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Soiling in Children: A Guide to Understanding and Support

Frowning little boy sitting on toilet trying to poop
Table of Contents

Soiling, also called encopresis, can cause a great deal of stress for both the child and the parents. It occurs more often in boys than girls and usually starts around age 4.

Soiling can happen because the child is not toilet trained yet. On the other hand, often parents find that their child has started soiling after a period of being toilet trained.

Soiling accidents are likely to occur during the school day when the child is away from home and parents are not able to provide immediate assistance. Children with soiled underwear can face teasing and bullying from other kids in school.

This can lead to low self-esteem and anxiety in kids. While soiling can make you feel frustrated, as a parent, have patience and offer encouragement to help your child overcome this issue. If your child is soiling, there are many ways to help them. But before that, let’s take a look at what soiling is and why it happens.

What is Soiling?

Soiling or encopresis is a condition in which a child intentionally or unintentionally (mostly) passes stool in their clothing. In this condition, the child is already toilet trained but has accidents due to constipation or holding their stool for too long. Soiling can also happen because the child has not yet developed the ability to control bowel movements.

Types of Soiling

The two mainly two types of soiling are:

  1. Soiling with Constipation
  2. Soiling without Constipation

Soiling with Constipation

In this type, soiling happens because the kid is holding in their stool for too long due to constipation. The stool becomes hard and dry, making it difficult to pass. The new poo can seep around the old hard poo and therefore cause soiling.

Soiling without Constipation

In this type, soiling happens because the child has not yet developed the ability to control their bowels. This can be due to a delay in toilet training or medical conditions such as neurological conditions. Soiling without constipation is also called non-retentive encopresis.

Why do Children Soil?

Most kids usually struggle with soiling because of constipation. When kids are constipated, they may withhold their stool because it hurts to pass it. This can cause the stool to become hard and dry, making it difficult to pass. When the child finally passes the stool, it may be large and can cause the child to continue to withhold passing their stool.

Soiling (encopresis) can be caused by a number of reasons. Some of these are as follows:

Inadequate Toilet Training

Soiling can also happen when a child is in the process of being toilet trained. Some kids may hold in their stool because they don’t want to use the toilet. This can lead to constipation and soiling. So, it’s crucial to provide adequate toilet training to kids to avoid soiling accidents.

Child’s Diet

Certain foods can contribute to soiling. These can include dairy, gluten, cheese, ice cream, chocolate, fast food, soy, eggs, artificial colours and flavours, preservatives, artificial additives, sugary drinks, and so on. Soiling can also happen if a child does not eat enough amount of high fibre foods such as fruits, vegetables, and whole grains.

Anxiety or Stress

Soiling can cause low self-esteem or anxiety in children. Also, it can be a way for kids to express anxiety or stress. For children who have experienced trauma or abuse, it can also be a coping mechanism for dealing with those experiences.

Abuse or Neglect

Soiling or encopresis can also be a result of abuse or neglect. Kids who are neglected or abused may not have access to proper hygiene, which can lead to soiling. It’s important to note that soiling is not the child’s fault and should not be used as a form of punishment. Also, neglecting or punishing kids can be counterproductive and may only make the problem worse.

Constipation

Chronic constipation is one of the most common causes of soiling. When a child is constipated, their stool can become hard and dry. In such cases, a piece of large and hard poop left in the rectum can block the exit of the stool. When this happens, liquid poop leaks around the hard stool and soil the underwear.

Overflow soiling happens when liquid stool leaks from the rectum around a piece of hard poop that is blocking the exit. This can also happen because of chronic constipation. Proper diagnosis can help identify the cause of a child’s constipation and treat it accordingly.

Underdeveloped Anal Sphincter

In some cases, soiling can be caused by an underdeveloped anal sphincter. This is a muscle that controls the release of poop. If this muscle is not fully developed, it can cause soiling. Children with this condition may also have other problems such as incontinence, diarrhea, and other medical conditions.

Health Conditions

There are some medical conditions that can lead to soiling or encopresis. These include neurological conditions, Hirschsprung’s disease, spinal cord abnormalities, cystic fibrosis, and so on. Soiling or encopresis can also be a side effect of certain medications. Often, it can be a sign of a more serious underlying health condition such as Crohn’s disease, ulcerative colitis, or celiac disease. If you suspect that your child’s soiling is due to a health condition, it’s important to talk to your child’s doctor. They can check for constipation or other problems and prescribe a stool softener or other medication if necessary.

