1. “Was there a time when the child’s bowel movements seemed typical?” History starts at birth with specifics surrounding bowel function and any treatments used. Past medical and surgical history may identify systemic diseases or medical causes of constipation that indicate treatments other than laxatives and maintenance of stool regularity.

2. “Did your child have a period of stooling into the toilet? How old was he or she? Did he or she feel the stool coming and get to the bathroom by her- or himself regularly?” Distinguishing delayed toilet training, where the child never consolidated the ability to stool independently into the toilet and is essentially afraid to use the toilet to stool, from encopresis is essential. Treatment will vary, depending on whether or not constipation underlies the stooling accidents, rather than toilet refusal (although toilet refusal is often associated with constipation as well).

3. “How often does your child stool and urinate into the toilet now? How often into underwear? Are the stools large? Hard? Liquid? Do they hurt?” Review details of present urinary and bowel patterns, such as frequency of stool evacuation into the toilet, stool accidents, stool consistency, and the urge to defecate. More severe, prolonged constipation generally will require more aggressive treatment. Any history of abuse or other trauma should be sought as well. Children who have been abused may become incontinent in times of stress or as part of regressive behavior and are less suitable candidates for rectal suppositories or enemas. They may also soil their underwear to keep someone away from them.

4. “Often stool problems coexist with wetting accidents. Has he or she had any urinary tract infections? Does she or he have urine accidents in the day or at night?” Urinary patterns, daytime wetting and nocturnal enuresis, and symptoms of urinary tract infection must be elicited and may indicate neurological abnormalities or urine contamination. Constipation and especially encopresis may be associated with urinary
tract infections, especially in females, due to poor hygiene. Even without infection, enuresis can be caused by a dilated rectum pushing on and irritating the bladder, thus causing bladder spasms.

5. “I see lots of kids who have poop accidents and don’t like having them. If you and your parents help me figure out what is going on, I think I can help so the accidents get better.” History taking provides an essential opportunity to communicate with the child. The child must be an active participant for the treatment to be effective, and often children with encopresis are overwhelmed and embarrassed when encopresis is discussed. The child often appears to not even be listening to the discussion, but they certainly are. When treatment is successful, the clinician often observes a drastic change in positive affect in the patient. Developing a sense of the child’s perspective can create a connection between caregiver and patient and should include questions about present school and family functioning.