Symptoms & Diagnosis Of Constipation

Constipation and Fecal Soiling

What is constipation and fecal soiling?

Constipation is defined as either a decrease in the frequency of bowel movements, or the painful passage of bowel movements. Children 1 to 4 years of age typically have a bowel movement 1 – 2 times a day and over 90% of them go at least every other day. When children are constipated for a long time, they may begin to pass stool in their clothing. This is called fecal soiling, and the child is typically unaware that they are going to have an accident.

Another term that is frequently used is encopresis. Encopresis refers to fecal incontinence not due to any particular disease. This form of soiling may be voluntary (passage of normal stools in clothing) or involuntary (often loose, liquid stools). Voluntary encopresis may represent significant psychological problems. Involuntary encopresis is much more common and associated with chronic stool withholding and associated leakage of stool.

Does behavior play a part in constipation and fecal soiling?

Children with constipation and fecal soiling have no control over these bowel movements and should not be punished for soiling episodes. They are often embarrassed by the accidents and may hide their soiled underwear in drawers or under the bed. This can be very unpleasant for other family members. Another common upsetting behavior is refusal to change dirty clothing even though the odor is very bothersome to other people. Children may also wet the bed at night or wet their clothing during the daytime, which is called enuresis. Playmates or siblings may tease children who have accidents. Teasing can lead to embarrassment, school refusal, fighting, and other problems.

As the child and family battle over the child’s bowel control, the conflict may extend to other areas of the child’s life. Their schoolwork may suffer, and the child may become angry, withdrawn, anxious, and depressed, often as a result of being teased and feeling humiliated.

North American Society for Pediatric Gastroenterology, Hepatology and Nutrition
The Association of Pediatric Gastroenterology and Nutrition Nurses
North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Foundation
The NASPGHAN Council For Pediatric Nutrition Professionals
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