Symptoms of Soiling

Soiling (encopresis) can be accompanied by a number of different symptoms in children. Some of the common signs include:

Loss of Appetite: One of the most common signs of soiling is a loss of appetite. This can happen because the child feels nauseous or has a poor appetite due to constipation. It’s crucial to make sure that your child is eating enough and getting the nutrients they need.

Changes in Behaviour: Soiling can also cause changes in behaviour in children. Kids may become withdrawn or start acting out. They can also become irritable or have trouble sleeping. It’s important to note that these changes in behaviour can be a result of the child’s embarrassment or shame about soiling.

Lack of Healthy Bowel Movements: A healthy bowel movement is typically soft and easy to pass. If a child is having difficulty passing stool, this can be a sign of constipation.

Straining: If your kid experiences strain sitting on the toilet while discharging faeces, it can be a symptom of constipation. Therefore, it’s essential to pay attention to find out whether your child is straining more than usual while passing the stool.

Passing Stool in Underwear: One of the most obvious signs of soiling is passing stool in underwear. This can happen because of a number of different reasons such as constipation or any other underlying medical condition.

Passing Gas: Another common symptom of soiling is passing gas more frequently than usual. This can be a sign of poor digestion or other digestive problems. Consider keeping a food diary to track which foods seem to trigger the gas.

Unusual Abdominal Pain: Soiling or encopresis can also cause abdominal pain in children. This pain can be due to constipation or other medical conditions. Listen out to your child if they are complaining of tummy aches or pain.

Rectal Bleeding: In some cases, soiling can cause rectal bleeding. This is usually a sign of a more serious underlying condition. It’s extremely crucial to talk to your child’s doctor if you notice any rectal bleeding.

Skid Marks in Underwear: Another symptom of soiling is skid marks in the child’s underwear. This can be caused by constipation, diarrhoea, or incontinence and lead to soiling.

Hiding Soiled Clothes: Kids who soil their clothes may try to hide them from others. They may be embarrassed about soiling their clothes and try to keep it a secret. This can be a sign that your child is dealing with soiling.

How is Soiling Diagnosed?

Soiling or encopresis can be diagnosed based on the child’s symptoms and medical history. A physical exam may also be done to look for any underlying medical conditions. In some cases, imaging tests such as an X-ray or MRI may be done to check for constipation or other problems.

A stool sample may also be taken to check for bacteria, parasites, or other infections. If soiling is due to a psychological problem, a mental health evaluation may be done.

How is Soiling (Encopresis) Treated?

The treatment for soiling depends on the underlying cause. If soiling is due to constipation, treatment will focus on relieving constipation. This may involve changes in diet, stool softeners, laxatives, enemas, or other treatments.

If soiling is due to an underlying health condition, treatment will focus on that condition. If soiling is due to a psychological problem, treatment will focus on that problem. Soiling can be treated with a combination of medical and behavioural interventions.

Medical interventions may include:

Changes in Diet: A change in diet may be recommended to help relieve constipation. This may include adding more fibre to the diet or increasing fluids.

Stool Softeners: Stool softeners may be prescribed to help relieve constipation. These can help kids have softer stools that are easier to pass.

Laxatives: Laxatives may be prescribed to help relieve constipation. As with any medication, laxatives should be used as directed by a doctor.

Enemas: In some cases, enemas may be prescribed to help relieve constipation. Consider learning the right way to use an enema before administering one at home. For kids, it’s essential to follow the doctor’s instructions carefully.

Antibiotics: Antibiotics may be prescribed if there is an infection. Often, soiling is caused by a bacterial infection. Kids with soiling issues should only take antibiotics as directed by a doctor.

Surgery: In rare cases, surgery may be needed to treat an underlying medical condition. In such cases, it’s better to prepare your kid for what to expect before, during, and after surgery to ease any fear or anxiety.

Behavioural interventions may include:

Toilet Training: In some cases, toilet training may be recommended. Proper potty training can help kids learn to control their bowel movements and avoid soiling accidents.

