Why Do Children Develop Encopresis?

Enco­pre­sis is a com­mon child­hood prob­lem.  Often, par­ents are embar­rassed to talk about enco­pre­sis so that it is dif­fi­cult to deter­mine the preva­lence.  Many fam­i­lies feel alone in suf­fer­ing with this con­di­tion and express relief when they dis­cov­er sup­port groups and chat groups on var­i­ous par­ent­ing and social media sites. Par­ents often ques­tion why this prob­lem is so com­mon and what caus­es the with­hold­ing that leads to enco­pre­sis. There are var­i­ous explanations.

Birth of a Sibling
After the birth of a sib­ling, old­er chil­dren often revert to more infan­tile behav­ior, to a pre toi­let train­ing stage, with the child demand­ing pull-ups for defe­ca­tion rather than using the toi­let.  By exhibit­ing this type of behav­ior, the child is able to receive atten­tion and con­trol his/her parents.

Aver­sion to Pooping
A child may devel­op an aver­sion to hav­ing bow­el move­ments.  This aver­sion can occur at any time due to pre­vi­ous pain or dis­com­fort dur­ing or after defe­ca­tion. A painful bow­el move­ment may have been due to a hard, con­sti­pat­ed stool.  Some babies have hard bow­el move­ments at 6–7 months of age and can very quick­ly move onto stool with­hold­ing by one year of age.  Although the prob­lem was ini­tial­ly phys­i­cal in nature, the prob­lem then becomes behavioral.

Toi­let Refusal 
Some chil­dren refuse to have a bow­el move­ment in the toi­let and and demand a pull-up or dia­per for bow­el move­ments.  I refer to this behav­ior as ‘pull-up depen­den­cy’.  Avoid­ance of the toi­let is a habit that can be chal­leng­ing to break. Rewards, gifts and oth­er induce­ments do not gen­er­al­ly help chil­dren over­come this avoid­ance behavior.

Dis­pos­able Train­ing Pants 
Kimberly–Clark invent­ed Pull-Ups®  in 1989 as a dis­pos­able train­ing pant.  Although dis­pos­able train­ing pants are mar­ket­ed as an aid to toi­let train­ing, they may actu­al­ly delay toi­let train­ing. I equate this to a child wear­ing a portable toi­let.  Dis­pos­able train­ing pants are avail­able for chil­dren weigh­ing up to 50 pounds, per­mit­ting old­er chil­dren to refuse to toi­let train. 

Poop­ing in Pub­lic Places 
It is com­mon for chil­dren to with­hold if they have to use bath­rooms that offer lim­it­ed pri­va­cy.  Chil­dren often with­hold dur­ing school hours because of an unwill­ing­ness to uti­lize school bath­rooms.  With­hold­ing dur­ing school is seen in chil­dren of all ages from ear­ly child­hood through adolescence.

Stress
Any stress such as a house­hold move, change of school, mar­i­tal dis­cord, social stress­es, etc, can set the stage for with­hold­ing and enco­pre­sis. The with­hold­ing behav­ior becomes a way for a child to main­tain con­trol at a time when that child is par­tic­u­lar­ly stressed or feel­ing out of control.

Oth­er Causes
Chil­dren who have emo­tion­al or behav­ioral issues, espe­cial­ly oppo­si­tion­al, defi­ant dis­or­ders can have trou­ble with fecal soiling.

Chil­dren who have been with­hold­ing for a long time may lose the sen­sa­tion or nor­mal urge to go to the bath­room. This loss of sen­sa­tion per­pet­u­ates the with­hold­ing behavior.

Regard­less of the cause of with­hold­ing and enco­pre­sis, effec­tive treat­ment can be achieved to man­age this con­di­tion. A care­ful­ly admin­is­tered bow­el man­age­ment pro­gram of oral lax­a­tives and behav­ioral strate­gies can be imple­ment­ed to re-pro­gram a child to poop on the toilet.