doctor or nurse may use a small X-ray or ultrasound to see how much stool is in the bowel, if needed.
• Sometimes a simple test for celiac disease or thyroid problems is done with a blood test, if the doctor thinks it might be relevant.
• In rare cases, a doctor may recommend a type of test called a bowel transit study to see how fast food moves through the intestine.

What to expect at your appointment

The doctor will explain why the soiling happens and work with you to create a treatment plan. This is usually a step-by-step approach and may involve a few visits. You do not need to bring a ‘perfect’ diary; just do your best to describe what you have seen. You are the expert on your child’s daily habits.

Treatment

Treatment for encopresis usually happens in three stages. First, the blocked bowel is cleaned out. Next, stool is kept soft and regular so the bowel can shrink back to its normal size. Finally, good toilet habits are built with a regular routine. This takes time and patience, but the outlook is very good.

Self-care at home

• Make a regular toilet time: sit on the toilet for 5–10 minutes after a meal, usually after breakfast and dinner.
• Use a step stool so the feet are supported and the knees are slightly higher than the hips.
• Praise every sit on the toilet, even if no poo comes out.
• Encourage plenty of water to keep poo soft.
• Add high-fiber foods gradually, like fruit, vegetables, whole grains, and beans.
• Keep a daily routine and avoid punishment or shame around accidents.
• Clean up calmly and kindly, letting the child help if appropriate.

Medical treatments

Doctors often use medications called laxatives to clean out the bowel and keep stool soft. These are usually given as liquids, powders, or tablets, and the dose is tailored to each person. Laxatives are not a crutch — they are a medical tool to help the bowel return to normal size and function. Sometimes stool softeners or rectal medications may be used, but only under the advice of a doctor or nurse. Behavioral support, such as a chart with stickers or rewards, is also part of a successful plan.

When is surgery considered?

Surgery is rarely needed for encopresis. It may be considered only if there is another physical problem, such as a narrowed part of the bowel or a nerve issue that does not improve with standard treatment. Your healthcare team would not suggest surgery unless they have done a full assessment.

Living with this condition

Living with encopresis can feel challenging, but a predictable routine helps. Start with a toilet schedule — for example, sitting after meals. Help the child understand that the feeling of needing to poo is normal and not scary. Use a calm voice, a step stool, and a book or small toy to make the toilet a relaxing place. Accidents will happen; when they do, clean up matter-of-factly without anger. This is a medical issue, not a choice.

Lifestyle tips

• Set 3–4 regular toilet times each day, and never rush.
• Allow your child to use toilets at school without fear — talk to the teacher if needed.
• Give positive attention for trying, not just for success.
• Make physical activity part of the day; movement helps the bowel work.
• Keep a simple bathroom kit at school or in the bag if necessary (change of underwear, wipes, plastic bag).

Diet and exercise

Drink plenty of water throughout the day — around 6–8 cups for children (less for younger ones). Include fruits, vegetables, and whole grains at most meals. High-fiber foods like apples, pears, oats, and lentils help keep poo soft. Regular physical activity, like walking, cycling, or playing outdoors, also encourages a normal bowel pattern. Try not to force huge changes; introduce fiber and fluids bit by bit.

Mental health and emotional wellbeing

Encopresis can cause embarrassment, low self-esteem, and worry. Children may feel bad about themselves or get teased at school. It is very important to protect their emotional health. Remind them that they cannot help it and that it will get better with treatment. If you notice ongoing sadness, anxiety, or withdrawal, speak to your doctor about support, such as talking therapies. Adult soiling can also feel isolating; it is always okay to discuss it with a healthcare professional.

Prevention

Encopresis can often be prevented by keeping bowels healthy. This means regular toilet habits, enough water, a balanced diet with fiber, and responding to the urge to poo rather than waiting. If constipation starts early, addressing it quickly can help prevent overflow soiling.

Complications

If left untreated

• Long-term constipation with a stretched bowel that takes longer to heal
• Persistent soiling and toilet accidents
• Bladder problems, such as daytime wetting or urinary tract infections (more common in children)
• Emotional difficulties including low confidence, anxiety, or depression
• Social problems at school or work due to embarrassment

Long-term outlook

With the right treatment, encopresis gets better in the vast majority of cases. It may take weeks or months, and relapses are normal, but a steady program of clearing the bowel, softening stools, and building a routine leads to success. Patience, kindness, and teamwork with your healthcare provider are the key ingredients.

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