Some of the common symptoms of stool soiling in children include constipation, extreme straining during a bowel movement, less than three bowel movements a week, abdominal pain and bloating, hard, dry and painful bowel movements, crankiness, tiredness, to name a few.
What is Stool Soiling in Children?
Stool soiling happens when children who are already toilet trained accidentally leak feces into their underwear or clothing. This is a common phenomenon among kids and usually happens when the child is constipated, for several reasons, including anxiety, fear, Irritable bowel syndrome, etc. and has a large amount of stool in the colon. It is also called as encopresis and fecal incontinence.
Causes for Stool Soiling in Kids
Constipation is the main cause for stool soiling in children. The amount of soiling is small and just stains the underwear. This soiling may be voluntary by the passage of normal stools in clothing or involuntary by often loose and liquid stools. Involuntary is more common and associated with chronic stool withholding and leakage of stool.
Studies show that approximately 4% of all children 4-27 years of age will experience stool soiling. Mostly affected children are boys.
Constipation decreases the frequency of bowel movements which leads to painful or incomplete bowel movements. Due to this child try to hold the stools which makes constipation worse. In this soft or liquid stools leak from anus (the opening to the rectum)around a mass of stool stuck in the lower bowel and which cause stool soiling. This happens because the amount of stool can become so large that it leaks out of the anus causing stool soiling which has a very bad smell.
Children 1 to 4 years of age typically have a bowel movement 1-2 times a day and over 90% of them go at least every other day. When children are constipated for a long time they may begin to pass stool in their clothing or underwear. Hence, leading to stool soiling.
Cause of constipation is not clear and found. It may occur if the child is not eating enough high-fiber foods, drinking enough water or other fluids. The painful bowel movements may cause a child to begin resisting the urge to have a bowel movement. Therefore, not having a bowel movement when the urge occurs can lead to constipation. Sometimes the child is scared of being alone in the bathroom or scared of the toilet. As a result of this, the child may experience shame and guilt.
Constipation that turns into stool soiling has many different causes. These include-
- Tension and anxiety because of problems during toilet training
- Scared of using the toilet
- Irritable bowel syndrome
- Low fiber diet in fruits, vegetables and whole grains
- Food that causes constipation such as milk, cheese, rice and bread
- Not drinking enough liquids or fluids
- Little exercise or physical activity
- Not paying attention to the feeling or urge to have a bowel movement
- Hypothyroidism and diabetes
- Family history
- Medications like antidepressants
Sign and Symptoms for Stool Soiling in Children
- Extreme straining during a bowel movement
- Less than three bowel movements a week
- Abdominal pain and bloating
- Hard, dry and painful bowel movements
- Foul body odour
- Loss of appetite between bowel movements
- Bedwetting during the day or night
- Pain in the lower abdomen or rectum
- Stool incontinence
- Extreme reluctance to use the toilet
Methods to start toilet training for bowel movements –
- Keep a toilet diary
- Teach the child to sit on the toilet
- Make sure child’s bowel movements are soft and well-formed
- Have set times for sitting on the toilet
Treatment for Stool Soiling in Children
Stool soiling among young children is curable. Children who follow the treatment plan will be able to control their bowel movements. It may take several months or longer for bowel function to become normal and many children may benefit from long-term medication. This is especially true if the child is regularly taking other medications that can cause constipation.
7 Effective Ways to treat Stool Soiling in children:
- Clearing the bowel of the large chunk of stool which is done with medications like laxatives which work by increasing the amount of water in the large intestine. Examples are magnesium citrate and miralax.
- Enemas or rectal suppositories are used which softens the stool in the rectum and creates pressure within the rectum. The pressure gives the child a powerful urge to pass a bowel movement and therefore the stool is expelled rapidly. Widely used enemas include commercial sodium phosphate preparations and suppositories include dulcolax and coorectol.
- Preventing the return of constipation by taking stool softeners like lactulose and mineral oil to allow bowel movements to pass more easily and comfortably.
- Teaching normal bowel habits done by making the child sit on the toilet for 10 to 15 minutes at regular times during the day, including after every meal. Keep on check to follow regular routine for bowel movements.
- Start giving a reward to the child which will motivate them.
- Diet is extremely important for the child. Make sure the child gets plenty of fiber-rich foods such as fresh fruits like strawberries, grapes and dried fruits like prunes and raisins, dries beans and vegetables containing roughage like broccoli and high fiber bread and cereal. These must be included in the diet to have normal and soft bowel movements. Along with this plenty of fluids or liquids should be given to keep the stools soft for easy passage. Restricting caffeine consumption can also help prevent dehydration.
- Daily exercise helps move materials through the intestines. Make sure the child should exercise regularly.
The problem of stool soiling and constipation has developed over a long time. Constipation is often the cause of stool soiling. Keep in mind, with much encouragement and by following the treatment plan, the child will improve. It is also possible that soiling may happen again after normal bowel habits have developed. When this happens, call the doctor for advice to help the child. This can be prevented by increasing the amount of fiber in child’s diet and drinks plenty of fluids. By having the child sit on the toilet for 10-15 minutes twice each day.