Stool Leakage

What Parents Need to Know?

Stool leakage, also known as encopresis or fecal incontinence, can be a distressing and confusing issue for both children and their families. It occurs when a child over the age of four (who is past the typical toilet-training stage) has repeated accidents involving the leakage of stool into underwear. While it might seem like a behavioral issue, stool leakage is usually linked to chronic constipation and underlying medical or emotional causes.

What Causes of Stool Leakage?

The most common cause is chronic constipation. When a child holds in stool, it becomes hard and difficult to pass. Over time, the colon stretches, reducing the urge to go, and softer stool may leak around the blockage without the child even realizing it. Other contributing factors can include: stress of emotional challenges, toilet training difficulties, diet low in fiber, withholding behavior (often after a panful bowel movement), fluids, lack of physical activity and neurological or developmental disorders (less common).

Signs and Symptoms

• Frequent soiling of underwear without the child noticing
• Large, hard stools or difficulty passing stool
• Abdominal pain or bloating
• Decreased appetite
• Avoidance of using the bathroom
• Irritability or low self-esteem

Many parents feel confused because their child may deny the accidents or seem unaware of them. This is often due to a desensitized rectum, which can’t send strong signals to the brain.

How It’s Diagnosed

At our clinic, we start with a detailed medical history and physical exam. We may recommend abdominal X-rays to check for stool buildup or other tests if we suspect a neurological or anatomical issue.

Treatment Options

Encopresis is highly treatable with a structured and compassionate approach. Treatment usually involves:

• Bowel clean-out: Often with medication to relieve any impaction.
• Maintenance therapy: Daily use of stool softeners or laxatives to prevent re-accumulation.
• Scheduled toileting: Encouraging regular bathroom habits after meals.
• Dietary changes: Increasing fiber and fluids.
• Behavioral support: Positive reinforcement and avoiding punishment.

In some cases, psychological support or counseling is recommended—especially if the child is experiencing anxiety, embarrassment, or social issues related to the condition.

Supporting Your Child

• Be patient and supportive—accidents are not intentional.
• Avoid shaming or punishment; focus on encouragement and routine.
• Praise successes, no matter how small.
• Stay consistent with the treatment plan recommended by your doctor.

When to See a Doctor

If your child is over the age of 4 and continues to have regular accidents, or if they are experiencing abdominal pain, constipation, or emotional distress, it’s time to schedule a visit. Early intervention helps prevent complications and improves outcomes.

How We Can Help:

Dr. Sima Stein of Sima Stein, MD, located in San Jose, California, is a board-certified physician who can help your child determine if he or she has a stool leakage and how to help them manage it. Learn more about food allergy or sensitivity and the ways Dr. Stein can help you and your child manage their condition. Our team can assess underlying causes, recommend dietary changes, and provide safe, age-appropriate treatments—including allergy tests when necessary.

If you're concerned about your child’s bowel habits, we’re here to help. Call our office to schedule an evaluation. https://www.doctor-stein.com/blog/prepping-for-your-childs-immigration-medical-exam-our-top-tips#:~:text=call%20the%20office%20of%20Sima%20Stein%2C%20MD%2C%20or%20request%20an%20appointment%20online