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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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    irritable bowel syndrome (ibs)

    reflux & vomiting

    failure to thrive

    constipation or diarrhoea

    incontinence

    chronic abdominal pain

    gastroparesis

    liver disease

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      1 Reason for referral *

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      3 Patient First Name *

      4 Email *

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      6 Phone *

      7 Child’s date of birth *

      8 Address