Hello, Welcome to Healthcare Magic forum. Your grandson is suffering from encopresis and hence may have related psychological problems like low self esteem which is commonly seen in about 20% of children with encopresis. Also,Encopresis can develop from a range of causes apart from medical reasons including simple phobia, poor toilet training experience, painful constipation experience, social immaturity, fear of getting older, as an attempt to regain/exert control etc. Untreated encopresis can pose several risks to a child s health: megacolon- enlarged colon, desensitisation of nerves and muscles, bleeding and cracking of the skin fissures, urinary tract infections and wetting accidents. The psychological concerns include: shame, guilt, loss of self esteem, social ostracism by peers, delayed social development, withdrawal, anxiety and hopelessness. Parents often also feel a range of emotions when their child has encopresis including feelings of embarrassment, and fears of incompetence as a parent. The most important thing needed for your grandson is accurate medical assessment. Once all possible medical avenues have been exhausted psychological causes and maintenance factors need to be explored. Generally, the earlier treatment begins for encopresis, the better. The first step in treatment focuses on clearing the colon of retained, impacted stool. After that, treatment includes encouraging healthy bowel movements. This includes training your child to go to the toilet as soon as reasonably able when the urge to defecate occurs. in cases of encopresis without constipation and simple toileting refusal psychological treatments are often very simple and effective. Psychological assessment will involve a detailed history of development, absences from parents, history of increasing independence, toilet training history and the child s general behaviour . Once the psychological assessment is complete it may be that toileting refusal is not the major concern, there maybe difficulties in the parent child relationship or frequently the child may have low self esteem and poor self confidence. Psychological treatments for encopresis generally tackle a number of areas of concern at once. They usually work on improving the parent child relationship, improving the child s self esteem including their sense of accomplishments and independence. So I would advice you to get your grandson first evaluated by a pediatric gastroenterologist to rule out any medical causes and complications and with his recommendation a psychotherapist can be consulted for appropriate psychotherapy. Please do not worry as with appropriate therapy your grandson can grow into a normal self esteemed individual. Wishing him a speedy recovery and good health forever. Regards