Soiling (encopresis) in children

What is soiling?

Soiling occurs when your child is unable to control a bowel movement. The child soils their pants, or has an "accident" before reaching the toilet. Soiling is also called encopresis.

All children who have been toilet trained have the occasional accident. This is normal, especially in two to four year-olds. Concerns arise when your child is soiling often after being toilet trained.

Causes of soiling

Constipation is the most common cause of soiling. When children are constipated, it is difficult and painful to pass the hard stool. Fecal liquid leaks around the hard retained stool, and out of the anus.

Some children, especially toddlers, will start to hold their stool, because they are not ready to toilet train, or because of painful bowel movements due to constipation. This can start a cycle of holding, constipation and soiling.

Another cause is illness. Children with diarrhea may have a hard time controlling their bowel movements. This usually goes away when the diarrhea improves.

Sometimes, soiling is associated with emotional or behavioural difficulties.

Some very rare neurologic or spinal cord diseases can cause soiling. These children may also have peeing accidents, and clumsiness or weakness of their legs.

How you can help your child control their bowel movements

Prevent and cure constipation

Make sure your child is not constipated. If they are not interested in toilet training, be patient and give them time. Do not punish your child. Humiliation and anger are not good ways to prevent soiling.

Be helpful, not hurtful

Encourage other members of the family to offer support. One way to do this is to reduce anxiety as much as possible. Another option is to encourage your child to pass stools frequently.

Establish routine

One toilet training tip is to have your child sit on the toilet for about five minutes after every meal. Give your child a book to read or have music playing in the bathroom. Reward your child every time they pass stool into the toilet. Support and praise this behaviour. Continue this pattern for three to six weeks, or until soiling stops.

When to seek medical assistance

See your child's doctor if your child:

• is also having trouble peeing, walking or with balance (this is an emergency)
• is passing stool in places other than the toilet or potty, or hiding soiled underwear
• is soiling very often
• has stools that are very hard and they are straining
• is still soiling routinely after the age of four years
• starts soiling often after toilet training

Your child's doctor will examine your child, and may order some tests If there is no physical cause for the soiling, your doctor may suggest certain toilet training tips. A child with encopresis may be referred to a child psychiatrist.