Encopresis

Encopresis is an elimination disorder. The essential feature is repeated passage of feces into inappropriate places (e.g., clothing or floor). Most often this is involuntary but occasionally may be intentional. The event must occur at least once a month for at least 3 months, and the chronological age of the child must be at least 4 years (or for children with developmental delays, a mental age of at least 4 years). The fecal incontinence must not be due exclusively to the direct physiological effects of a substance (e.g., laxatives) or a general medical condition except through a mechanism involving constipation.

When the passage of feces is involuntary rather than intentional, it is often related to constipation, impaction, and retention with subsequent overflow. The constipation may develop for psychological reasons (e.g., anxiety about defecating in a particular place or a more general pattern of anxious or oppositional behavior) leading to avoidance of defecation. Physiological predispositions to constipation include dehydration associated with a febrile illness, hypothyroidism, or a medication side effect.

Once constipation has developed, it may be complicated by an anal fissure, painful defecation, and further fecal retention. The consistency of the stool may vary. In some individuals it may be of normal or near-normal consistency. It may be liquid in other individuals who have overflow incontinence secondary to fecal retention.

Symptoms

• Repeated passage of feces into inappropriate places (e.g., clothing or floor) whether involuntary or intentional.

• At least one such event a month for at least 3 months.

• Chronological age is at least 4 years (or equivalent developmental level).

• The behavior is not due exclusively to the direct physiological effects of a substance (e.g., laxatives) or a general medical condition except through a mechanism involving constipation.

Diagnostic criteria summarized from:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.