Bed Wetting or Soiling (encopresis) should be relatively uncommon after the age of 4. Soiling in children can be grouped into late developers, toilet refusers, and school-age soilers.
Late developers do not have any physical or psychological reason for delayed bowel control -- they are just developing at a slower rate.
Toilet refusers are developmentally normal, but for some reason have a strong aversion to using the toilet.
In school-age soiling, it is likely that there is an underlying physical cause for the continued soiling.
If your child has faecal incontinence (loss of bowel control), you need to see a doctor to determine the cause and treatment. Faecal incontinence can occur in children because of a birth defect or disease, but in most cases it's because of chronic constipation.
Potty-trained children often get constipated simply because they refuse to go to the bathroom. The problem might stem from embarrassment over using a public toilet or unwillingness to stop playing and go to the bathroom. But if the child continues to hold in stool, the feces will accumulate and harden in the rectum. The child might have a stomachache and not eat much, despite being hungry. And when he or she eventually does pass the stool, it can be painful, which can lead to fear of having a bowel movement.
A child who is constipated may soil his or her underpants. Soiling happens when liquid stool from farther up in the bowel seeps past the hard stool in the rectum and leaks out. Soiling is a sign of faecal incontinence. Try to remember that your child did not do this on purpose. He or she cannot control the liquid stool and may not even know it has passed.
The first step in treating the problem is passing the built-up stool. The doctor may prescribe one or more enemas or a drink that helps clean out the bowel, like magnesium citrate, mineral oil, or polyethylene glycol.
The next step is preventing future constipation. You will play a big role in this part of your child's treatment. You may need to teach your child bowel habits, which means training your child to have regular bowel movements. Experts recommend that parents of children with poor bowel habits encourage their child to sit on the toilet four times each day (after meals and at bedtime) for 5 minutes. Give rewards for bowel movements and remember that it is important not to punish your child for incontinent episodes.
Some changes in eating habits may be necessary too. Your child should eat more high-fiber foods to soften stool, avoid dairy products if they cause constipation, and drink plenty of fluids every day, including water and juices like prune, grape, or apricot, which help prevent constipation. If necessary, the doctor may prescribe laxatives.
It may take several months to break the pattern of withholding stool and constipation. And episodes may occur again in the future. The key is to pay close attention to your child's bowel habits. Some warning signs to watch for include
- pain with bowel movements
- hard stool
- constipation
- refusal to go to the bathroom
- soiled underpants
- signs of holding back a bowel movement, like squatting, crossing the legs, or rocking back and forth
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