Fecal soiling, referred to medically as encopresis in children over four years of age, affects about 1.5 percent of young school children, with boys outnumbering girls by a ratio of six to one. While much rarer than accidental urination or minor leaks, it can be more upsetting to both parent and child. Not only is the odor more noticeable and disturbing, but children as young as two are expected in our culture to “know better” than to soil their pants.
In most cases, however, fecal soiling is not voluntary, but occurs when emotional stress, resistance to toilet training, or physical pain during bowel movements causes a child to resist having bowel movements. This resistance, or stool retention, leads to constipation, which in turn leads to involuntary leakage or soiling when the pressure becomes too great. If this continues to happen, the muscles involved in stool ejection may begin to stretch, and nerve sensations in the area diminish, making it more difficult for the child to feel the need to defecate. The intestines may lose their ability to contract, making bowel movements even more of a challenge and fecal soiling more likely.
In most cases, the best way to approach the problem of fecal soiling due to constipation is to address the underlying issue that is causing your child to resist having a bowel movement. He may stop retaining stool if you ease the pressure to use the potty, for example, or if you stay with him while he defecates—and as his bowel movements become more regular, his fecal soiling may disappear.
If the problem continues beyond one or two accidents, however, be sure to make an appointment with your child’s pediatrician. He will review your child’s medical history to determine whether a physical condition rather than stool retention may be causing the soiling. Congenital megacolon or Hirschsprung’s disease (a congenital condition that prevents a child from feeling the sensation of having a full bowel), ulcerative colitis, allergies, or even a diet containing too many dairy products or high-fat foods can sometimes lead to accidental soiling.
If these physical causes have also been eliminated, emotional or psychological causes should be considered. Fecal soiling can occur when a child is anxious or emotionally distraught over some aspect of his life over which he has little control, such as family conflicts, academic difficulties, or problems with social relationships. Physical and sexual abuse may also need to be considered if soiling continues.
Of course, it is quite possible for any young child to have even this kind of accident once or twice. No matter what the cause, your child needs to know—and needs to know that you know—that what has happened is not his fault.
As with bedwetting, the situation is best corrected by quickly cleaning up, avoiding shame and embarrassment as much as possible, and providing him with the information he needs to better control his bowel movements and keep his clothes clean. Once your child’s feelings are protected, you can take action to identify the underlying cause, with the understanding that a remedy may take some time.