358 Elimination Disorders
Specify whether:
With constipation and overflow incontinence:  There is evidence of constipation on
physical examination or by history.
Without constipation and overflow incontinence:  There is no evidence of constipa-
tion on physical examination or by history.
Subtypes
Feces in the with constipation and overflow incontinence subtype are characteristically
(but not invariably) poorly fo rmed, and leakage can be infr equent to cont inuous, occur-
ring mostly during the day and rarely during sleep. Only part of the feces is passed during
toileting, and the incontinence resolves after treatment of the constipation.
In the without constipation and overflow inco ntinence subtype, feces are likely to be of
normal form and consistency, and soiling is intermittent. Feces may be deposited in a
prominent location. This is usually associated  with the presence of  oppositional defiant
disorder or conduct disorder or may be th e consequence of anal masturbation. Soiling
without constipation appears to be less common than soiling with constipation.
Diagnostic Features
The essential feature of encopresis is repeated passage of feces into in appropriate places (e.g.,
clothing or floor) (Criterion A). Most often the passage is involuntary but occasionally may be
intentional. The event must occur at least once a month for at least 3 months (Criterion B), and
the chronological age of the child must be at least 4 years (or for children with developmental
delays, the mental age must be at least 4 years)  (Criterion C). The fecal incontinence must not
be exclusively attributable to the physiological ef fects of a substance (e.g., laxatives) or another
medical condition except thr ough a mechanism involving constipation (Criterion D).