Soiling (Encopresis)

Soiling, also called encopresis (en-ko-PREE-sis), is having uncontrolled bowel movements in one's underwear.

What Is Soiling?

Young children routinely have bowel movements in their diapers or underwear, but by about three years of age, most children are able to maintain good bowel control and can be toilet trained. When people who have established bowel control begin to have a bowel movement in their pants, the condition is called soiling or encopresis. This soiling is often leakage and not a full bowel movement. Most people who have a problem with soiling do not even realize that it is happening, because they do not feel as if they are having a bowel movement. In the majority of cases, encopresis is a medical problem. This medical problem can have serious psychological effects, ranging from embarrassment and teasing to family stress.




Soiling results when solid body waste becomes hard and compacted in the large intestine, blocking it and causing it to stretch out of shape. If softer waste (liquid stool) seeps around the blockage, it can leak out of the anus, causing soiling.





Soiling results when solid body waste becomes hard and compacted in the large intestine, blocking it and causing it to stretch out of shape. If softer waste (liquid stool) seeps around the blockage, it can leak out of the anus, causing soiling.
Illustration by Frank Forney. © 2016 Cengage Learning®.

Why Does Soiling Happen?

Soiling is related to constipation (kon-sti-PAY-shun). Constipation is infrequent, hard, and painful bowel movements. When food goes through the digestive system, it is broken down into a thick sludge-like liquid. The nutrients that the body needs, such as sugars, are absorbed from this liquid in the small intestine. The rest of the material passes into the large intestine, where water is reabsorbed. The remaining solids, called feces (FEE-seez), are then passed out of the body as a bowel movement.

When the bowels move infrequently, the large intestine reabsorbs so much water that the feces become hard and compacted. As a result, bowel movements are painful, causing many people to try to avoid having them. Doing so only makes the problem worse. Eventually, the mass of hard solids in the large intestine causes it to stretch out of shape. As it stretches, small amounts of liquid sludge from the small intestine seep around the hard mass of feces in the large intestine and then leak out of the body. This is the material that causes soiling.

Some adults think that children soil on purpose or that soiling is evidence of a psychological problem. In reality, soiling accidents are not intentional. Sometimes children who are teased or embarrassed about soiling can have emotional or behavioral problems. Generally, once the soiling is treated and stops, these problems disappear.

How Is Soiling Treated?

There are three steps to treating soiling:

An enema or a laxative medication is often used to empty the large intestine. With an enema, liquid is pushed into the large intestine to soften the hard mass of feces and stimulate the urge to expel it. Sometimes strong laxatives are used instead to encourage the intestine to contract and push out the feces.

Once the large intestine is unblocked, it is important for an individual to establish regular bowel movements to keep it clear. A doctor may recommend laxatives taken by mouth, such as milk of magnesia, products that contain senna, or mineral oil. These laxatives keep waste material moving quickly through the large intestine so that it remains soft. Setting aside time each day to have a bowel movement (usually after breakfast or dinner) also helps establish a regular schedule.

See also Bed-Wetting (Enuresis) • Constipation • Incontinence

Resources

Books and Articles

Hodges, Steve and Suzanne Schlosberg. It's No Accident: Breakthrough Solutions to Your Child's Wetting, Constipation, UTIs, and Other Potty Problems. Guilford, CT: Lyons Press, 2014.

Websites

American Academy of Pediatrics. “Soiling (Encopresis).” (accessed July 10, 2016).

Continence Foundation of Australia. “Soiling.” http://www.continence.org.au/pages/soiling.html (accessed July 10, 2016).

NHS Choices. “Encopresis (Soiling of Clothes in Children).” (accessed July 10, 2016).

Organizations

American Academy of Pediatrics. 141 Northwest Point Blvd., Elk Grove Village, IL 60007-1098. Telephone: 847-434-4000. Website: http://www.aap.org (accessed July 10, 2016).

American College of Pediatricians. PO Box 357190, Gainesville, FL 32635-7190. Telephone: 352-376-1877. Website: http://www.acpeds.org (accessed July 10, 2016).

  This information is not a tool for self-diagnosis or a substitute for professional care.