Soiling In Children

Key points about soiling

• the medical name for soiling is encopresis
• soiling 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 constipation and an overloaded bowel
• soiling problems can be frustrating and upsetting for parents and tamariki (children)
• you are not alone - there are many tamariki 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 tamariki need to take medicine for many months and often years to manage the problem

What is soiling?

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 tamariki. It can happen in any child, toddler or teenager.

Causes of soiling

• soiling is usually caused by long-lasting constipation and an overloaded bowel
• for a few tamariki, emotional and behavioural problems are a factor rather than constipation - you may need professional help for these issues

How a child can get an overloaded bowel

Hard poos

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.

Bowel wall and nerves get stretched

If your child 'holds on' to their poo, the poo gets bigger and harder and stretches the bowel wall and the nerves around the bowel.

More poo gets stuck in the bowel which becomes more stretched. Overloading becomes worse - a vicious cycle begins. 

The sensation or 'the urge' to have a poo is lost because the nerves have been stretched.

Overloading can be present even without the constipation being obvious. Your child can do poo daily but the backlog continues

Leaking poo

When the bowel gets overloaded, poo trickles down or overflows without the child noticing. This often happens when they are relaxing, exercising, or after eating.

This is terrible for your child who has no idea what is happening to them. Your child won't be able to understand why this is happening and so won't be able to explain it.

When to get medical help for your child with soiling

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

Your health professional may suggest your child sees a specialist nurse or doctor if:

• your child's soiling is proving difficult to treat after standard treatments or,
• the health professional thinks there may be another condition causing your child's constipation and soiling

Managing soiling

Treatment for soiling focuses on:

• unblocking and emptying the bowel - usually with a bowel washout
• taking laxatives to help your child do a soft poo at least once a day - this keeps their bowel empty so that it returns to a normal size and may take a few months
• establishing a regular routine of sitting on the toilet

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

Constipation Treatment

How you can help your child

Soiling problems can be frustrating and upsetting for parents and tamariki. It's important to understand the cause and not to blame your child for soiling. It can be hard to understand that stretched nerves really do mean your child isn't aware when they've soiled. Soiling is upsetting and can cause other behaviour problems which usually improve when the soiling is treated.

You could watch the video below with your child. 

Be supportive

Educate and encourage your whole whānau (family) to be supportive and understanding.

Stay calm and be supportive of your child. Remember the poo is the problem, not your child. Getting angry will make you feel bad and make your child tense and treatment is less likely to be successful. 

Talk to your child's school

Older tamariki with soiling are often teased. It is useful to talk to your child's classroom teacher.

Ask your health professional to help you contact a public health nurse who can work with you, your child and the school.

Talk to your child's school about a separate toilet where your child can clean and change themselves when needed.