Why does my child keep soiling themselves? Faecal Impaction

My 4-year-old has been off school for a few days. She suffers from Faecal Impaction, like her older sister before her. Thankfully, because Rhian also suffered from Faecal Impaction, I recognised the signs in Reese and I knew that it wasn’t her being lazy and refusing to go the toilet when she kept pooping in her pants, but there was actually more going on. It may sound surprising, but the fact that she was pooping her pants was actually a sign of constipation!

bristol stool chart showing different looking poo and what it means

When Rhian suffered from Faecal Impaction it was a different story. I thought she was being lazy or that because we had a new baby she was after more attention. She was 3.5 years old and still in nappies and I was worried about her going to school. We tried encouraging her to use the potty, a reward chart, praise on the rare occasions when she pooped on her potty, making her sit on it several times a day, plenty of fluids and fruit and we even told her that she wouldn’t be able to go to school if she kept pooping in her pants but nothing worked. The hardest part was seeing how upset she would get when she had an accident, or how often she didn’t seem to realise she had pooped!

Something didn’t seem right so I decided to make her an appointment at the doctors for a check-up. We saw the doctor but it wasn’t a very good appointment. The baby woke up and decided she was hungry so I had to carry her into the appointment and then started breastfeeding her to quieten her so I could talk to the doctor. The doctor tried to examine my three-year-old, but she wouldn’t let her and hid behind me and of course, with my arms full of baby I couldn’t hold her. She gave her a quick feel of her tummy and told me it felt fine and that the issue was just behavioural and I should go and see my health visitor.

I went home feeling depressed. Being told it was just behavioural didn’t sit right with me as I felt there was more to it than that. Yes, I knew we had a new baby and that sometimes toddlers get jealous and can start pooping themselves for attention, but she had never pooped properly in the potty so it was an ongoing issue rather than a new one. I did feel some of it was attention seeking as she will come and tell me she’s pooped when I’m nursing the baby, but if that was the case why would she be so proud of herself on the rare occasions that she does the tiniest poo in the potty and then say “I go school now?”

It was a chance conversation with a friend which helped point me in the right direction. We were chatting and I mentioned the problems I was having with Rhian and she told me it reminded her of her daughter at the same age. It was a huge relief to know that I wasn’t alone and that other people had been through the same issue! She told me her daughter had ended up seeing the consultant who had diagnosed her with faecal impaction and she asked me whether my daughters poo had a shape like ordinary poo, which it didn’t, it looked really flat. She explained that with faecal impaction the child is constipated, which surprised me as I thought a constipated child wouldn’t poo yet she seemed to be constantly pooping. What she explained summed up what my daughter was like and it all made sense to me. I saw the health visitor a few days later when she weighed the baby and I had a quick chat with her, and I mean quick as I had to leave to pick her up from school. She said to try giving her more to drink and then to see her the following week.

The following week I saw the health visitor again and I told her that she was drinking more but that there was no improvement and she said the next step was to try her with medication. I mentioned what my friend had been telling me and she agreed that she thought she could be constipated as well and that’s why I was to get her the medication.

Later that day I got chatting to another friend and she also told me that she had the same issue with her five-year-old daughter. She explained that it was extremely common, one in 5 children will suffer from it, yet people don’t talk about it and even doctors dismiss it as behavioural which makes it worse and the doctor had told her she had a very sick child (emotionally) because it had gone on so long and been dismissed.

Finally, I spoke to a different doctor, all geared up for a battle, but I didn’t need to. As soon as I mentioned the issue, he diagnosed her with what I suspected and prescribed her Movicol twice a day for the first week and then once a week. He also said that if it didn’t get better to go back and seem him. It was such a relief to finally be taken seriously and know that it was something medical rather than her fault or my fault. Too many times it seems like the parents are blamed for everything!

But what is Faecal Impaction?

Faecal Impaction means that there is a build up of poop in the child’s lower bowel. This happens because the poop is too hard or too painful for the child to pass. Because it hurts it puts the child off going to the toilet for a poo.

diagram showing a bowel full of stuck poop

When the bowel is impacted it becomes stretched to hold the extra poop. The rectum, which is the final part of the bowel, usually helps by telling us when we need to go for a poo, but when children have faecal impaction it can’t function properly. This means children don’t know they need to go to the toilet. Poop will also squeeze around the blockage in the bowel, and because it has squeezed past, not only is there no sensation that they need to go to the toilet, there’s no control. This is why children soil their pants and why it is the main sign that a child is constipated.

What are the symptoms?

Children with faecal impaction often pass very large painful poo. They will also have lots of accidents and soil their pants. The soiling can look watery or like diarrhoea, which means parents often don’t realise the child is suffering from constipation. Children don’t realise they have messed their pants and this can cause problems as parents blame the child and think they’re being naughty or attention seeking.

What is the treatment?

The first treatment is to give the child medication to clear out the bowel of all the stuck poop. This is known as disimpaction. The medication given is a stool softener, usually Movicol, which will dissolve the hard poop and turn it watery. This can be a very messy process and the medication needs to be given until the child is no longer passing any hard formed poo and the poop has consistently been watery. It can take up to two weeks or even longer.

Sometimes disimpaction doesn’t work. It could be that the medicine was stopped before the bowel was completely cleared or it could be that the child is refusing to take the medicine. This was Rhian’s issue and we tried everything we could think of to get her to take it. Reese isn’t so bad as we make it into a drinking game with her sisters and she has to drink her drink before they do and she seems to enjoy it. We mix the Movicol in strong orange juice as it doesn’t taste very nice.

Once the poop has all been cleared out of the bowel, the bowel will be clear but still stretched. Because it is stretched it won’t work properly and the child will need to remain on a smaller dose of medicine to stop the blockage from reforming. Eventually, the bowel will return to its normal size and shape, but because it will take time, children have to stay on medication for a number of months, even years.

How is Rhian now?

With Rhian, because she refused to take the Movicol she had to attend the Constipation Clinic at the hospital once every three months to discuss how she was doing and her medication. She was prescribed Sodium Picsulphate to be taken at night and we were given tips on positive toilet training and to encourage her to take her medicine and to use the toilet. It was a long journey but eventually, we saw the end and after attending the Constipation Clinic for about 18 months Rhian no longer takes any medication and her bowel has returned to normal.

I won’t lie. It was a very difficult and stressful time. We had to take spare clothes wherever we went and to remember to take them to school. I would sometimes get a phone call from the school asking me to go clean her up if she had a very messy accident. The worst part was that the old stale poop would burn her skin and she would get a rash, similar to a nappy rash, that was so severe the skin was blistered and bleeding. I would have to hold her down to clean her and apply the cream as she would be screaming in pain and I would feel so guilty.  The doctor prescribed a special cream and we stopped using baby wipes, just using cotton wool and water to try and cotton underwear to try and limit the irritation.

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