4 years or older children have encopresis due to chronic (long-term) constipation. With constipation, children have fewer bowel movements than normal, and the bowel movements they do have can be hard, dry, and difficult to pass. The child may avoid using the bathroom to avoid discomfort. Stool can become impacted (packed into the rectum and large intestine) and unable to move forward. The rectum and intestine become enlarged due to the hard, impacted stool. Eventually, the rectum and intestine have problems sensing the presence of stool, and the anal sphincter (the muscle at the end of the digestive tract that helps hold stool in) loses its strength. Liquid stool can start to leak around the hard, dry, impacted stool, soiling a child's clothing.
Any child with chronic constipation may develop encopresis. For unknown reasons, boys develop encopresis six times more than girls. Family stress can be linked to constipation. Children are often ashamed or embarrassed. They may avoid going to school, playing with friends, or spending the night away from home. Parents may feel guilt, shame, anger, or distaste by the problem. Symptoms may include: loose, watery stools, involuntary stooling, or needing to have a bowel movement with little or no warning, scratching or rubbing of the anal area due to irritation by watery stools, hiding their underwear.