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 long lasting (chronic) constipation and an overloaded bowel
  • soiling problems can be frustrating and upsetting for parents and children
  • you are not alone - there are many children with this problem
  • soiling 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

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 long lasting (chronic) constipation and 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?

  • Soiling 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 and the nerves 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 have a poo is lost because the nerves have been stretched
  • overloading becomes worse; a vicious cycle begins
  • 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

When should I take my child to a doctor?

If your child is soiling, you should take them to your family doctor. Public health nurses can also be very helpful for your child with soiling. You could ask your family doctor about your local public health nurses. 

Your doctor may refer your child to a paediatrician (specialist children's doctor) if:

  • your child's soiling is proving difficult to treat after standard treatments or,
  • your doctor thinks there may be another condition underlying your child's constipation (if this is the case, some tests/investigations may be needed)

What is the treatment?

Treatment for soiling is the same as for constipation - see the page on constipation.

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

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. Remember the poo is the problem, not your child
  • older children with soiling are often teased - it is useful to talk to your child's classroom teacher. Ask your family doctor to help you contact a public health nurse who can work with you, your child and the school
  • soiling is upsetting and can cause other behaviour problems which usually improve when the soiling is treated

References

  1. ESPGHAN and NASPGHAN. 2014. Evaluation and treatment of functional constipation in infants and children: Evidence-based recommendations from ESPGHAN and NASPGHAN.
    http://www.naspghan.org/content/63/en/Clinical-Guidelines-and-Position-Statements [Accessed 14/05/2015]
  2. Royal Children's Hospital, Melbourne. Clinical Practice Guideline: Constipation.
    http://www.rch.org.au/clinicalguide/cpg.cfm?doc_id=11659 [Accessed 14/05/2015]
  3. National Institute for Health and Clinical Excellence, U.K. May 2010. Constipation in children and young people. http://www.nice.org.uk/guidance/CG99 [Accessed 14/05/2015]

Acknowledgements

The animated soiling graphic comes from Constipation and encopresis: A multimedia tutorial, at the University of Virginia Health System website (US). Thank you to The University of Virginia Health System for permission to reproduce this.

This page last reviewed 15 December 2015
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Printed on 30 August 2016. Content is regularly updated so please refer to www.kidshealth.org.nz for the most up-to-date version
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