Soiling (encopresis)

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Key points to remember

  • soiling (encopresis) is when your child does poo in their pants after the age when you would expect them to be toilet-trained
  • soiling is usually caused by chronic constipation and an overloaded bowel
  • soiling problems can be frustrating and upsetting for parents and children (see What can I do to help my child?); older children with soiling are often teased
  • you are not alone; there are many children with this problem
  • most children with soiling problems have had pain doing poo in the past
  • soiling often occurs without your child knowing; it is not deliberate and your child did not develop this problem to upset you or be manipulative
  • the treatment of constipation and soiling takes time; most children need to take medication for many months and often years to manage the problem
  • children who soil sometimes have other behaviour problems which improve when the soiling is treated

What is it?

Soiling (encopresis) is when your child does poo in their pants after the age when you would expect them to be toilet-trained. Soiling is a common problem affecting many children. It can happen in any child, toddler or teenager.

What causes it?

  • soiling is usually caused by chronic constipation and an overloaded bowel (see How does my child get an overloaded bowel?)
  • for a few children, emotional and behavioural problems are a factor rather than constipation; these children and families need professional help to address these issues

How does my child get an overloaded bowel?

  • poo usually comes down and passes out in "single file"
  • if for some reason your child does a hard poo and it hurts, they may try to avoid pain again by “holding on” to the next poo
  • if your child “holds on” to their poo, it gets bigger and harder and stretches the wall of the bowel
  • when the bowel gets overloaded, poo can trickle down (overflow) unnoticed (often when relaxing, exercising, or after food)
  • this is terrible for your child who has no idea what is happening to them
  • the sensation or "the urge" to go have a poo is lost
  • overloading becomes worse; a vicious cycle begins
  • by the time the child sees a doctor, the original cause will have long since gone and the child is suffering from the mechanical consequences of the lower bowel (rectum) being very full of poo
  • overloading can be present even without obvious constipation, as your child can do poo daily but the backlog continues
  • your child is unable to explain that they no longer have control over their bowels
 
Soiling
See Acknowledgements for this graphic.

What is the treatment?

Treatment for soiling is the same as for constipation.

See the following sections in the constipation fact sheet:

Treatment focuses on:

  • unblocking and emptying the bowel
  • keeping the bowel emptying regularly for a few months to allow it to come down to a normal size
  • establishing a regular routine of sitting on the toilet
  • developing the habit of a soft motion at least once a day

Taking laxatives is important in helping to resolve the problem.

Treatment should continue for enough time to allow the bowel size and feeling (sensation) to return to normal. This is usually for months or years.

What can I do to help my child?

  • learn about the causes of constipation and soiling
  • establish a regular and consistent routine of sitting on the toilet and taking laxatives; this is the key to helping resolve the problem
  • educate and encourage the whole family to be supportive and understanding
  • stay calm and be supportive of your child; getting angry will make you feel bad and make your child tense and less likely to be successful
  • it is often best to ignore suggestions from friends and family who give unhelpful advice 
  • remember the poo is the problem, not your child

Where to go for more information

On this website
 
Children’s Health Camps www.healthcamps.org.nz
Children's Health Camps run a programme for children who have constipation and soiling problems.
 
NZ Continence Association www.continence.or.nz / 0800 650 659
Parent to Parent www.parent2parent.org.nz
Parent to Parent offers a support service to parents of children with a range of conditions and can put you in touch with parents experiencing similar situations.
 
This is a brochure (available in pdf format) with diagrams. It is designed for printing. 
 
International websites
 
Bristol Stool Chart atWikipedia en.wikipedia.org/wiki/Bristol_Stool_Scale
The Bristol Stool Scale / Chart is a medical aid, with diagrams, designed to classify poo into seven groups indicating constipation, normal poo or diarrhoea.
 
ERIC (Education and Resources for Improving Childhood Continence) www.eric.org.uk
ERIC has a number of leaflets that can be downloaded. It provides information for parents, children and adolescents and for health professionals.
 
University of Virginia Health System (U.S.)
The University of Virginia website provides the following tutorial for patients and families:

Acknowledgements

This fact sheet was originally developed in consultation with:

Royal Children's Hospital logo

  • Paediatric Department, Christchurch Hospital
  • Paediatric Department, Nelson Hospital
Images
The animated soiling graphic comes from Constipation and encopresis: A multimedia tutorial, at the University of Virginia Health System website (U.S.). Thank you to The University of Virginia Health System for permission to reproduce this.


References

  1. NASPGHAN Constipation Guideline Committee. September 2006. Clinical practice guideline: Evaluation and treatment of constipation in infants and children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. 
    http://www.naspghan.org/user-assets/Documents/pdf/PositionPapers/constipation.guideline.2006.pdf [Accessed 4/03/2011]
  2. Royal Children's Hospital, Melbourne. November 2010. Clinical Practice Guideline: Chronic constipation.
    http://www.rch.org.au/clinicalguide/cpg.cfm?doc_id=11659 [Accessed 4/03/2011]
  3. National Institute for Health and Clinical Excellence, U.K. May 2010. Constipation in children and young people.
    http://guidance.nice.org.uk/CG99 [Accessed 4/03/2011]

 

This page last reviewed 07 May 2013
© Paediatric Society of New Zealand and Starship Foundation 2005 – 2014
Printed on 29 July 2014. Content is regularly updated so please refer to www.kidshealth.org.nz for the most up-to-date version
Content endorsed by the Paediatric Society of New Zealand