ABSTRACT
This chapter presents a case of an 11-year-old boy who presents with soiling in different places throughout the house, for example, in the living room behind the sofa. He has been doing this for some years but the situation has recently worsened. Physical examination shows he has a small abdominal mass, and rectal examination and abdominal X-ray show that he is constipated. However, the deliberate soiling and the history suggest emotional and behavioural disturbance. Attachment problems are likely given the history of current neglect and history of abuse. Rare physical causes like short-loop Hirschsprung disease, if considered, would require referral to a paediatrician. It tends to improve with age and is relatively uncommon after age 16. Most children with encopresis have learnt to control their bowels, but for various reasons lose this ability and develop secondary encopresis. Child protection issues need to be reviewed, particularly as these behaviours may represent a 'flag' for emotional disturbance that needs to be addressed.
