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 well being

It’s possible that your child is going through “a phase.” Your child may not have the skills yet to use the toilet. Teach your child to know when it’s time to go to the toilet. Teach your child to tell you and not wait for you to ask. Young children should tell a parent before they use the bathroom, in case they need help.

If your child keeps soiling after about 3 months of being able to use the toilet to urinate, it’s time for him or her to learn to work on bowel movements. Here are some tips to toilet train your child for bowel movements:

  • Keep a toilet diary. This shows when, where and what kind of bowel movements your child has. It helps 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 track patterns in your child’s toileting. Below is a sample toilet diary you can print out and use at home or daycare.
  • Teach your child to sit on the toilet. Play in the bathroom with your child to teach him or her that the bathroom is not a bad place. Allow your child to sit on the toilet with pants on at first. 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 in the bathroom. 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 at first. Remember, he or she is still getting used to the idea of sitting on a toilet. Start with a very short amount of time (30 seconds). 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.
  • 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 family doctor about diet changes. At first, your child may have more soiling accidents. Have your child help clean the messes. Don’t yell or punish your child for soiling. Being angry with your child when he or she soils only makes toilet training harder. Stay calm when your child soils, so he or she won’t feel bad.
  • 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. Time them 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.
  • 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 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. Pretty soon your child will be trained. Then you can stop giving rewards.

Things to consider

Constipation may cause painful or incomplete bowel movements. If bowel movements are painful, a child may try to “hold” his or her stools. This makes constipation worse. In children who have constipation, formed, soft, or liquid stools can leak from the anus. This is 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.

Constipation may occur if your child is not eating enough high-fiber foods, drinking enough water, 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.

Constipation symptoms 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.

Treatment

If your child doesn’t have a bowel movement for 3 or 4 days in a row, call your doctor. He or she will 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 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.

Stool Soiling Diary

Day/date TimeTimeTimeTimeTimeTime
Mon/4-229 a.m. BMB, UB12 p.m. PS, UT2 p.m. BMP, UP

Directions:

When your child has a bowel movement or urinates:

  • Put day of week and date in the first column.
  • Put time of day in “Time” column.
  • Add the code to the “Time” column.
  • Continue 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

Questions to ask your doctor

  • How do I know if my child is ready for toilet training?
  • Can lactose intolerance contribute to the problem?
  • Can it just be a hygiene problem?