ABOUT SOILING IN CHILDREN

'Soiling' is when the bowels are emptied in places other than the toilet (also known as faecal incontinence). Children usually develop the ability to be toilet trained by about three years of age. 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. 


Children's Bristol Stool Chart

The Bristol Stool Chart was developed as a clinical assessment tool. According to the Bristol Stool Chart there are seven types of stools (also known as 'faeces' or poo). You can use the Bristol Stool Chart to check what your stools are telling you. Everyone has different bowel habits, but the important thing is that your stools are soft and easy to pass (like types 3 and 4 below).

  • Type 1 - 2 indicate constipation
  • Type 3 - 4 are ideal stools as they are easier to pass, and
  • Type 5 - 7 may indicate diarrhoea and urgency.

 

Childrens/Paediatrics Bristol Stool Chart

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

WHY CHILDREN SOIL

In almost all cases soiling happens because the large bowel is not emptying properly and the child is constipated.

About constipation

Constipation is common and can occur in up to 25% of children at any time. If it is not recognised and treated, bowel actions (poo) may become harder and less frequent and soiling can occur as a result. 

You may not realise that constipation is the underlying problem. It is quite possible that there is hard poo inside the bowel and the soiling is soft runny poo leaking around the hard poo. 

Over time, stretching the bowel makes it less sensitive, so the child may not feel when poo needs to come out and has an accident.  

  • painful bowel actions may lead to a child avoiding pooing
  • the child may not want to use kinder/school toilets because of privacy or cleanliness issues
  • the child may not be able to access a toilet when they feel the urge to go
  • some children just don't feel the need to go when they are busy playing
  • 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 does not squeeze effectively and some food allergies can cause soiling but these reasons are less common. 

Soiling is  NOT caused by attention-seeking, naughtiness or laziness.

TIPS FOR PARENTS

The social consequences of soiling are distressing for parents and children. It is important to realise that soiling can be treated and early recognition will minimise its impact. 

What parents can do

  • seek medical advice
  • make a diary of your child's bowel actions and accidents for a couple of weeks and take this when you see the doctor
  • provide a comfortable and supported toilet seat and environment

Punishing children for soiling can make things worse – remember, children may not feel the need to poo or even be aware of soiling.

What to expect from a medical assessment

  • the doctor will take a detailed history and perform a physical examination
  • the doctor may order an x-ray or ultrasound of the bowel
  • 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 under medical supervision. If this doesn't resolve the problem, referral to a paediatrician or paediatric gastroenterologist for further testing and advice may be required.
While your child is being treated, their kinder or school needs to be aware of the problem, so your child receives support they need if soiling should occur. 

SEEK HELP

Your doctor is a good place to start if you are concerned about your child's bowel habits or soiling. You can also contact the National Continence Helpline on 1800 33 00 66 for confidential advice and support.

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Last Updated: Wed 15, Jul 2020
Last Reviewed: Fri 27, Mar 2020