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Soiling

Children usually develop the ability to be toilet trained by about three years of age. 'Soiling' is when the bowels are emptied in places other than the toilet. Even after a child is toilet trained, there may be occasional accidents with soiling (poo) in your child's underwear.

If a child is unable to be toilet trained or has regular poo accidents after the age of three to four years, then they should be medically assessed. If a child has been toilet trained and at a later stage starts to soil, this also needs medical assessment.

If you are caring for a child with special needs and incontinence, practical tips and advice are available to assist you with your care. Read more on caring with someone with incontinence.

How many children get soiling?

About 1-3% of children can have this problem and some of them may have wetting as well. It is more common in boys.

Soiling may vary from a 'skid mark' to larger amounts that need to be removed from underwear before it can be washed.

Childrens Bristol Stool Chart

Children's bristol stool chart

Reproduced with kind permission of Dr KW Heaton, formerly Reader in Medicine at the University of Bristol. ©2000-2014, Norgine group of companies.

Why do children soil?

In almost all cases soiling happens because the large bowel is not emptying properly and the child is constipated. Constipation is very common and occurs at some time in up to 25% of children. If it is not recognised and treated, bowel actions may become harder and less frequent. Over time, stretching of the bowel makes it less sensitive, so the child may not feel when poo needs to come out and therefore has an accident. It is quite possible that there is hard poo inside the bowel, but the soiling is soft runny poo leaking around the hard mass, and so you don't realise that constipation is the underlying problem.

How does this cycle happen?

1. Painful bowel actions may lead to the child avoiding pooing.

2. The child may not want to use kinder / school toilets because of privacy or cleanliness issues.

3. The child may not be able to access a toilet when they feel the urge to go.

4. Some children just don't feel the need to go when they are busy with someing else.

Are there other reasons?

Yes, occasionally there is a physical cause of soiling, but these are usually diagnosed at birth or soon after.

There are some conditions where the bowel itself does not squeeze effectively and some food allergies may cause constipation or diarrhoea leading to soiling - but these reasons are less common.

Soiling is NOT caused by attention-seeking, naughtiness or laziness, and although it may cause emotional upset, soiling is not usually caused by it.

Children who have poo accidents may appear to be unaware they have happened, or not want to change. This is not a sign of naughtiness or not caring - they are usually very upset deep inside.

The social consequences of soiling are distressing for parents and children. It is important to realise that the problem can be treated and early recognition and effective treatment will minimise the impact it has.

What can parents do? 

Seek medical help

  • Make a diary of all your child's bowel actions and accidents for a couple of weeks and take this with you when you see the doctor.
  • Provide a comfortable and supported toilet seat and environment.
  • Punishing children for soiling may make things worse - remember, children may not feel the need to poo, or even be aware of soiling.

What to expect?

The doctor will take a detailed history and feel your child's tummy and oberve the anus.

  • An x-ray may be ordered.
  • Occasionally a blood test may be required.
  • A toileting program will be started, and laxatives prescribed if necessary.

A toileting program works best if carried out for at least 6-12 months, and is supervised by a doctor or continence health professional. If this doesn't solve the problem, referral to a paediatrician or paediatric gastroenterologist for further testing and help may be required.

While your child is being treated, the kinder or school needs to be aware of the problem, so your child gets the support they need if soiling should occur. 

Your GP is a good place to start if you are concerned about your childs bowel habits or soiling. You can also contact the National Continence Helpline on 1800 33 00 66.