Paradoxical Diarrhea in Children

Children who have been potty trained may have regular or occasional episodes of incontinence. This is known as paradoxical diarrhea. Being aware of the signs and causes of this disorder will help parents to handle these episodes.
Paradoxical Diarrhea in Children

Last update: 23 April, 2018

Many parents consider paradoxical diarrhea in children to be a sign of a behavioral disorder, but in many cases, there is a physical cause.

Finding soiled underwear when your child has already learned to use the bathroom can be worrying.

What are the reasons why a child may not empty their bowels when they go to the bathroom?

What is paradoxical diarrhea in children?

Children sometimes defecate in the wrong place and at the wrong time, whether voluntarily or involuntarily.

This kind of incontinence usually appears in children aged 4 or older who are already potty trained. It’s more common in boys than in girls.

This problem is known as paradoxical diarrhea, since it’s diagnosed after doctors have ruled out disease. Another name for it is encopresis.

When the child feels the need to go, they squeeze their sphincter to hold it in. Eventually, the child’s colon can’t hold any more fecal matter and this can leak out.

Signs of paradoxical diarrhea in children

The main symptoms of encopresis or paradoxical diarrhea in children are:

  • Irregular bowel movements. The child may only pass stool twice a week or less.
  • Dry, hard or large stool which are painful for the child to pass. Children with this issue go to the bathroom less frequently, and pass large stool for their age.
  • Fear of defecating in the toilet or potty. The child may be too afraid to tell you when they need to go.
  • Anal bleeding.
Paradoxical Diarrhea in Children
  • Sudden incontinence. This means the child isn’t able to contain the feces until they get to the bathroom.
  • Leakage of loose, watery stool or unexpected diarrhea.
  • Abdominal stress during bowel movements. This may lead to an increased heart rate and make the child feel dizzy.
  • Abdominal pain or discomfort.
  • Bowel movements in unsuitable places, such as in clothing, a chair, a corner of the house or other places that aren’t the toilet.

“Children sometimes defecate in the wrong place and at the wrong time, whether voluntarily or involuntarily”

Causes of paradoxical diarrhea in children

Some of the most common causes of paradoxical diarrhea in children are:

Chronic constipation

Sometimes, stool can get stuck in the colon, becoming hard or impacted. This can make going to the toilet a painful ordeal.

Early or faulty potty training

When potty training begins at a very early stage of childhood, it can lead to a phobia of using the bathroom.

Oppositional defiant disorder

The child wants to show that they’re the one in control of the situation. To do this, he or she refuses to use the toilet to defecate.

Stressful situations

When children aren’t able to express their negative emotions, it’s the body that shows the strain.

Paradoxical diarrhea in children can be a sign of emotional distress.

Other factors that can lead to paradoxical diarrhea in children include:

  • Being a victim of sexual abuse. 
  • Fissures around the anus.
  • Genetic predisposition to bowel disorders.
  • Dehydration or a diet poor in fiber.
  • Excessive use of suppositories or laxatives.
Paradoxical Diarrhea in Children

Consequences of paradoxical diarrhea

Apart from the physical consequences, paradoxical diarrhea in children can have lasting psychological effects.

Feelings of guilt

As children become aware of the problem, they may experience feelings of shame and guilt. These feelings will impact their self-confidence.

Social exclusion

Children who suffer from paradoxical diarrhea may avoid spending time with other people out of fear or embarrassment.

The child may refuse to go to school and try to keep away from other children. Obviously, this is not a good idea.

“This kind of incontinence usually appears in children aged 4 or older who are already potty trained, and is more common in boys than in girls”

Low self-esteem

Nagging your child about occasional incontinence or allowing people to make fun of the problem could seriously harm their self-esteem.

With this in mind, you shouldn’t put off seeing a doctor.

It’s easy to think that this is a stage your child will grow out of, but in fact, paradoxical diarrhea can lead to further complications, both physical and emotional.

From around 4 years of age, parents should be on the alert for episodes of incontinence occurring more than once a week.

Children with this disorder need extra support from their parents, not criticism or teasing.


All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

  • Warsame MO, McMichael JR. Chronic abdominal pain and diarrhea. J Fam Pract. 2020 Sep;69(7)
  • Fathallah N, Spindler L, Zeitoun JD, De Parades V. Fissure anale [Anal fissure]. Rev Prat. 2019

This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.