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Soiling

Soiling

How do Bowels Work?

Your bowel is a long muscular tube that moves and empties faeces (poo). The opening of the bowels is called the anus. Pelvic floor and sphincter muscles control the opening and closing of the anus. Nerves also send messages between your bowels, muscles and brain to let the brain know when it is time to empty.

What is Soiling?

Soiling is when your bowels are emptied in places other than the toilet. Soiling may vary from a ‘skid mark’, to a smear, to larger amounts that need to be removed from underwear before it can be washed. Encopresis is the medical term for regular soiling. About 1-3% of children have regular soiling problems and it is more common in boys. Some of these children may also have problems with daytime wetting or bedwetting. Soiling can be very distressing for children and their families, and in many cases, the child may have little or no control over the soiling accidents. 

Children normally develop bowel control during the toilet training stage, by about three years of age. Even after this stage, however, occasional soiling accidents are not unusual. However, if your child is unable to be toilet trained, or has regular soiling accidents after the age of four, it is essential to speak with a medical professional. If your child has been toilet trained and spontaneously starts to soil, medical assessment is also required.

What Causes Soiling?

In many cases, the underlying cause of soiling is constipation. Constipation is when your bowel motions are less frequent, you are having trouble passing bowel motions or they are too hard and dry. Constipation is common and occurs at some time in over 25% of children. It can be hard to know your child is constipated when they are also experiencing frequent soiling, as the soiling can give the appearance that they are regularly emptying their bowels.

Severe constipation, if left untreated, means that over time the bowel may stretch and become less sensitive. This results in your child ‘not feeling’ when their bowel motion is ready to come out, which sometimes results in a soiling accident. On other occasions, hard bowel motions that are difficult to pass may cause a partial blockage high up in the bowel. When this happens, watery bowel motions often flow around the constipated stool without warning. This is sometimes mistaken for diarrhoea.

In rare occasions there are structural causes for soiling, but these are often diagnosed at birth. A medical specialist should be consulted if your child is identified as having an anatomical or neurological cause for soiling.

TREATMENT

Assessments and treatments at the Mars Clinic are provided by advanced-trained Physiotherapists. The type and duration of treatment for soiling will vary depending upon the cause of the soiling and the needs of the individual. Treatment may include:

  • Teaching correct bladder and bowel habits
  • Practical advice and strategies for management at home
  • Timed voiding and drinking programs
  • Urostym biofeedback™ computer games to teach pelvic floor muscle control and relaxation
  • Recommendation for medications that may assist constipation. There are various types of bowel bulking agents, stimulants and lubricants, but they all work differently so it is important to talk to a medical professional before commencing long-term use
  • Referral to a medical specialist, or other allied health professional, as required