Soiling refers to when children pass stools (poo) into their underwear. Soiling may also be referred to as faecal incontinence and was previously called encopresis.

A common trigger is an episode of constipation that resulted in the child experiencing pain when they tried to do a poo. This experience may leave the child feeling scared to pass a poo and can lead to them “holding on”. Children may adopt various “with-holding postures”, such as squeezing their buttocks together, standing on their tip toes, or sitting on their heels in an attempt to hold the stools in. Holding the stools in results in the poo drying out further, becoming harder, lumpier and more painful to pass.

Straining may result in anal fissures, (small tears in the skin around the anus). These can be very painful. This cycle of painful hard stools leads to the child avoiding going to the toilet and develops into a repeated pattern. Eventually, if the child avoids going to the toilet there may be leakage around the hard, blocked poo lying in the rectum (back passage) and this results in soiling.

When children soil their underwear, they may be unaware that this has happened. These children often become so used to the smell that they do not have awareness of any odour when they have soiled themselves. This can be frustrating and upsetting for family members and others who are very much aware of the smell.

It is important for your child to be assessed by a health care professional if this occurs. Often laxative medicines that soften the stool and encourage softer, more regular bowel movements will help. Laxative therapy needs to be continued for many months to allow for the muscles in the lower bowel and back passage (rectum) to heal and recover their ability to prevent leakage.

A toileting routine can help, this is often best in the morning after breakfast or in the afternoon after school.

Ensure that your child adopts a good toileting posture as this will help to ensure that they are in an effective position to open their bowels and do a poo.

A good fluid intake and diet rich in fruit and vegetables can also help.

Untreated constipation can have serious consequences.

Children can experience faecal impaction, which is when the bowel becomes blocked due to a build-up of poo. It is essential that a health care professional assesses and treats this urgently – this may sometimes be done in hospital.

Children can become seriously unwell if they have faecal impaction.

This highlights the need to have constipation and soiling properly assessed and treated by a health care professional.

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Kylie – parent of a child that wets the bed 

Kylie rang our service as she was concerned about her five-year-old daughter, Mia, who was wetting the bed. Kylie had tried limiting Mia’s drinks in the late afternoon and evening and was also getting up at night to wake Mia and take her to the toilet.

Our advisor explained that it may take children until they around 5 ½ years old before they gain bladder control during sleep. Kylie was advised to encourage Mia to drink well throughout the day and was cautioned against cutting out drinks in the afternoon and early evening. Kylie was discouraged from waking Mia at night to take her to the toilet. Kylie was provided with information on obtaining a referral from Mia’s doctor to a bedwetting clinic if Mia continues to wet the bed past 5 ½ years of age.

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Anastasiya’s story

“As a mum of two young children, I have experienced the joys of two pregnancies and postpartum recoveries. I was shocked after the birth of my first child to discover that my pelvic floor muscles had become weak. I sought advice from Bladder and Bowel Health Australia and learnt the importance of exercising these muscles. This knowledge helped, and because I was better informed second time around, I have now fully restored the dignity of my body and truly enjoyed the changes - and my motherhood. Thank you, Bladder and Bowel Health Australia, for informing young families about bladder and bowel health issues.” 

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Doreen – carer of her husband who has dementia 

Doreen was becoming exhausted caring for her husband Tom, who has dementia. Tom was not always making it to the toilet on time and needed his trousers to be changed several times a day. Every day Doreen was also washing bedlinen and the four towels that Tom was laying on at night as he was soaking through his pull-up pants. 

Tom was receiving a high-level Home Care Package, and Doreen was able to arrange with their provider for some of Tom’s package to be allocated to funding continence assessment and management.  

Our advisor went to Tom’s home and conducted a thorough continence assessment. A continence management plan was developed with input from Doreen, and appropriate incontinence aids and linen protection were organised. Doreen is relieved that Tom’s incontinence has reduced, and her washing load has lessened. Doreen is now confident that she can continue caring for Tom in their home. 

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Gary – experiencing leakage after his recent prostate surgery 

Gary met with one of our Bladder and Bowel Health advisors, as he was concerned about his urine leakage that was persisting after his radical prostatectomy five weeks earlier.   

Gary discussed his concerns with the advisor and was reassured that he was making good progress towards regaining bladder control. This reinforced the information he had received from his urologist. Gary was encouraged to switch to a smaller incontinence pad rather than continuing to wear the pull- up incontinence pants he had worn since his surgery. The advisor arranged some smaller pads for him to trial and provided details on where he could buy them close to his home. 

Gary was encouraged to drink plenty of fluid (particularly water) and to increase his fruit and vegetable intake to avoid constipation. Gary was uncertain if his pelvic floor muscles were working properly and he was referred to a pelvic floor physiotherapist. Gary left the clinic in a brighter frame of mind, confident that he was improving and had clear strategies to further support his recovery.