Stool soiling, also called encopresis, happens when children who are already toilet trained accidentally leak feces into their underwear. Constipation is often the cause of stool soiling. Usually, the amount of soiling is small and just stains the underwear. In almost all cases, stool soiling is involuntary – your child does not mean to soil his or her pants. If soiling happens often – every day or many times a day – your child may need to be treated for it.
Other causes of stool soiling include:
In very few children stool soiling is caused by disease or birth defects.
Constipation may cause painful or incomplete bowel movements. If bowel movements are painful, a child may try to "hold" his or her stools, making constipation worse. In children who have constipation, formed, soft or liquid stools can leak from the anus (the opening to the rectum) around a mass of stool stuck in the lower bowel and cause soiling. This happens because the amount of stool can become so large that it leaks out of the anus, causing soiling. Often, these stools have a very bad smell.
Constipation may occur if your child is not eating enough high-fiber foods, drinking enough fluids or getting enough exercise. In many children, a cause for constipation cannot be found. Painful bowel movements may cause a child to begin resisting the urge to have a bowel movement. Not having a bowel movement when the urge occurs can lead to constipation. Your child could be scared of being alone in the bathroom or scared of the toilet. Some children just don't want to stop playing to go to the bathroom.
An illness that leads to poor food intake, physical inactivity or fever can also result in constipation and stool soiling. This problem can remain even after the illness goes away.
It's possible that your child is going through "a phase." Your child may not have the skills yet to use the toilet. But, if your child keeps soiling after about 3 months of being able to use the toilet to urinate, it's probably time for him or her to learn to use the toilet for bowel movements. Your doctor can offer advice.
1. Keep a toilet diary.
Keep a "diary" showing when, where and what kind of bowel movements your child has. It will help you and your doctor see patterns in your child's bathroom habits. Try to keep a toilet diary for at least 1 week before going on to step 2. If your child is in day care, ask the teacher to help you look for patterns in your child's toilet behavior. At the end of this handout there's a sample toilet diary you can print out and use to help you.
2. Teach your child to sit on the toilet.
Play in the bathroom with your child to show him or her that the bathroom is not a bad place. Allow your child to sit on the toilet with pants on for a few minutes at a time. It may be helpful to have a foot stool so your child can rest his or her feet. Allow your child to have his or her favorite books, dolls or small toys during bathroom time.
Read to, play with and talk to your child when you're in the bathroom together. Don't expect--or ask--your child to have a bowel movement on the toilet yet. Remember, he or she is still getting used to the idea of sitting on a toilet. Start with a very short amount of time (about 30 seconds) and slowly work up to 5 minutes. A kitchen timer can be the signal for the end of "bathroom fun." Move to step 3 once your child is sitting on the toilet 3 to 5 times a day, for 5 minutes each time.
3. Make sure your child's bowel movements are soft and well-formed.
It helps if you give your child less dairy food and more high-fiber foods. If your doctor says it's okay, you may be able to give your child fiber supplements for a short time. Ask your family doctor about diet changes.
At first, your child may have more soiling accidents. Have your child help clean up messes, but don't yell or punish your child for soiling. Being angry with your child when he or she soils only makes toilet training harder. Try to stay calm and relaxed when your child soils, so he or she won't feel bad.
4. Have set times for sitting on the toilet.
Once your child is having healthy bowel movements and is used to sitting on the toilet, start having him or her sit on the toilet at regular times during the day. Time the sits to start about 10 to 20 minutes after each meal and during times when your child usually has a bowel movement. You'll be able to tell these times from the toileting diary. Your child should sit on the toilet at least 3 to 5 times per day, for about 5 minutes each time.
5. Reward bowel movements in the toilet.
The first time your child has a bowel movement in the toilet, give him or her a reward. Good rewards are stars on a chart or fun activities. At first, give a reward after every bowel movement in the toilet. Later, give the reward after every few bowel movements. Pretty soon your child will be trained. Then you can stop giving rewards.
Next, teach your child to know when it's time to go to the toilet. Teach your child to tell you, instead of waiting for you to ask. Young children should tell a parent before they use the bathroom, in case they need help.
If your child doesn't have a bowel movement for 3 or 4 days in a row, you should call your doctor. He or she will probably want to remove the stool that has collected in the lower bowel. Your doctor can do this in the office by giving your child an enema or a suppository. It is also possible that your doctor may have you give your child high doses of laxatives to remove the stool.
After the stool has been removed, it is important to be sure that your child can have bowel movements easily. Easy bowel movements will help prevent another large collection of stool. Treatment may include changing your child's diet to include more fluids and fiber-rich foods, having your child sit on the toilet several times a day and giving your child laxatives every day to help soften the stools.
Directions: When your child has a bowel movement or urinates:
BMT=bowel movement in toilet
BMP=bowel movement in pants
BMB=bowel movement in bed
UT=urinates in toilet
UP=urinates in pants
UB=urinates in bed
Treatment Guidelines for Primary Nonretentive Encopresis and Stool Toileting Refusal by BR Kuhn, PH.D., BA Marcus, PH.D., and SL Pitner, M.D., M.P.H. (American Family Physician April 15, 1999, http://www.aafp.org/afp/990415ap/2171.html)
Written by familydoctor.org editorial staff