Cognitive Behavioral Therapy for Encopresis

Encopresis or fecal incontinence is a common childhood concern in which a child over the developmental age of 4 years passes stool into an inappropriate place (e.g., underwear or onto the floor). Although this condition can be diagnosed in adulthood, it is often first diagnosed in childhood or early adolescence. Encopresis has both biologic and behavioral components, is often very distressing for the youth and their family, and can cause significant disruption in day-to-day functioning. This chapter addresses biological and behavioral factors and reviews the evidence-based cognitive behavioral interventions for encopresis. The most common biological contributor to fecal soiling is constipation, which should be medically managed at the outset and throughout the course of treatment for this condition. Behavioral contributors such as stool withholding, delayed defecation, and noncompliance with toileting routines may also need to be addressed in order to achieve full symptom remission. Cognitive factors such as incorrect assumptions about the reasons for soiling, learned helplessness, and fear of the toilet or stooling should also be assessed and intervened upon if present. A combined medical and behavioral/psychological treatment approach is recommended.