Signs & Symptoms
Most often encopresis is involuntary, but occasionally may be intentional. When it is involuntary, the child usually withholds his stool, often because he is constipated and therefore experiences pain when he has a bowel movement. The stool then becomes harder and even more painful to pass. In severe cases, a large amount of dry stool becomes impacted in the rectum and watery feces leaks out, soiling the child's underwear. The retained feces results in large masses of stool that can dilate the colon, causing megacolon.
Subtypes (according to the Diagnostic and Statistical Manual of Mental Disorders - IV (DSM-IV))
Subtypes of encopresis are defined according to the following characteristics:
- With Constipation and Overflow Incontinence: There is evidence of constipation on physical examination or by history. Feces are characteristically (but not invariably) poorly formed and leakage is continuous, occurring both during the day and during sleep. Only small amounts of feces are passed during toileting, and the incontinence resolves after treatment of the constipation.
- Without Constipation and Overflow Incontinence: There is no evidence of constipation on physical examination or by history. Feces are likely to be of normal form and consistency, and soiling is intermittent. Feces may be deposited in a prominent location. When this occurs, it is usually associated with the presence of Oppositional Defiant Disorder or Conduct Disorder and may be the consequence of anal masturbation.