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Faecal Incontinence

Summary

Faecal incontinence, also known as encopresis, is the involuntary passing of stool in inappropriate places after the typical age of toilet training (4 years and older). It is most commonly caused by chronic constipation, where hardened stool builds up in the rectum, leading to overflow soiling.

This condition can be distressing for both children and their families, often affecting self-esteem, social interactions, and quality of life.

Diagnosis and When to Seek Help

A doctor will diagnose faecal incontinence based on a detailed medical history and physical examination. Additional tests (such as X-rays or blood work) may be needed in certain cases to rule out underlying medical conditions.

Seek medical advice if your child:

  • Has regular stool accidents after the age of 4
  • Complains of painful bowel movements or difficulty passing stool
  • Has very hard or large stools
  • Experiences abdominal pain or bloating
  • Shows changes in appetite or weight loss

Early intervention is important to prevent complications and improve your child’s comfort and confidence.

Management

Treatment focuses on establishing regular bowel movements and preventing constipation. This typically includes:

  1. Clearing impacted stool (disimpaction) – Using prescribed laxatives or enemas to clear built-up stool.
  2. Long-term laxative therapy and stool softeners – To maintain soft, easy-to-pass stools and prevent re-impaction.
  3. Bowel retraining – Encouraging regular toilet habits, such as sitting on the toilet at the same time each day (especially after meals).
  4. Dietary changes – Increasing fiber (fruits, vegetables, whole grains) and fluids to promote healthy digestion.
  5. Emotional support – Addressing anxiety, embarrassment, or frustration that may come with the condition.

Patience and consistency are key, as recovery may take several months.

Follow-Up and Monitoring

Regular check-ups help track progress and adjust treatment if needed. Parents should encourage a positive, stress-free approach to toilet habits, as pressure or punishment can make symptoms worse.

With the right treatment, most children fully recover and regain control over their bowel movements. If you’re concerned about your child’s symptoms, speak with a healthcare provider for personalized guidance.

History and Exam

Key diagnostic factor

  • history of anorectal, neurological, or spinal abnormalities, or gastrointestinal surgery
  • faecal soiling or diarrhoea
  • constipation
  • peri-anal skin irritation

Other diagnostic factors

  • behaviour problems
  • painful bowel movements
  • abdominal pain/cramping
  • posturing described as tightening of buttocks

Risk factor

  • chronic constipation
  • male sex
  • age: 5 to 6 years
  • diet lacking in fibre

Diagnostic Investigations

1st investigations to order

  • abdominal x-ray

Investigations to consider

  • unprepared barium enema
  • spinal x-ray
  • MRI spine
  • radiopaque marker transit x-ray

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    Other Related Conditions

    coeliac disease

    Inflammatory bowel disease (Crohn’s disease or Ulcerative Colitis)

    Eosinophilic Oesophagitis

    cow’s milk protein intolerance, food allergies

    irritable bowel syndrome (ibs)

    reflux & vomiting

    failure to thrive

    constipation or diarrhoea

    incontinence

    chronic abdominal pain

    gastroparesis

    liver disease

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      Social and emotional functioning refers to a child’s ability to understand, express, and manage their emotions, as well as to interact effectively with others. These skills are fundamental for building positive relationships, developing empathy, and coping with the everyday challenges of growing up.

      Children who experience difficulties in social and emotional functioning may struggle with recognizing their own feelings or those of others, regulating emotional responses, or responding appropriately in social situations. This can lead to challenges such as anxiety, low self-esteem, difficulty making friends, or misunderstandings with peers and adults.

      In the school environment, social and emotional difficulties can impact a child’s engagement, cooperation, and overall learning experience. Emotional distress may manifest as withdrawal, irritability, or disruptive behaviour, which can further affect academic progress and peer relationships.

      Assessment of social and emotional functioning as part of a neuropsychological evaluation typically includes behavioural observations, standardized rating scales, and information gathered from parents, teachers, and sometimes the child. This comprehensive approach helps identify strengths and areas for support in emotional regulation, social skills, and adaptive behaviours.

      Understanding a child’s social-emotional profile allows for the development of tailored strategies to enhance emotional wellbeing, build resilience, and improve social communication. Early intervention and supportive environments can empower children to navigate their emotions more effectively, fostering confidence and meaningful connections. 

      At Offspring Health, we aim to provide transparent information about the costs involved in neurodevelopmental and educational assessments.

      Neuropsychological assessments typically involve multiple sessions that usually take between 8 and 16 hours in total, depending on the complexity and individual needs. Our hourly rate is $260, so the total cost typically ranges between $2,300 and $4,230.

      Fees generally cover:

      • Initial consultation and history gathering
      • Testing sessions where your child will complete various fun and interactive tasks
      • Liaison with schools or health professionals as needed
      • Comprehensive case analysis and report preparation
      • Feedback sessions with families and, where applicable, educators or other professionals

      Please note that standard neuropsychological assessments are generally not covered by Medicare. However, some assessments and therapy services may be funded through the National Disability Insurance Scheme (NDIS) for eligible participants. We recommend discussing funding options with your NDIS planner or support coordinator prior to booking. Private health insurance may offer partial rebates depending on your level of coverage.

      What’s the next step?

      Please phone reception for a discussion about your needs or email psychology@offspringhealth.com