Elimination Disorders and Encopresis in Children

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Elimination disorders occur in children who have problems going to the bathroom -- both defecating and urinating. Although it is not uncommon for young children to have occasional "accidents," there may be a problem if this behavior occurs repeatedly for longer than three months, particularly in children older than 5 years.

There are two types of elimination disorders, encopresis and enuresis.

• Encopresis is the repeated passing of feces into places other than the toilet, such as in underwear or on the floor. This behavior may or may not be done on purpose.
• Enuresis is the repeated passing of urine in places other than the toilet. Enuresis that occurs at night, or bed-wetting, is the most common type of elimination disorder. As with encopresis, this behavior may or may not be done on purpose.

In addition to defecating in improper places, a child with encopresis may have other symptoms, including:

• Loss of appetite
• Abdominal pain
• Loose, watery stools (bowel movements)
• Scratching or rubbing the anal area due to irritation from watery stools
• Decreased interest in physical activity
• Withdrawal from friends and family
• Secretive behavior associated with bowel movements.

The most common cause of encopresis is chronic (long-term) constipation, the inability to release stools from the bowel. This may occur for several reasons, including stress, not drinking enough water (which makes the stools hard and difficult to pass) and pain caused by a sore in or near the anus.

When a child is constipated, a large mass of feces develops, which stretches the rectum. This stretching dulls the nerve endings in the rectum, and the child may not feel the need to go to the bathroom or know that waste is coming out. The mass of feces also can become impacted -- too large or too hard to pass without pain. Eventually, the muscles that keep stool in the rectum can no longer hold it back. Although the large, hard mass of feces cannot pass, loose or liquid stool may leak around the impacted mass and onto the child's clothing.

Factors that may contribute to constipation include:

• A diet low in fiber
• Lack of exercise
• Fear or reluctance to use unfamiliar bathrooms, such as public restrooms
• Not taking the time to use the bathroom
• Changes in bathroom routines; for example, scheduled bathroom breaks at school or camp

Another possible cause of encopresis is a physical problem related to the intestine's ability to move stool. The child also may develop encopresis because of fear or frustration related to toilet training. Stressful events in the child's life, such as a family illness or the arrival of a new sibling, may contribute to the disorder. In some cases, the child simply refuses to use the toilet.

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