If your son or daughter is way past the diaper years and still has the tendency to move bowels in inappropriate places (anywhere besides the toilet), it can be embarrassing and frustrating for you, but even more so for your child. Some parents are under the impression that when children soil their pants, they are actually looking for attention, are deliberately misbehaving or are just too lazy to run to the toilet when they feel a number two coming. While this behavioral standpoint may be true, soiling one’s pants could actually be a physiological concern that parents must look into with care.

Children normally master bladder and bowel control after the toddler years. However, if beyond the age of four, a child is still having “accidents”, he or she may have a condition known as encopresis, or “defecating in one’s underpants”. A child with encopresis may have a bowel disorder or infection that prevents him or her from exercising control. The bowel disorder may also prevent the child from “feeling the urge”, and so he or she moves bowels without even being aware until his or her pants have been soiled.

Encopresis affects approximately one to two percent of children under ten years of age. However, more than 25% of clinic visits to pediatric gastroenterologists are recorded as concerning constipation and encopresis. Therefore, 90% of soiling cases is actually because of functional constipation (which means the constipation is not due to a medical problem per se). Children who are constipated have dry and hard stools which cannot be excreted with ease. As a result, a child may “hold it in” so that they don’t feel the pain, and in doing so, inadvertently do a number two in public.

Encopresis is truly frustrating for parents and caretakers. However, it is important to remember that how a child views his elimination capabilities has a direct impact on his well-being and self-image. A very young child, when scolded for soiling his pants, may feel that defecating is bad, and must be prevented. This could lead to medical problems. Parents must be educated on how to deal with encopresis positively, without putting elements of shame and guilt onto the child. Here are some suggestions:

1. Understand why it happens. Look for symptoms of bowel disorders in your child, starting off with constipation. There are many things that could cause your child to be constipated – diet, insufficient fluid, lack of physical activity and even stress could cause constipation. Some children develop constipation when they do not have access to clean toilets when they need to go. Holding poop in is a big factor that causes constipation. Ask your child if he or she has had difficulty pooping lately, or if he or she feels any pain. Sometimes, when poop becomes so hard and large in the intestines, the feeling or “urge” is decreased, and that’s why the child can’t feel he or she has to go.
2. Call your doctor upon seeing these signs: watery stools when  your child isn’t ill, extreme pain when moving bowels, completely not having BM in the toilet, pain in the abdomen, and appetite loss
3. Look beyond the nonchalance. A child who has soiled his pants may not panic or run in shame. He or she may just stand there, or be unfazed about the whole incident. Do not take this as misbehavior. A child will be so embarrassed and guilty, that he or she may completely be in denial of what happened. Another reason for the indifference is that the brain may have gotten so used to the smell and texture of feces, that a child isn’t even aware that he or she soiled his or her pants anymore. Let your kid know you understand and encourage him or her to come see a doctor so you can figure out together what’s wrong.