There is almost always s a behavioral component. First , when the conditIion is taking hold .Kid's will hold it in for various reasons. If not diagnosed and treated , it can turn into il years of having to deal with shame, blame, not being like others. For my son being bullied for years ....before school would even help. Sounds like you're doing a great job. Empower the child to be in control of his body, will gain self confidence. There are encopresis support groups around the country. Yes access to bathroom at any time and water. Goes to school clinic after lunch for privacy.