Constipation & Encopresis

If you work with someone who is constantly constipated you know what a big deal this is. Often their stomach is upset and cramping. We shouldn’t be surprised that people with chronic constipation do poorly in school, seem distracted, and are not interested in interacting with others. No one wants to work or socialize when they don’t feel good.

Chronic constipation can make defecation painful. This can cause a child to resist toilet training or even try to hold in a stool causing impaction. If a child passes a hard stool it can be painful and may even cause an anal fissure. Fear of facing this pain can cause a child to be unwilling to toilet train. If this is your child’s situation you must take into account your child's feelings and perceptions while potty training.

Signs and symptoms of constipation include:

  • Less than three bowel movements a week.
  • Hard stools.
  • Pain, cramping, toe-walking, and holding the stomach.
  • Holding in stools or resisting defecating.
  • Blood on the stool or toilet paper that indicates an anal fissure.
  • Rectal impaction or abdominal fecal mass.


Encopresis is a condition that can develop in children who have chronic constipation. This often develops as the result of a vicious cycle: the child becomes constipated, they feel pain when they defecate, they withhold defecation, become constipated, feel pain when they defecate and so on.

This cycle can cause the stool to become impacted, lead to enlarged intestines, and eventually cause the child to have problems sensing when they need to go to the bathroom. Eventually, liquid stool will start to leak around the hard, dry, impacted stool, soiling a child's clothing. Unfortunately, this can be misinterpreted as diarrhea.

For an encopresis diagnosis, a child must meet the following DSM IV-TR criteria:

  • Repeated passage of feces into inappropriate places (e.g., clothing or floor) whether involuntary or intentional.
  • At least one such event a month for at least 3 months.
  • Have a chronological age of at least 4 years (or equivalent developmental level).
  • This behavior is not due to the effects of a substance (e.g., laxatives) or medical condition. It can only be cause by constipation.