Stress Management: Stress can make soiling worse. Learning stress management techniques can help reduce stress and improve soiling.

Positive Reinforcement: Positive reinforcement may be used to help children with soiling issues. This may include praise, stickers, or other rewards.

Biofeedback: Biofeedback is a type of therapy that can help kids learn to control hold in their stool. This can be done with the help of a therapist.

Behaviour Modification: Behavior modification may be used to help children with soiling issues. This may involve changing the way the child responds to soiling accidents.

Psychotherapy: In some cases, psychotherapy may be recommended. This type of therapy can help kids with soiling issues deal with their emotions.

Soiling can be a difficult problem to deal with. It can be embarrassing for the child and frustrating for the parents. But with proper treatment, soiling can be resolved.

How to Stop Poop Accidents and Promote Healthy Bowel Movements

When children have soiling issues, it can be difficult for them to feel comfortable and confident. Soiling can cause anxiety and low self-esteem in children. If your kid is soiling, there are things you can do to help. Working with a doctor or therapist can help your child overcome soiling issues.

You can also help your kid by being supportive and understanding. Talk to your kids about soiling in a calm and positive way. Help them understand that soiling is not their fault and encourage them to keep trying to overcome soiling. Be patient and soiling will eventually become less of a problem for your child.

If your kid is soiling, here are some things that might help:

  • Help your child get to the toilet on time. Set a timer to remind them.
  • Train your kid to sit on the toilet properly.
  • Make sure your little one has a regular toilet routine. Help them establish a regular time for pooping.
  • Encourage your child to eat foods that are high in fibre. This will help with constipation.
  • Make sure your kids are drinking enough water throughout the day.
  • Avoid punishments. Soiling accidents are not under your child’s control. Punishing them will only make the problem worse.
  • Encourage your child to wipe well after a bowel movement. Help them clean their bottom if needed.
  • Talk to your toddler about soiling. Help them understand that it’s not their fault.
  • Encourage your child to keep trying. Soiling is a problem that they can overcome.
  • Be patient and have a proper understanding of the issue. Soiling will eventually become less of a problem.

Conclusion

Soiling can be difficult for children to deal with. Though it can be an embarrassing issue, soiling is not usually a sign of bad parenting or poor hygiene. In fact, most children who soil actually prefer to maintain proper hygiene.

Soiling or encopresis can be caused by a number of different factors and there are many different treatment options available to overcome it. If you find your little one with soiled underpants frequently, consult your doctor for sound advice to help your little one overcome it at the earliest.

Proper diagnosis can help rule out any serious underlying medical problems. Also, support from family and friends can also go a long way in helping your child feel better about themselves. Thus, with the right approach, your child can soon overcome soiling.

Resources:

Soiling (child pooing their pants). (2022). Retrieved 10 June 2022, from https://www.nhs.uk/conditions/soiling-child-pooing-their-pants/#:~:text=Soiling%20is%20when%20a%20child,from%20a%20GP%20can%20help.

Soiling (Encopresis) (for Parents) – Nemours KidsHealth. (2022). Retrieved 10 June 2022, from https://kidshealth.org/en/parents/encopresis.html

Encopresis Causes, Symptoms & Treatment. (2022). Retrieved 10 June 2022, from https://my.clevelandclinic.org/health/diseases/17849-encopresis-soiling

staff, f. (2022). Stool Soiling and Constipation in Children – familydoctor.org. Retrieved 10 June 2022, from https://familydoctor.org/stool-soiling-and-constipation-in-children/

(2022). Retrieved 10 June 2022, from https://www.nationwidechildrens.org/conditions/fecal-incontinence

Library, H., & Children, E. (2022). Encopresis in Children | Causes, Diagnosis & Treatment. Retrieved 10 June 2022, from https://www.cincinnatichildrens.org/health/e/encopresis

default – Stanford Children’s Health. (2022). Retrieved 10 June 2022, from https://www.stanfordchildrens.org/en/topic/default?id=encopresis-90-P01992

Soiling | Continence Foundation of Australia. (2022). Retrieved 10 June 2022, from https://www.continence.org.au/who-it-affects/children/soiling

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