Encopresis: A Four-Pronged Treatment Approach

May 13, 2020

Encopresis, more commonly called “soiling” or fecal incontinence, refers to the involuntary passage of feces. Typically, this condition results from chronic constipation, but it can also be triggered by emotional issues. Encopresis, which has a 9% occurrence rate worldwide, is not considered to be a medical condition until a child is 4 years old.

While encopresis is often very distressing to both the child and the family, it is treatable. The earlier treatment begins, the better the outcome. In my years of private practice as an art therapist, I have successfully treated many children with encopresis using the following four-pronged treatment approach.


Medical Interventions

The first step is to consult with the child’s pediatrician followed by an evaluation with a pediatric gastroenterologist to address any physiological factors. Then follow the doctors’ recommendations which may involve taking medication such as MiraLAX or Ex-Lax, using an enema, or scheduling an x-ray to check for a potential blockage. It is also important to maintain a diet that limits constipation such as: eating high-fiber foods, increasing liquids, and avoiding constipating foods.


Behavioral Interventions

I begin treatment by working with parents to implement a schedule that has the child sit on the toilet for 5-10 minutes starting 20 minutes after every meal. Parents should accompany younger children during these bathroom visits and create ways to make it enjoyable and relaxing for their child. Blowing bubbles, reading a book or playing a game such as I-Spy are just a few ideas. Additionally, create a routine in which everyone in the home uses the bathroom before heading out.

Next, we formulate a plan for accidents that may happen at school or home. Parents should decide with their child how accidents will be dealt with and who will be involved in the cleanup process. Creating a plan gives children control over a difficult situation, as well as a greater sense of security.

Also, it is important for parents to keep a detailed log of when medication is given and when and where accidents occur. This helps identify patterns and formulate ways to mitigate accidents in the future.


Psycho-education Interventions

All children, even those as young as four, can be taught how their bodies work. When children understand this, they are more likely to be amenable to various interventions. Therefore, I work with children to explain to them in an age appropriate manner how their bodies pass bowel movements. Books, videos, and even art projects are ways this can be accomplished. For example, there is an excellent YouTube video called “The Poo in You” which explains to children how food gets digested, what happens when a person holds their stool, and how accidents happen. It even describes when and how to properly sit on the toilet to facilitate bowel movements.


Emotional Interventions

There are many emotional interventions that I incorporate into the therapeutic process, tailored to each child’s underlying issues. Here are a few examples:

  1. ·         Develop emotional vocabulary through games and art. At home, parents can model various emotions, as well as discuss and accept all feelings.
  2. ·         To help foster a stronger attachment and better parent-child relationship, create nighttime rituals which include snuggling, reading, or playing a fun game.
  3. ·         Teach relaxation techniques, mindful activities, and coping techniques. Parents put daily these into daily practice and discuss how various family members utilize them.

Children will take time to heal and may experience periodic setbacks, but with consistency, successful outcomes are achievable. With a combination of medical intervention and therapeutic approaches, it is possible to overcome the challenges of encopresis.


A note to parents: It is especially important for parents to receive support throughout this process. It is often a time of great stress on the entire family and the more support you can receive the easier it will be to navigate this challenging time. 



Sara Feinberg ATR-BC, LCAT, is a licensed and board-certified art therapist with a Master’s degree in Art Therapy from New York University. She maintains a private practice in Ramat Bet Shemesh, Israel and provides telehealth options for both therapy and clinical supervision.

Sara has eighteen years of clinical experience working with children, adolescents, and families. Her specialties include helping children and families cope with medical procedures and serious illnesses, bereavement counseling, anxiety, encopresis, and selective mutism.


Resources for encopresis:

·         The Poo in You  https://www.youtube.com/watch?v=SgBj7Mc_4sc

·         Apps for breathing while sitting on the toilet:

v  Pinwheel

v  Candle cake

·         App for young children who are afraid of going to the bathroom

v  Poo Goes Home to Pooland

·         It Hurts When I Poop by: Howard J. Bennett https://www.amazon.com/Hurts-When-Poop-Children-Hardback/dp/B00FKYTWN2