We determined the incidence of stool toileting refusal in 53 children with overflow encopresis; 24 (45%) experienced difficulty toilet training for bowel movements. One-year follow-up data were obtained for 43 children, 31 with secondary encopresis and 12 with primary encopresis. Among the children with secondary encopresis, no difference was observed in response to treatment between children with and without difficulty toilet training. Ninety-one percent (11 of 12) of the children who had been soiling for less than 1 year at the time of presentation were free of soiling and no longer required therapeutic medication, compared with 55% (10 of 18) of the children who had been soiling for a longer period. Only 1 of 12 children with primary encopresis was free of soiling and no longer receiving therapeutic medication at 1 year, compared with 21 of 37 with secondary encopresis (p = 0.003). We concluded that children with primary encopresis who demonstrated stool toileting refusal during toilet training were resistant to medical treatment.