Key points to remember about soiling

Soiling occurs without your child knowing - it is not deliberate.

• 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 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 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 children. It can happen in any child, toddler or teenager.

What causes soiling?

• soiling is usually caused by long-lasting constipation and an overloaded bowel
• for a few children, emotional and behavioural problems are a factor rather than constipation - you may need professional help for 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 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 the constipation being obvious - 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 for soiling?

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 suggest your child sees a specialist nurse or doctor if:

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

What is the treatment for 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

See Constipation treatment [1].

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.

What can I do to help my child with soiling?

Soiling problems can be frustrating and upsetting for parents and children. 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.

Remember the poo is the problem, not your child. Don't blame them.

• educate and encourage your 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 treatment is 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
• talk to your child's school about a separate toilet where your child can clean and change themselves when needed
• soiling is upsetting and can cause other behaviour problems which usually improve when the soiling is treated