My dd has struggled with this for YEARS. We have worked with a specialist for 6 months and seen very little improvement. I recently read the book, "It's no accident" and found it to be more helpful than other books I'd looked at over the years. There is a yahoo group for parents of children with encopresis that I have found helpful. A lot of folks on there end up traveling to the Cinncinnatti Colorectal Center if when other options do not lead to improvement. Good luck!