Understanding Encopresis: You’re Not Alone, and There Is Help

As a paediatric pelvic floor physiotherapist, one of the most emotionally charged and often misunderstood challenges I support families through is encopresis – a condition where a child has involuntary bowel movements, often resulting in soiling their underwear, well past the age of toilet learning. If you’re a parent navigating this with your child, I want to start by saying: you are not alone, and this is not your fault or your child’s.

Encopresis can be deeply frustrating and worrisome for both children and parents. It can feel isolating, confusing, and even shameful – but with the right support, children can overcome it. Let’s walk through what encopresis really is, why it happens, and how a pediatric pelvic floor physiotherapist can play an essential role in helping your child recover.

What Is Encopresis?

Encopresis is defined as the repeated passing of stool into clothing by a child who is past the age of toilet learning, typically over four years old. These accidents are usually involuntary and occur when the child is constipated and impacted, often without even realizing they need to go.

Many parents assume this is a behavioral issue, but encopresis is most often a medical and functional problem – not a child being lazy, defiant, or inattentive. It’s important to understand that these children usually cannot control the accidents. They may feel embarrassed, confused, and anxious about what’s happening to their bodies.

The Role of Withholding and Constipation

At the root of most cases of encopresis is chronic constipation. And behind constipation, we often see withholding behaviors. Here’s how it can play out:

A child experiences a painful bowel movement – maybe it was hard, large, or they were scared to use a toilet somewhere unfamiliar. As a result, they start withholding stool. Instead of going when they feel the urge, they hold it in, tightening the muscles around the anus to prevent the bowel movement.

Over time, this stool builds up in the colon, stretching it and dulling the body’s natural urge signals. As the colon becomes more and more backed up, softer or liquid stool may leak around the hardened mass and pass without the child realizing – this is the soiling that parents see in their child’s underwear.

Eventually, the child may lose the ability to feel when they need to go at all. And so the cycle of withholding, constipation, and involuntary leakage continues.

Why Might Encopresis Happen?

There is no single cause of encopresis, and it can show up in children for a variety of reasons:

• Painful or traumatic bowel movements that create fear or anxiety around using the toilet
• Changes in routine or environment, such as starting school or a move
• Toilet training too early or too fast, leading to resistance or fear
• Diet low in fiber or fluids, which contributes to hard stools
• Busy or stressful family dynamics, where toilet needs may not be prioritized
• Underlying sensory processing challenges, where a child might not register internal signals the same way
• Lack of privacy or comfort, especially in school or public settings

Every child is unique, and understanding the context around their constipation and withholding is key to treating encopresis effectively.

Treatment Options for Encopresis

Treatment for encopresis is multi-layered and usually includes a combination of medical, behavioral, dietary, and therapeutic strategies. It’s not a “quick fix”, but with consistency and support, full recovery is absolutely possible.

Here are the main components of treatment:

1. Medical Management: This often involves softening the stool and clearing any impaction. Paediatricians may recommend laxatives or stool softeners to help normalize bowel movements and allow the colon to return to a normal size and sensitivity
2. Scheduled Toileting: Creating a regular routine for sitting on the toilet, especially after meals, helps the body re-learn how to recognize and respond to the urge to go
3. Diet and Hydration Support: Increasing fiber and fluids helps promote regular, soft bowel movements. Sometimes a registered dietitian is involved to help tailor dietary changes to the child’s needs
4. Psychological or Behavioral Support: Children with encopresis often experience embarrassment, anxiety, or even bullying. Mental health support can be an essential part of helping them rebuild confidence and reduce fear around bowel movements
5. Pelvic Floor Physiotherapy: This is where I come in – and where we can often make a significant difference

How Pelvic Floor Physiotherapy Can Help

As a pediatric pelvic floor physiotherapist, my goal is to help children develop healthy and confident bowel habits by addressing the function of the muscles and nerves involved in bowel control.

Here’s what we focus on:

• Education and Empowerment: Helping your child understand their body in a simple, positive, and non-shaming way is step one. We talk about how the bowel works, what muscles are involved, and why it’s not their fault
• Posture and Positioning: Sitting posture on the toilet is critical. We help kids learn the best way to sit for effective emptying – often using a stool under the feet and leaning slightly forward
• Pelvic Floor Muscle Awareness and Coordination: Some children with encopresis have tight or overactive pelvic floor muscles from months (or years) of withholding. Through gentle exercises, breathing techniques, and body awareness tools, we teach kids how to relax those muscles for better bowel movements
• Sensory and Nervous System Regulation: For children who have trouble sensing when they need to go – or who are anxious and tense during toileting – regulating the nervous system can make a big difference. We use tools like breath work, body scans, and sensory strategies to support calm and awareness
• Consistent, Non-Judgmental Support: Perhaps most importantly, we create a safe space for both parents and children. We listen, we guide, and we walk with you – step by step – through what can otherwise feel like a very lonely road

A Final Word for Parents

If you’re dealing with encopresis, please know: you are not a bad parent and your child is not broken. This is a common and very treatable condition. It takes patience, compassion, and a team approach but there is a path forward.

No child wants to have accidents. And no parent wants to feel helpless. The good news is, you don’t have to do this alone. With the right support, kids can (and do) regain control, confidence, and comfort in their bodies.

If you think your child may be struggling with encopresis, reach out to a paediatric pelvic floor physiotherapist. We’re here to help – and we’ll meet your family with the kindness, expertise, and the care you deserve.

Sandra Ghaly is a pelvic health physiotherapist with a special interest in working with kids. She has advanced training in paediatric pelvic health and supports everything from bedwetting, constipation to abdominal pain with evidence-based and compassionate care. Sandra is also the founder of Makewell Health, a multidisciplinary women’s and children’s health clinic in Oakville, Ontario where her mission is simple: to help families feel better in their bodies.