Soiling pants, medically known as encopresis, is much more common in boys than in girls. It occurs more in children with a strong sense of privacy or a strong tendency to concentrate on an activity to the point that they are unwilling to stop long enough to use the toilet. By understanding why this unpleasant problem occurs, you can help your child master his bowel habits.
Why it happens?
This is how I explain pant soiling to a child. The bowel, like the bladder, sends a signal to the brain: “I need emptying.” (Draw a picture of the bowel below and the brain above and connect the two by an arrow, and refer to this diagram as you explain to the child.) When your bowel is full, it tells the brain it needs emptying, and the brain says: “Go to the nearest toilet.” (This defecation reflex, or urge to empty the bowel, automatically occurs in persons with healthy bowel habits.) If you listen to what your brain tells you, bowel and brain continue to talk to each other; you go to the toilet when necessary, and your pants stay clean.
But suppose you don’t listen to your brain, either because you’re too busy, too lazy, or you just plain can’t hear what your bowel and brain say. In this case, they stop talking to each other. The bowel lets go whenever it wants to and there’s poop in your pants. Usually a doughnut muscle at the opening of your bowel squeezes closed to help keep the poop inside until you can get to the toilet. Sometimes this muscle gets lazy and opens up. Sometimes you smell it before you feel it.
If you don’t listen to your bowel signals the poop gets big and hard and won’t come out. This weakens the doughnut muscle around the bowel. It doesn’t “feel” when the bowel is full, and you get all plugged up. It’s called constipation; it feels uncomfortable. That’s when you have two types of bowel movements, “hard poop” and “soft poop.” The hard poop stays in your bowel and the soft poop – sometimes it’s even watery – leaks around the hard poop, and you don’t even feel it until it’s in your pants. The longer this goes on, the harder the poop gets, the weaker the doughnut muscle gets, and the less bowel and the brain talk to each other.
So how can we keep this from happening? you ask. (Encourage the child to answer.) Always listen to what your bowel tells you. Instead of being busy and not paying attention to your body, go to the toilet as soon as your bowel says, “I’m full.” Next, you can keep your poop from getting hard. See constipation.
Busy little bowels. Keep (with your child’s help) a diary of when your child soils his pants. What triggers holding on to the bowel movements and what triggers letting go? Does he poop when he is stressed in group play? Is he so engrossed in play that he ignores his bowel signals? Little boys with little bowels are forgetful. If your diary detects a correlation between play and soiling, call this connection to your child’s attention. “As soon as you feel bowel pressure, go sit on the toilet. Don’t hold on to it.”
Embarrassed little bowels. Some children are embarrassed about toileting. Rather than let their playmates know they have to go to the toilet or ask the teacher to go to the bathroom, they ignore bowel signals; consciously or subconsciously they convince themselves – and their full bowel – that they really don’t have to go. Impress upon your child that toileting is as normal as eating. Everyone does it. Perhaps some children can’t imagine their teacher ever having to go to the bathroom.
Lazy little bowels. Some children don’t want to “waste time” going to the toilet. Rather than interrupt play, expending the effort to go all the way to the toilet, get undressed, redressed, and reenter play, the child ignores his body signals. To help your child do his own toileting quickly, have simple elastic bands on pants and shorts.
Blocked little bowels. Paradoxically, the most common medical cause of pant soiling that I see in my office is constipation. This diagnosis surprises parents (“But it runs out…”) What soils the pants is the soft, watery stool that leaks past the hard feces. By examining your child, the doctor can tell if constipation is the culprit. See constipation.
Click here for 7 simple steps to help minimize encopresis.