Health Topics

Soiling is often the result of constipation.  Constipation often begins when children hold back, or “with-hold,” their bowel movements.  Children will tighten their bottoms, cry, scream, hide in corners, cross their legs, shake, get red in the face or dance around to try and hold in their poop. Parents often will confuse these behaviors for trying to pass poop when actually children are trying to hold in the poop. Some reasons that children start holding bowel movements include:

• Pain before, during or after pooping
• Illnesses
• Hot weather
• Changes in diet, not drinking enough fluids
• Travel
• Diaper rashes that cause pain when the child has a bowel movement
• Having to use bathrooms that offer less privacy than children are used to using
• Not taking the time out during play or other activities to go to the bathroom when children feel the urge to poop

When children hold in their poop, the lower colon fills up.  Over time this can stretch the lower colon out of its normal shape.  The more a child holds in poop, the more the colon stretches and the poop gets larger and harder. This makes pooping even more painful. When this happens over and over again, the colon becomes so stretched and floppy that the muscles children use to help push out poop, do not work well.  Hard poop can get stuck and only liquid can pass around the hard poop.  The stretched nerves become less sensitive and the child does not feel the leaking poop.              

Children who have emotional or behavioral issues can have trouble with soiling.  There are more serious medical problems that children are born with that can cause encopresis, but these are rare.  Your health care team can talk with you more about these causes.

Some children will hold their poop in for many days then pass a very large, hard stool.  This poop can be so large that it clogs the toilet but children will also leak liquid poop at the same time.  Often parents of children who soil will share that the children use a lot of toilet paper trying to clean themselves.   Some children will refuse to poop in the toilet at all.

Other things you can see in children who soil:

• They may hide their soiled underwear or clothes
• Children who have trouble with soiling often cannot feel or even smell that they have soiled  
• They may also have trouble with bedwetting or have urine accidents
• Children may get teased causing them not wanting to go to school, to play with friends and this can lead to other problems with behavior

A doctor or nurse practitioner will examine your child, and obtain a medical history. Testing is usually not required but might include:

• Abdominal x-ray - a test to evaluate the amount of stool in the large intestine.
• Contrast enema - a test that checks the intestine for blockage, narrow areas and other abnormalities.

Treatment for soiling will be guided by child’s healthcare team with you and your child’s input.   

Treatment includes:

• Cleaning the hard stool out of the lower colon
• Keeping bowel movements soft so the stool will pass easily
• Toilet sitting at least twice a day (if age appropriate)
• Retraining the intestine and rectum to gain control over bowel movements

It is very important that you develop a routine and stick to it.  Long term success depends on how well you can follow the care plan.  This treatment will take many months of hard work for you and your child.  There is no quick fix for this.

Your child's doctor or nurse practitioner will often order medications to help keep your child's bowel movements soft. This will help your child not to hold in their poop and over time will allow the colon to return to its normal shape and function.  Please do not give your child stool softeners without the approval of a doctor or nurse practitioner. 

Diet

There are certain dietary changes to consider when helping a child with constipation and/or soiling.

• Adding more fruits and vegetables
• Adding more whole grain cereals and breads
• Encourage your child to drink more fluids, especially water
• Limit fast foods and junk foods that are usually high in fats and sugars and offer more well-balanced meals and snacks
• Limit drinks with caffeine, such as cola drinks and tea
• Limit whole milk to 16 ounces a day for the child over 2 years of age

Diets high in fiber usually help but sometimes can worsen constipation if your child does not drink enough water with a high fiber diet.  Check with your health care provider about how much fiber your child needs every day. 

Plan to serve your child's meals on a regular schedule. Often, eating a meal will cause children to feel the urge to poop.  Serve breakfast early so your child does not have to rush off to school and miss the opportunity to poop.

Exercise

Increasing the amount of exercise children get can also help.  Exercise aids digestion by helping the normal movements the intestines make to push food forward as it is digested.   Encourage your child to go outside and play rather than watch TV or play video games.

• Encourage your child sit on the toilet at least twice a day for 3-5 minutes, preferably 15-30 minutes after a meal. Make this time pleasant; do not scold or criticize the child if they are unable to poop.
• Giving stickers or other small rewards and making posters that chart your child's progress can help motivate and encourage him / her.
• Until the lower colon regains muscle tone, children may still soil. Pre-school children may be able to wear a disposable training pant until they regain bowel control.
• Taking a change of underwear and / or pants to school can help decrease your child's embarrassment and improve his / her self-esteem as bowel control improves.
• Talk to school teachers about your child's need to be able to go to the bathroom at any time. Many children prefer privacy in bathrooms and will avoid going to the bathroom at school.