Elimination Disorders in Children

  • Medical Author:
    John Mersch, MD, FAAP

    Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

  • Medical Editor: David Perlstein, MD, MBA, FAAP
    David Perlstein, MD, MBA, FAAP

    David Perlstein, MD, MBA, FAAP

    Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

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What are the symptoms and signs of constipation?

Pediatric gastroenterologists (GI doctors) indicate that symptoms of constipation generally involve six characteristics of abnormal stooling present in infants and toddlers for at least one month and children 4 to 18 years of age for two months. A minimum of two criteria must be present to fulfill the definition of constipation. These stooling patterns/problems include the following:

  1. Two or fewer bowel movements per week
  2. One episode of stool incontinence after mastering toilet-training skills
  3. A history of excessive stool retention which may be accompanied by characteristic retentive posturing ("the poop dance") in older children
  4. A history of passage of painful or hard bowel movements
  5. A history of large stools which may obstruct the toilet
  6. Palpation of a large mass of stool in the rectum during digital rectal exam

What are the symptoms and signs of encopresis?

Specialists who deal with encopretic children note that the above criteria for constipation are also characteristic of encopresis. In one recent study focusing on constipation, many of the children in the study first presented to their physician with a history consistent with encopresis. There are, however, several historical elements that are unique to encopresis. These include the following:

  1. Some children with encopresis may successfully stool every day, however, evacuation of their bowel is incomplete.
  2. Encopretic children commonly "defecate in places inappropriate to the social context at least once a month" (for example, the classroom).
  3. Children with encopresis seem oblivious or nonchalant to either obvious stool staining of their clothes or the heavy stool odor they produce.
  4. There is no underlying organic medical condition that explains the child's encopretic pattern.
Medically Reviewed by a Doctor on 3/11/2016

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