Encopresis

What is constipation with encopresis?

Constipation can mean that a child does not have a bowel movement very often, has hard, pebble-like stools, or has pain when having a bowel movement. When children are constipated for a long time, this can lead to stool staying in the intestines for too long and becoming hard. This can cause children to leak stool or have poop accidents, called encopresis. Constipation with encopresis is a medical condition that is treated with medications and behavioral strategies. 

What factors contribute to constipation with encopresis?

• Painful bowel movements that make children hold their stool and avoid using the toilet.
• Low-fiber diets and not drinking enough fluids.
• Avoidance behaviors related to toileting, such as withholding stool, ignoring the urge to go, refusing to use the toilet, and behavioral outbursts.
• Family stress around toilet training difficulties.
• Underlying medical conditions such as irritable bowel syndrome (IBS) or other disorders of the gut–brain interaction.

Is constipation with encopresis a behavior problem?

No, constipation with encopresis is not a behavioral problem. That means children are not having accidents on purpose. 

However, constipation with encopresis can be influenced by behavioral habits. Therefore, behavioral treatments can help support medical treatment by addressing avoidance behaviors (such as withholding stool or refusing to use the bathroom), improving children’s and families’ ability to follow doctors’ instructions, and children’s toileting routines.

How do we treat constipation with encopresis?

Treatment for constipation with encopresis focuses on making stools softer and easier to push out. This can break the cycle of withholding stool and can improve successful use of the toilet. Strategies that have been shown to work include:

• Medical management: Use of stool softeners and/or stimulant laxatives (prescribed by a healthcare provider)
• Dietary modifications: Increasing fiber and fluids in the diet to improve consistency and regularity of bowel movements
• Behavioral interventions: Use of one or several of the following strategies:
  • Education about how constipation affects the body and how treatments work
  • Skill-building to improve adherence to medical treatments
  • Gradual exposure to toileting to reduce avoidance
  • Reward systems to reinforce appropriate toileting behaviors
  • Parent training 
  • Preventing and planning for future difficulties with constipation with encopresis
  • Assessment of emotional or psychological difficulties or diagnoses that can contribute to and complicate constipation with encopresis 

What medical team members are needed to treat constipation with encopresis?

Constipation with encopresis is complex, so a multidisciplinary team often is involved in treatment:

• Pediatrician or pediatric gastroenterologist: Provides the medical diagnosis and manages the medical treatment
• Gastrointestinal psychologist or other specialized mental health provider: Provides behavioral teaching and support to the family 
• Dietitian: Helps make sure children get enough fiber and fluid in their diets to help make it easier to pass stool 
• Occupational therapist or physical therapist (if needed): In some cases, pelvic floor physical therapy can help children with proper sitting and pushing to make it easier and more comfortable to pass stool

Special considerations

Treatment plans for constipation with encopresis should be tailored to each child’s unique needs. Reasons why your child’s medical team might adjust the treatment plan might include: neurodevelopmental conditions [such as autism spectrum disorder or attention-deficit hyperactivity disorder (abbreviated ADHD)], psychological or psychiatric distress, and cultural background. If you have questions about your child’s specific situation or needs, please consult your healthcare provider. 

Resources

• https://gikids.org/constipation/ 
• van Tilburg, M., Reed, B., & Knowles, S. R. (2023). Pediatric Psychogastroenterology. https://doi.org/10.4324/9781003308683 

Authors: Anthony Cifre, PhD, MS and Maggie Stoeckel, PhD
Editor: Amanda Deacy, MD
June 2025