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
- Hot weather
- Changes in diet, not drinking enough fluids
- 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 healthcare team can talk with you more about these causes.