What is soiling, or encoporesis?
Soiling, or encoporesis, happens when a child passes all or part of a bowel movement into underwear or pajamas without meaning to. Often a child is actually not aware that soiling has happened until alerted by the smell.
This can be enormously frustrating for parents and caregivers, who may struggle to understand how a child can have a bowel accident without being aware of it.
And it is almost always embarrassing for a child, particularly if it continues even when a child is trying to pay attention and avoid accidents.
What causes soiling?
There are several causes of soiling.
- Constipation: this is actually the most common cause of soiling. If a child fails to pass all the stool he produces in the day, over time leftover stool can build up in the bowel. This becomes a hard plug and stretches the rectum (the last part of the bowel where stool is held before passing). New stool then begins to seep around the plug and out into the underwear. Because constipation has built up over time, a child can lose sensation of when the bowel movement is leaking out.
- Delayed toilet training: when training is delayed, constipation has often already started to develop, which leads to soiling.
- Developmental delays: soiling is more common with delays of muscle tone (motor development) and learning (cognitive development). Sometimes this is part of a genetic sydrome, such as Down Syndrome, for example.
- Emotional problems, which can lead to defiance and oppositional, or resistant, behaviour.
- Toilet refusal: refusing to use the toilet for bowel movements, and prolonged use of diapers or pull-ups can result in soiling as well.
Which children are more likely to have soiling?
Soiling usually occurs after age 4, although it can start earlier.
Boys are somewhat more likely to experience soiling than girls.
Other risk factors include:
- refusing to use the toilet for bowel movements
- chronic constipation
When should I see my doctor or nurse practitioner?
You should definitely see your doctor or nurse practitioner if there is any suggestion of other developmental delays, including motor development, social connection and learning.
Children with a history of feeding problems should also be assessed if they begin to have soiling.
A physical exam is usually needed, including a rectal examination (done in the office with a gloved, lubricated finger, looking for impacted stool). An x-ray of the abdomen may be needed.
How do I treat soiling in my child?
There are several treatment options, depending on how bad the problem is.
- Toilet time: All children with soiling, no matter what the cause, need to develop a toilet routine. This involves sitting on the toilet for 5 minutes or so after dinner, ready for stool to pass. Your child does not have to push and strain during this time. He or she can take a book, video game, or other activity. This needs to be done for at least 3-6 months or longer, to help your child develop a regular bowel habit.
- Double-stooling: After your child has passed a bowel movement, he or she should remain on the toilet for another 3-5 minutes to allow for more stool to pass. This will help to be sure that all of the bowel movement produced each day is passed.
- Medications: These must be chosen carefully. Some medications, like stool softeners and suppositories, can lead to bowel dependence. With some of these, the bowel can become dependent on the medication to pass any stool. Be sure to discuss medications with your doctor or nurse practitioner before you start, including over-the-counter options.
- Other treatments may be available for children who refuse to use the toilet.
– Dr G Paul Dempsey
Image credits: James Heilman, MD and anthony kelly