Encopresis, Soiling and Constipation

Many parents may spend a bit of time worrying about how many times your child goes or is constipated. According to research there is 1-36% of children being constipated and is more prevalent in boys. If your child has constipation or poos in their pants past their developmental age, you might have come across the term ‘Encopresis’  or Soiling?

Eric the Bowel and Bladder Charity define Encopresis as:

‘The passage of a normal poo in an inappropriate place’ – for example a child who chooses to do their poo behind the sofa. It is not associated with constipation. Primary Encopresis is a name given to children never potty trained, Secondary Encopresis can be diagnosed following a trauma or constipation, soiling is an overall term for both.

What goes wrong in the body when we soil

When children become severely constipated, often from withholding their stool, the walls of the rectum stretch. The ability of the external anal sphincter muscles to contract and keep stool in the rectum is overcome by the stretch of the enlarged rectum and stool then leaks out without the child knowing.

What goes wrong in their minds

Children and young people who soil are often distressed, worried, upset, sad or angry. Some young people have these feelings due to the soiling but in my experience, it may due to feelings about the trauma and what may have happened to them, they often don’t know what to do with the feeling. They may hold on to their poo, they may be frightened of the toilet, some children are frightened of falling down it. This makes the toilet and bathroom a scary place to be!

What can help:

Encopresis1. This has to be a multi-faceted approach which includes your pediatrician or GP/school nurse. If your child is constipated then you will need to have a healthy diet, drink lots of water, exercise in combination with the medication that will make the stools softer. I know many parents stop this intermittently but it is important to take it regularly.

2. Going to the toilet at a regular time helps too

3. Help with Emotions

Your child will be feeling awful about this and sometimes scared too. Help them to feel safe by paying with sensory mediums such as paint, clay, and water. Your child will want to ignore this due to feelings of shame so try having a word for it.

4. Help them to overcome their fears about the bathroom and toilet. Make it a relaxing place, let them read a book or listen to music so they feel more relaxed. There are some great fun sheets from Eric here at https://www.eric.org.uk/fun-stuff

5. Help them to clean up

For younger children, this is difficult but for older children have a box with clean up things and this could be the same at school too.

6. Ensure you give your child a positive time with them independently.

I’ve worked with many children who soil can unconsciously want to be a baby and regress for you to care for them, so give them time. Special time each week regardless if they poo in their pants.

Remember it is not your fault or theirs and do seek help if you need support and I am happy to offer psychological support once your GP or Paediatrician has examined your child in the first instance, contact me here.

For more Information and References:

Royal College of Psychiatry 

Eric

Nice Guidelines