Faecal incontinence in children (encopresis)
Underwear soiling is a problem that arises in children commonly as a result of chronic constipation. It is known medically as encopresis or faecal incontinence. Soiling is most common in children aged 3-7 years, and affects more boys than girls.
Why does soiling occur?
Nearly all children who soil are constipated. Encopresis usually develops because your child continually avoids passing stools, for whatever reason.
It may be because of a painful experience going to the toilet in the past, or because they feel anxious or are too busy playing, or they are not allowed to go to the toilet when the urge arises, or because toilet facilities are unpleasant, or they are teased in the toilets.
Sometimes when a child becomes constipated they end up passing very large movements which cause considerable pain. Sometimes they can even cause small tears around the anus (anal fissures), and this can further frighten your child from wanting to go to the toilet.
Over time, their large intestine fills with faeces and stretches, becoming considerably larger than normal. This condition is known as ‘megacolon’. The formed stool becomes impacted.
The more stretched the large intestine becomes, the less sensitive it is to the nervous stimulation that tells your child that they need to go to the toilet. So the condition becomes self-perpetuating.
As a result, liquid faeces from the small intestine may leak around the harder faeces in the large intestine and onto the underwear. At first it might just seem as if your child is not wiping their bottom properly.
If left untreated, the bowel may expand to the extent that the whole movement just exits into the underwear. Because the stool is leaking around the impaction and isn’t being totally digested it can be very smelly and dark in colour.
Is encopresis a behavioural problem?
Children with encopresis are not soiling their pants deliberately, and they can’t stop the ‘accidents’ from happening. They are not being lazy or dirty, and must receive medical assistance to help resolve the problem. If the condition is not managed then it may well lead to the development of behavioural problems associated with shame and embarrassment.
How is encopresis treated?
The treatment for encopresis is similar to that recommended for constipation:
- emptying the large intestine;
- establishing regular bowel movements; and
- keeping regular bowel movements.
To begin with, suppositories, enemas or high-dose oral treatments may be used to empty the intestine. These are given only under the supervision of your doctor or, for severe cases, in hospital.
All future stools must then be kept soft so that they can be passed regularly until such time as the intestine returns to its normal size. This can take some time and is achieved through a combination of dietary change (see below), rewarding good outcomes, and administration of a daily stool softener, such as docusate or liquid paraffin. Your child's age will help determine which is the most appropriate choice.
Stimulant laxatives, such as senna, bisacodyl or magnesium salts, and bulking agents, such as psyllium, should be used only if your doctor recommends them. Never give a laxative to a child younger than 3 years old without consulting your doctor.
What you can do to help
You should never scold your child for soiled underwear as a result of leaking stools, because the action is completely involuntary. Above all, try to be patient and positive rather than angry, disappointed or exasperated. Treatment may take many months, and your child will need your encouragement and support during this time. Try to de-mystify the condition by explaining it to them in simple terms.
Diet
Try to ensure that your child's diet contains adequate fruit and vegetables, fibre and fluid (water and fruit juice). Good sources of fibre are cereals, brown rice, bran, prunes and high-fibre breads.
Toilet times
Regular toilet times are important. Try to get your child into the habit of going to the toilet after breakfast and dinner, as our bowels tend to contract after we eat. They may have to sit on the toilet for 5-10 minutes. Often children won’t go to the toilet when at school so it is important to make these sessions a habit.
Reward good outcomes
Try to make going to the toilet a positive experience for your child. Reward their successes with hugs and praise. Consider using a star chart, and reward sitting on the toilet, not just producing a stool.
Stresses
You might also consider whether there are any underlying stresses in your child's life, such as the arrival of a new baby, that may be contributing to their anxiety, and try to avoid these stresses or deal with them in some way.
Laxatives
Laxatives may be required for 3-4 months and sometimes for up to 6-12 months in younger children, but this should be done under the supervision of your doctor.
Medical help
Consult your doctor for help with underwear soiling in your child. Your doctor is best placed to advise you on a programme to help your child and to take any medical action (such as enemas) or to organise counselling for your child.
Last Reviewed: 13 May 2009
