Monday 19 February 2018

Dear David Coleman: My 5-year-old son soils himself and he deliberately avoids going to the toilet

Soiling is a common enough problem among young children.
Soiling is a common enough problem among young children.
David Coleman

David Coleman

Clinical psychologist David Coleman offers parenting advice in his weekly column.

Q. I am concerned about my 5-year-old son soiling himself. I will notice him crouching down in a corner as if holding or preventing himself from doing a poo. I will ask him to go to toilet and he says he doesn't need to, then when I check him he will have soiled his underwear and will then go and finish a large poo in the toilet. We have avoided giving out to him. When we ask him about it he always responds that he doesn't know why it happens, and always says it won't happen again. We'd appreciate any advice.

David replies: Soiling is a common enough problem among young children. Encopresis is the medical term for it. When we talk about encopresis we differentiate between primary encopresis and secondary encopresis.

Primary encopresis refers to soiling problems that have always been present. So, right from when a child was first trained, they had occasional, or ongoing, accidents in which they poo in their pants. This is usually a sign that the child hasn't quite 'got' the training inasmuch as they haven't developed a consistent and effective habit of using the toilet to poo.

Secondary encopresis refers to soiling that develops after a child has been in a good and consistent habit of pooing, successfully, in the toilet. Most often, secondary encopresis can develop after a period of severe constipation, or when a child has developed some kind of fear of using the toilet, perhaps because they had to pass a very painful stool.

Sometimes, secondary encopresis is an indication of quite a severe emotional disturbance for a child.

It isn't clear from your query whether your son has a primary or secondary encopresis, although your description seems to fit more with primary encopresis. If so, the best way to try to deal with it is to try a renewed and structured approach to training him.

One of the things to consider is that if he is holding a large stool, it may well be associated with some pain when it passes through. He may just have some reluctance to let the poo come out at all.

How frequently does your son poo? If the large stool that collects in his bowel is there for a number of days before it passes, he may well also have a back-up of runnier poo that leaks out past the solid stool. It is very hard for children to notice and prevent this leaking.

You may want to visit your GP to just ensure that there is no long-standing constipated stool in his bowel and that his digestive system is working normally, albeit with this creation of large solid stools.

You may also need to ensure that his diet is well balanced, with enough fibre and plenty of water, as these are the key to keeping everything moving!

Assuming there are no physical issues, I suggest reinstituting a toilet training programme for him. I think that some kind of star or reward charting system may be best.

If his biggest issue is that he just doesn't independently head toward the toilet when he gets the urgency to poo, then the behaviour of actually going to the toilet and sitting on it, ready to poo, is what you will be encouraging and reinforcing.

So, I think you may want to get him in the habit of just going to the toilet on a regular basis, in case a poo is coming. Hopefully you will have noticed a pattern to his bowel rhythms, such that you can remind him to head to the toilet at about the right time.

In many ways this is what you already do, but I think you need to add in the attractive element of a reward for making it to the toilet before the poo comes.

Either as part of the schedule, or as soon as you see him squatting in a corner, bring him to the toilet, reminding him that he is in line for the star/treat/reward.

If a poo comes as he sits on the toilet, then he might get a second star or a slightly bigger/better treat. After that, it is just perseverance on your part, giving him little choice but to get to the toilet if you sense a poo is coming, and continuing to play down, or ignore, any accidents that might occur.

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