Encopresis, Soiling and Constipation

Many parents may spend a bit of time worrying about how many times their 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 trauma or constipation, hence, 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 the stool in the rectum is overcome by the stretch of the enlarged rectum and stool then leaks out without the child knowing.

Children express their feelings through their behaviour

  • Young children have limited ability to think and be reasoned with.
  • They can’t link their feelings, thoughts and behaviour in their early years.
  • The sections of the brain responsible for these areas are not ‘switched on’ in early childhood, starts at 5-6 years of age.

Children show their feelings through their behaviour, due to the underdeveloped emotional brain:

When they are distressed they show it through their behaviour. Hence, we might notice they suffer from:

  • Sleeping, feeding & toileting difficulties
  • Separation anxiety
  • Anxiety, sore tummies and headaches, safety behaviours.
  • Anger / tantrums / aggression
  • Over-activity
  • Shyness Withdrawal

Some young people have these feelings due to the soiling but in my experience, it may due to feelings about the trauma, anxiety, life circumstances. They do not have the capacity to talk out or express their feelings. Hence, they may hold on to their poo, they may be frightened of the toilet, some children are frightened of falling down it or even being consumed by the toilet.

Your Childs Emotional Brain

Children are mostly in their downstairs brain. Soiling and constipation are part of the limbic system as above. The deepest and most ancient part the Reptilian Brain ( not quite just lizards) controls basic, instinctive functioning and regulation. Hunger and elimination ( toileting, this is why you also want to go to the toilet a lot of you are anxious)

What can help:

Fussy and Faddy eating1. This has to be a multi-faceted approach that 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 the medication 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 the siling or constipation due to feelings of shame so try having a word for it. For example ” sneaky poo”.

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 older children have a box with nice clean up things ( such as nice wipes, colourful pants etc). They can bring this to school and place it on a shelf in the disabled toilet. In my experience, teachers are more than happy to accommodate this.

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

I’ve worked with many children who soil, 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.

In Conclusion

I am thinking of running an online workshop in Autumn 2020 on the Psychological aspects of this, if you/group are interested in me hosting one, then do contact me below.

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 


Nice Guidelines

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