If a child is toilet trained and still soils his or her pants, it can be embarrassing for the child and frustrating for the parents. The child may be scolded for misbehaving, but their actions may not only be related to behavioral issues. They could potentially have a condition known as stool soiling, a problem with bowel movements.

Children over the age of 4 who soil their clothes frequently may have a condition known as encopresis. Encopresis causes a dulling of the normal urge to have a bowel movement. Subsequently, a child then cannot control the accidents that occur. Encopresis happens when a child resists bowel movements, causing a collecting of impacted stool in the colon and rectum. When the impacted stool fills the colon, liquid stool leaks around the impacted stool and out of the anus, causing soiling.

Chronic constipation is the main cause of encopresis. With constipation, the stool becomes hard and painful to pass, so the child tries to avoid a bowel movement, making the situation worse. When the colon cannot hold the stool anymore, it signals the nerves and muscles to push the stool out.

Constipation occurs due to a lack of fiber, not drinking enough water, ingesting too much dairy, intolerance to milk, irritable bowel syndrome, some genetic conditions, and diseases. Emotional stress such as a recent family change, the birth of a brother or sister, or toilet training can contribute to encopresis.

Symptoms of encopresis include:

Constipation

Urinary tract infection

Holding of stool

Cramps

Loss of appetite

Abdominal pain

Treatment should be started as soon as possible. A doctor may recommend one or more treatment methods such as colon lubricants, stool softeners, enemas, or rectal suppositories. A high fiber diet and use of stool softener is advised for at least six months. It may be difficult to get children to eat fiber, but kid-friendly recipes such as apples with peanut butter; bran waffles with fruit toppings or whole grain pancakes can make fiber more palatable.

If necessary, a counselor or psychiatrist can help the child overcome issues related to stool soiling. The child can learn to overcome stress, as well as any depression or shame they may be experiencing.

Toilet training should begin between the ages of 18 to 24 months. Parents should maintain a toilet diary, noting a child’s bowel movements. This can help the doctor understand the child’s patterns.

The goal of toilet training is to make the bathroom a comfortable place for the child. When training, a child should be taught how to sit on the toilet seat. If they cannot reach the seat or their feet do not touch the ground, a foot stool should be provided. Allow them to bring their favorite books or toys. A child should not be expected to pass stool immediately. Start by allowing them to stay on the toilet for 30 seconds, and then gradually work up to 5 minutes. This should comfortably ease them into the idea of toilet use. Another suggestion is to establish patterns of expectation for the child such as spending time on the toilet after each meal. This takes advantage of a normal reflex to evacuate the bowels after filling the stomach.

Once the child starts having healthy bowel movements, he or she should use the toilet at regular intervals. Once a pattern of bowel movements is established, it should be noted in the diary and shown to the doctor. Regular bowel movements for a child means they are going three to five times a day and sitting for at least five minutes. Reward the child for every successful bowel movement. Rewards will encourage the child to go to the toilet. Once bowel movements are regular, the rewards can end.

When a child soils their clothes, it is crucial for parents to remain calm and not scold the child. The parent could let the child help in cleaning the accident, but this should not be used as punishment.

Conclusion

Treatment of stool soiling relies on the support a child is given. Positive encouragement can make treatment easier for a child, as can rewards. Most importantly, parents should not lose patience and strive to give the child all the emotional support he or she needs to move past this problem.