Stool Soiling and Constipation in Children

Stool soiling (encopresis) happens in children who are toilet trained. It’s when they accidentally leak feces (poop) into their underwear. Constipation is one of many causes of stool soiling. Other causes include irritable bowel syndrome or when a child is fearful of the bathroom. In rare circumstances it is caused by disease or birth defects. Usually, the amount of soiling is small. It just stains the underwear. In most cases, it is involuntary. This means your child does not mean to soil his or her pants. If soiling happens often (daily or throughout the day), your child may need to see a doctor.

Path to improved health

It’s possible that your child is going through “a phase.” Or your child may not have the skills yet to use the toilet. However, stool soiling is often the result of children holding in their poop for many days. This can lead to constipation. It’s important to teach your child to know when it’s time to go to the toilet. Note that young children should tell a parent before they use the bathroom, in case they need help.

Here are some steps you can follow to toilet re-train your child for bowel movements:

Keep a toilet diary

Record when, where, and what kind of bowel movements your child has. The diary helps you and your doctor see patterns in your child’s bathroom activity. If your child is in daycare, ask the teacher to help you track patterns in your child’s toileting. Try to keep a toilet diary for at least 1 week before moving to the next step. Below is a sample toilet diary you can print out and use at home or daycare.

When your child has a bowel movement or urinates, enter the day and date in the first column of the diary. In the second column, record the time, along with the code that best describes that bathroom activity. See the code list below. Fill out this diary each day.

Codes:

• BMT=bowel movement in toilet
• BMP=bowel movement in pants
• BMB=bowel movement in bed
• PS=practice sits
• UT=urinates in toilet
• UP=urinates in pants
• UB=urinates in bed

Make sure your child’s bowel movements are soft and well-formed

It helps if you give your child fewer dairy foods and more high-fiber foods. If your doctor approves, you may be able to give your child fiber supplements for a short time. Ask your doctor about diet changes, too.

Have set times for sitting on the toilet

Once your child has healthy bowel movements and sits on the toilet, have him or her sit on the toilet at regular times during the day. 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.

Reward bowel movements in the toilet

When your child has a bowel movement in the toilet, give them a reward. Good rewards include stars on a chart or fun activities. Give a reward after every bowel movement in the toilet. Later, give the reward after every few bowel movements. This is a good way to encourage pooping on the potty and not holding it in.

Things to consider

There are many reasons your child may not want to use the bathroom for a bowel movement. They may be scared of being alone in the bathroom. They may be scared of the toilet. Some children just don’t want to stop playing to go to the bathroom.

If bowel movements have been painful in the past, your child may “hold” their stools when they have the urge to pass one. They do this to avoid the pain. This can lead to constipation. Constipation may occur if:

• Your child is not eating enough high-fiber foods, drinking enough water, or getting enough exercise.
• Your child has an illness that causes them to have a fever and not to eat much. This problem can remain even after the illness goes away.

In many children, the cause for constipation cannot be found.

Children who have constipation may have soft or liquid stools leak from the anus (the opening to the rectum). This is caused by a mass of stool stuck in the lower bowel. This happens because the amount of stool can become so large that it leaks out of the anus, causing soiling. These stools have a very bad smell.

Symptoms of constipation include:

• Extreme straining during a bowel movement
• Abdominal pain and bloating
• Crankiness
• Tiredness
• Loss of appetite between bowel movements
• Wetting during the day or night
• Extreme reluctance to use the toilet

If your child doesn’t have a bowel movement for 3 or 4 days in a row, call your doctor. They may 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. This is medicine that is inserted into the anus. Your doctor also may have you give your child 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 daily laxatives to help soften the stools.

Questions to ask your doctor

• How do I know if my child is ready for toilet training?
• What are some tips to help my child clean up any messes?
• How long does it take to toilet train?
• Is it true girls toilet train faster than boys?
• Can lactose intolerance contribute to the problem?
• Can it just be a hygiene problem?

Resources

Mayo Clinic: Encopresis