Soiling

What it is

Encopresis is the repeated passing of stool into inappropriate places, usually the clothing, whether involuntary or, rarely, intentional, in a child who is old enough to have bowel control, generally from around age four. As with bedwetting, the great majority of cases are involuntary, and understanding this is essential to helping the child.

The crucial fact that transforms how this condition is understood is that most encopresis is caused by chronic constipation, not by behaviour or emotional disturbance. When a child becomes constipated and a large mass of hard stool builds up in the bowel, softer or liquid stool from higher up can leak around it and escape without the child feeling it or being able to control it, a process called overflow soiling. The child is typically unaware it is happening and is often as distressed and confused by it as the parents. This is why telling a child to simply stop, or punishing them, does not work and is deeply unfair: they genuinely cannot control it while the underlying constipation persists.

What it can look like, and the toll it takes

Parents may find soiled underwear, sometimes with smears or liquid stool, and may understandably but mistakenly think the child is being careless or defiant. The child may not notice the soiling or its smell, because the bowel, when chronically stretched by constipation, signals less effectively. There may be a history of painful or infrequent bowel movements, very large stools that occasionally block the toilet, tummy aches, or poor appetite. The emotional cost is significant: children feel ashamed and may hide soiled clothing, avoid school or social situations, and lose confidence, especially if scolded or teased. A calm, understanding response protects the child while the real problem is treated.

How common is it

Encopresis is a fairly common childhood problem, more so in boys, and chronic constipation, its usual cause, is very common in children. It often goes unspoken because of embarrassment, which can delay the simple, effective treatment that resolves most cases. Knowing that it is common and usually caused by a treatable physical problem helps lift the shame.

What causes it

In the large majority of cases the cause is chronic constipation with overflow, as described above. Constipation in children can begin for many reasons: a painful bowel movement that leads the child to hold on and avoid going, changes in diet, too little fluid or fibre, illness, stress, or difficulties with toileting such as fear of the toilet or lack of privacy at school. A cycle then develops in which holding on worsens constipation, which makes stools harder and more painful, which leads to more holding on. Less commonly, soiling occurs without constipation and may be linked to emotional or developmental factors, which a clinician can assess. In either case, it is not caused by bad parenting, and treating the child as naughty makes things worse.

How it is treated

Encopresis is treatable, and treatment is mainly medical and behavioural rather than psychological, because the usual cause is physical. The cornerstone is treating the constipation thoroughly and patiently: clearing the built-up stool and then keeping the bowel soft and regular over a sustained period, usually with laxatives prescribed and guided by a doctor, since under-treating or stopping too early allows the cycle to return. Alongside this, a calm toileting routine helps, such as sitting on the toilet at regular times after meals, with encouragement and rewards for effort rather than punishment for accidents. Attention to diet, fluids and fibre supports the bowel. Removing blame is essential throughout. Where soiling occurs without constipation, or where emotional factors are involved, psychological support is added. Most children do very well once the constipation is properly treated, though it requires patience over months.

Encopresis in the African context

Soiling is heavily stigmatised, and a child who soils is often assumed to be dirty, lazy, or defiant, and punished, when in the great majority of cases it is overflow from constipation that the child cannot feel or control. Constipation itself is common and easily overlooked. Embarrassment keeps families from seeking the simple medical treatment that resolves most cases, and the shame falls hardest on the child. The most important shift is understanding: this is a treatable physical problem, not misbehaviour, and a calm, blame-free response protects the child while it is treated.

Helping the child

How adults respond matters as much as the medical treatment.

• Never punish, scold, or shame a child for soiling, since it is almost always outside their control.
• Reassure the child that it is a common, treatable problem and not their fault.
• Stick patiently with the doctor's constipation treatment, since stopping too early lets the cycle return.
• Reward effort and a calm toileting routine rather than reacting to accidents, and keep it private.
• Protect the child from teasing, and seek medical help early. Our find a therapist page can help where emotional factors are involved.