Soiling is defined as emptying bowels in places other than the toilet. Even if a child is toilet trained, you may notice that they are still having accidents by finding poo in their underwear.

If your child is toilet trained and is experiencing soiling after the age of four, it’s important that they are medically assessed. As for how common it is, studies have shown that soiling (also known as encopresis or faecal incontinence) affects 3% of 4-year-olds and 1.6^ of 10-year-old children. It’s also estimated that 0.75% of kids between the ages of 10 and 12 also experience soiling [1, 2].

While many cases of soiling may not be serious and the child can be helped with, you need to ensure that there are no other underlying issues causing the soiling.

This article will give you more information on the reasons why soiling may be occurring in your child even after toilet training and what you can do to both prevent and manage the condition.

The most common cause of soiling in children is chronic constipation. In fact, up to 25% of children can be experiencing constipation at any time.

When a child is chronically constipated over a long period of time, poo will build up in their rectum. This can then cause the rectum to stretch and therefore the child might lose the urge to go to the toilet. Essentially, the stretched rectum can also allow soft or liquid stool to overflow around the constipated stool without the children feeling it.

If you’re unsure how to tell whether your child is constipated, the general rule of thumb is that if a child passes a soft, medium-sized stool without any problems (straining for example) every three days or less, they are not constipated.

However, if they’re passing a hard stool (small or large) or small little ‘pebbles’ or ‘balls’ of stool every other day, then they may be constipated. The same goes if they experience the feeling of stool being stuck in their rectum.

Ask your child to communicate with you about their toilet habits so you can monitor and action medical assistance should you need to.

You and your child can also refer to the Bristol Stool Chart to identify what their bowel movements look like against what a healthy one looks like.

The causes of hard stools and constipation can include:

• Lack of fibre and overall diet

• Illness

• Not drinking enough water and fluids

• Fear of going to the toilet

• Limited access to a toilet

Some children may also develop chronic constipation following stressful life events, such as bullying, divorce or the death of a relative.

Other causes of soiling or faecal incontinence in children can include:

• Neurological disorders

• Developmental delays

• Abnormalities of or nerve damage to the anus/rectum

• Rectal surgery

As mentioned, the main symptom of soiling is doing a poo in places other than the toilet, which is most often in the child’s underwear. This can range from ‘skid marks’ to larger bits of stool.

If your child is constipated you may notice that they strain or feel pain when they poo, have stomach pains, or they having less frequent bowel movements (because they tell you or because you may still accompany them to the toilet).

Other signs your child is experiencing soiling can include:

• They experience a sudden urge to have a bowel movement and can’t get to the bathroom in time

• Itching or rubbing the anal region because it’s been irritated by watery or hard stools

• Emotionally and socially withdrawing from family and friends

• Hiding their worn/dirty underwear

Your first port of call, if you notice your child is experiencing soiling, is to visit their GP.

Ensuring your child receives a professional medical assessment means they'll receive the appropriate treatment and avoid the condition worsening.

A medical assessment can include:

• Using a stethoscope to listen to sounds coming from the abdomen

• Checking the abdomen for swelling, tenderness or pain, masses or lumps using gentle hand pressure

• Checking blood pressure, temperature and heart rate

• Checking for signs of dehydration (dry mouth, lips and eyes for example)

• A rectal exam

During the medical assessment, the doctor may also decide on a blood test, stool test, and/or an X-ray or ultrasound of the abdomen.

A toileting program or schedule may be prescribed for your child and could involve them taking laxatives if necessary. Changes to diet and lifestyle factors may also be suggested to help both manage and prevent further constipation.

If the problem doesn’t resolve, the GP may then refer the child to a paediatric gastroenterologist for further testing.

While your child is undergoing treatment, it’s recommended you make their school aware so they can receive adequate support should they experience any faecal incontinence during school hours. Managing incontinence at school can be done in a private and respectful manner, so be sure to reassure your child that they can maintain a level of discretion to avoid possible embarrassment.

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Diet, exercise and other lifestyle factors can play a significant part in preventing constipation in children, which can therefore help prevent soiling incidents.

Here are some things you can do at home to help prevent soiling:

• If relevant for your child’s age group, set up a rewards chart where you put a sticker every time they go to the toilet (whether for a wee or a poo)

• Make sure your child is eating enough fibre in their diet and drinking plenty of water to keep hydrated

• Encourage your child to be physically active every day, for at least half an hour

We hope this article has given you some helpful and practical tips to help your child through soiling incidents. Remember, always seek professional advice from your doctor.

Citations:

1 - Rex DK, Fitzgerald JF, Goulet RJ. Chronic constipation with encopresis persisting beyond 15 years of age. Dis Colon Rectum 1992;35(3):242-4. 8.

2 - Bellman M. Studies on encopresis. Acta Paediatr Scand 1992; 170(l)