Soiling and chronic constipation in children
poo; faeces; soiling; toilet; training; constipation;
Soiling (doing poo in the pants or leaking poo into the pants) becomes a problem if it goes on after the child is about four years of age. This is sometimes called encopresis. It usually happens when a child has been constipated for a long time.
Often young children of two or three do their poos in the garden or their pants or anywhere but the toilet. This is part of learning to manage for themselves - for ideas to help them, see the topic on 'Toilet training'.
The information in this topic is about long-lasting constipation and soiling, or doing poo in the pants after a child has been toilet trained. The topic 'Constipation' has information about more simple-to-manage constipation.
What causes soiling
- What often happens is:
- The child develops hard, dry poo for some reason, perhaps a fever or an illness. It can hurt when the poo comes out. Sometimes there is even a small tear in the skin around the anus and you might see a bit of blood. The child then tries to hold onto her poo to avoid being hurt. Most children with soiling problems have had pain doing poo in the past.
- Sometimes the pain makes the muscle where the poo comes out tighten up and this makes doing poo even harder for the child.
- The poo gets bigger and harder and stretches the walls of the bowel. This makes it harder for the child to feel that it is time to go to the toilet because she does not know when her bowel is full.
- In the end, bits of poo break off and fall into the child's pants or sometimes softer poo from above the large hard poo leaks around the edges and into the pants in small amounts.
- The doctor needs give you advice about how to move the big hard poo (often an enema needs to be used) and then the child needs to learn or relearn that doing poo does not hurt, and about the signals and how to use the toilet. This needs some special training.
- Sometimes soiling happens because of problems with toilet training, or starts when the child has some stress eg a new baby arrives.
- Very rarely, chronic (long lasting) constipation can be caused by physical abnormalities of the bowel such as Hirschsprungs disease (the muscles of the bowel cannot work normally because the nerve supply to part of the bowel is missing) or the anus is not normal. These problems are usually picked up when the child is younger.
Whatever the cause - soiling usually stops as a child gets older.
- Soiling is not done purposely and usually happens without the child knowing. It is not the child's fault.
- Sometimes people think it is laziness but it is not.
- It can sometimes be caused by battles over toilet training.
- Children who soil sometimes have other behaviour problems which tend to go when the soiling gets better.
- Sometimes where soiling has gone on for a long time, both parents and children can get frustrated and upset with each other as the parents try to help and children struggle with trying to get it right. This distress and anger is caused by the soiling. It is rarely a cause of soiling.
Soiling is embarrassing for children. They often get teased and sometimes don't have friends if it happens at school. It needs to be treated. Family members also are often unkind.
Any persistent constipation or soiling in a child four years or older should be checked by a doctor to make sure the bowel is normal, and because it usually necessary to use an enema to get things going again.
What parents can do
- You might feel guilty (as if somehow it is your fault), annoyed (as if the child is purposely trying to be difficult), upset and frustrated.
- Remember that the problem began because your child was in pain. Your child did not develop this problem to upset you or to be manipulative.
- You may have had criticism from neighbours and grandparents who think they know what you should do.
It is important to try not to get angry with the child because this will make him tense up and make it harder for him to get it right. Try to think of ways that will help you with this, for example leave the scene until you feel you can cope.
- It is a problem that needs sorting out and it needs assessment from a health professional to give advice about what will help. There is no magic wand - it will take time to stop the soiling happening. You could ask your family doctor or staff at a child health service.
- While you wait for an appointment, try to take all the pressure off your child.
- When the child does a poo, say calmly "Doing poo is good for you". If the child is doing poo in the wrong places you could add "Poos go in the toilet."
- Keep it as low key as possible.
- Do not use rewards or bribery because they do not work. Sometimes a child may be clean for a day, but this is not under their control. Star charts are not useful.
- Don't make a young child clean up after himself because this feels like punishment for something he can't help. Older children may get some sense of control if they can rinse their pants and put them somewhere where they will be washed.
- Remember that getting in control of soiling takes time.
- If you are getting pressure from relatives or other people, say something like "I'm getting some help with it, and I can only listen to the doctor/counsellor".
- Think about any stresses that your child may have that are putting pressure on him. For example does he need more opportunities for choice in his life?
- It is important that it does not get to be a battle and that parents don't think they have to win. Try to find lots of times in your child's life where she can have some say about what happens to her - such as what she eats and wears.
There does not seem to be any evidence that soiling is caused by family stresses or relationship issues. However soiling very often causes parents and the child to feel very stressed and unhappy.
- Treatment can be difficult at the beginning. You will need to find a doctor or health worker who understands the situation and who will support you for several months as your child's bowel is 're-trained' in knowing when poo needs to be passed.
- The thing that needs to happen first is to empty the bowel of the large hard lump of poo. Enemas (liquid put into the bowel through the anus) are usually used. This process can hurt and it is often distressing and embarassing, but it has to happen. Your doctor may have other strategies for this.
- Your child needs to have a diet which makes softer poo (high in fibre for example) and more water to drink.
- Usually laxatives are also used to make the poo slippery, so that it can come out more easily. Paraffin oil in a mixture that tastes reasonably acceptable may be recommended.
- Behaviour modification programs with 'star charts' and rewards do not work at the beginning because the child cannot control his poo. Other behaviour change programs will often be recommended, such as regularly going to the toilet a short while after a meal when the bowel is active and it might be easier to pass poo.
- Because soiling is distressing for children and some stress may have triggered the soiling, seeing a counsellor can be helpful.
Parent Helpline 1300 364 100
CAMHS (Child and Adolescent Mental Health Services)
Raising Children Network
Garfunkel LC 'Constipation and encopresis' in Garfunkel LC, Kaczorowski J, Christy C, (Ed) Pediatric Clinical Advisor', Mosby 2007.
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).
This topic may use 'he' and 'she' in turn - please change to suit your child's sex.