Children may develop constipation despite normal transit times after repeatedly withholding stool, which leads to stretching of the rectum and lower colon resulting in lower tone, retention, and eventually impaction, leading to a defecatory disorder. Secondary encopresis may develop as liquid stool begins to leak around the impaction, often leading to an initial misdiagnosis of diarrhea. Often functional constipation begins in relation to pain or discomfort with stooling and avoidance of repetition of these symptoms. Perianal fissures, mild infections (such as perianal Streptococcus), or perianal abscess may be inciting factors for pain or discomfort. Other causes of functional retention in children include desire for control during toilet training, psychological stressors, or unintentional retention while distracted or otherwise occupied for long periods of time