Encopresis is the medical term for a toilet-trained child (aged four or older) soiling their clothes.
They usually cannot help it, and some children may not even realise they've had an accident.
The soiling usually happens during the day, when the child is awake and active, often in the late afternoon.
Children who have this problem may feel ashamed, guilty, frustrated or angry, and may act secretively to try and hide the problem.
If your child is aged four or older and soiling their clothes, or if they are constipated and reluctant to pass stools, see your doctor.
In the meantime, you can read on to learn the likely cause of your child's problems and how you can help them.
Why is my child doing this?
Most children who soil their pants are severely constipated.
They may ignore the urge to go to the toilet and 'hold on' to avoid the pain of passing stools. This leads to faecal impaction – when a large, solid stool becomes stuck in their rectum (back passage) and begins to stretch and weaken the surrounding muscle walls. Watery stools then leak out from around this blockage.
At first, you may just notice streaks in your child's underwear and assume they are not wiping properly, but it will usually get worse and can lead to entire bowel movements in their underwear.
Children who do not get enough fibre and fluids in their diet may be at risk of becoming constipated. However, a poor diet alone is rarely the cause of childhood constipation.
Constipation may also be related to a lack of toilet training or toilet training at too early an age. Constantly intervening when your child is using the toilet may make them feel anxious about it and reluctant to go, which only makes the problem worse.
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How would my doctor diagnose and treat it?
Your doctor may want to physically examine your child to see if they have faecal impaction. This normally just involves feeling your child's tummy.
Sometimes anis needed to see how much stool is in your child's bowel and to see if their bowel is enlarged as a result.
If your child has faecal impaction, the first step is to prescribe laxative medication to rid their bowel of the hard, retained stools and to prevent further constipation. Your child will also need to follow a balanced diet and be encouraged to pass stools regularly.
Your doctor may prescribe an osmotic laxative such as macrogol, which is a sachet of powder you dissolve in water for your child to drink.
This will increase the amount of fluid in your child's bowel to soften their impacted stools and stimulate their body to push them out.
Your doctor or nurse will explain how many sachets your child will need to take each day and how much water to add to the powder. Once the powder has been mixed with the water, you may add fruit juice or squash to improve the taste.
To start with, your child will be on a higher dose to clear their bowel ('disimpaction'), then a reducing dose to maintain regular emptying of the bowel. Your doctor will tell you when to stop the medication, but this will be after the dosage has been gradually reduced.
If you stop the laxative medication abruptly or before your doctor recommends, the bowel may not have recovered to its usual size and function and your child may become constipated again.
Some children may need to continue taking laxatives for several years, and a few children for longer, to completely cure their constipation.
The treatment to get rid of impacted stools may initially increase your child's soiling and tummy pain, but it is important to follow the course that your doctor has prescribed.
There is no evidence to support the commonly held belief that using laxatives produces a 'lazy bowel'.
Your child should have a well-balanced diet that includes lots of fibre – fruit, vegetables, and wholegrain foods such as wholemeal bread and pasta. They should also drink plenty of fluids.
Children with chronic (long-term) constipation normally don't have anything physically wrong with them, but it can take time to correct the problem, so be patient.
Healthy toilet habits
Try to minimise stress or conflict associated with using the toilet.
Establish a regular routine where, for example, they sit on the toilet for 5-10 minutes after breakfast and again after dinner every day. Be positive and encouraging about this routine. Also, encourage your child to go to the toilet as soon as they have an urge to go.
It might help to make a diary of your child's bowel movements linked to a reward system.