Updated 05 March 2019

Your child still having 'accidents' long after being potty trained? Here's what you should know

Soiling long after potty training can be a real problem. Here’s what you should know.

Encopresis is the condition where children soil themselves long after they’ve been potty-trained.

According to the Cincinnati Children’s Hospital, soiling in children is common, with at least one in 100 children showing encopresis. Encopresis is described as the passing of normal stools, but at inappropriate times and inappropriate places. Because of the fact that bowel movements are normal and not linked to a physical condition, doctors don’t see encopresis as a medical disorder.

Encopresis is often distinguished from bowel incontinence or any disease of the digestive tract. Uncontrollable leakage of liquid or loose faecal material can occur, soiling underwear. Children might hide their soiled clothes out of fear or embarrassment.

This symptom nearly always indicates that the child and parents need assessment and help from a clinical child psychologist. This may involve behavioural and individual psychotherapy, parental counselling and family therapy. Children with encopresis respond well to a proper training programme, warmth and encouragement.

Even though it’s mostly psychological, there are also biological reasons for encopresis, which can lead to involuntary bowel movements or faecal incontinence in children. This includes chronic withholding of bowel movements which prevents a child from defecating normally, or other factors such as spinal cord injury or damage to the bowel.

What to do if your child soils him/herself

There are many factors that can lead to encopresis, including inadequate toilet training or severe emotional disorder. It can reflect a poor parent-child relationship, or be associated with other psychiatric problems. Faecal soiling is occasionally a manifestation of sexual abuse. 

Factors that might lead to encopresis

Here are some risk factors that could lead to encopresis:

  • Physical or sexual abuse, or neglect
  • Bullying at school
  • Lack of fibre and water in the child's diet
  • Chaos, trauma or upheaval in a child’s life

Tips on managing encopresis in children 

  • Monitor your child’s bowel behaviour carefully to determine if there is a set time (e.g. right before bedtime) when it happens.
  • Never embarrass or scold your child about the encopresis. Rather encourage him or her to tell you when it happened.
  • Encourage a healthy diet with plenty of fresh fruit and vegetables, as well as water.
  • Consider an appointment with a child psychologist to determine whether there is a reason, or if there is something your child is not telling you.
  • If the encopresis doesn’t stop after a couple of months, you should have your child examined by a medical professional to determine if there are any physical factors that could be causing the condition.

How is encopresis treated?

According to Quirky Kid Psychology, there are two main steps that can be taken to treat encopresis during childhood:

  • Medical intervention, to rule out any physical factors.
  • Behavioural therapy with the help of a psychologist specialising in children. Parents can encourage a child to sit on the toilet for at least 10 minutes after meal times to help establish a regular bowel movement.

Image credit: iStock


Ask the Expert

Incontinence Expert

Dr Prenevin Govender completed his MBChB at the University of Cape Town in 2001. He obtained his Fellowship of the College of Urologists in 2009 and graduated with distinction for a Masters in Medicine from the University of Cape Town in 2010. His special interests include laparoscopic, pelvic organ prolapse and urinary incontinence surgery. He consults full-time at Life Kingsbury Hospital in Claremont.

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