A child may even have no awareness of when stool pushes out into the underwear. Watery stools can also seep past harder stool, soiling pants without a child being aware of it until after the fact. Regardless of the basis of the problem, both parents and children need to know they are not alone here and no one is to blame for this problem.
Not all doctors are trained in successful therapy for this problem so look for one who is, as this problem needs to be approached medically as well as psychologically. If your county medical association can't help, seek out a children's hospital or university teaching hospital. Encopresis is treated by a gradual retraining of the bowel which includes dietary changes, supplements, and behavior modification. There is not an overnight cure for this condition.
One helpful workbook for parents and children dealing with encopresis is Childhood Constipation and Soiling published by Behavioral Services of Minneapolis Children's Health Care/family Resource Center (612-813-6816). There is also the children's book, Clouds and Clocks: A Story of Children Who Soil (Magination Press, 212-924-3344).
Excerpted from Toilet Training: A Practical Guide to Daytime and Nighttime Training by Vicki Lansky