CHAPTER 19
Faecal Soiling
Children have normally acquired reliable bowel control by the age of
3 or 4, though they may still have the occasional accident after that.
When soiling occurs more than once a month after the age of 4 years,
this is generally regarded as an elimination disorder. For children with
intellectual disability, however, the cut-off should probably be at a mental
rather than a chronological age of 4 years. Soiling occurs more than once
a month in roughly 5% of 4-year-olds, falling to 1–2% of 7-year-olds, and
under 1% of 11-year-olds. By the age of 16, the prevalence of soiling is
practically zero. Both epidemiological and clinic series show that soiling is
roughly three times commoner in boys than girls.
Faecal soiling can be divided into five types:
constipation with overflow;
failed toilet training;
toilet phobia;
stress-induced loss of control;
provocative soiling.
Each of these has specific implications for treatment. The term encopre-
sis may be used to refer to all types of faecal soiling, or may be used more
narrowly to refer to the passage of relatively normal stools in inappropriate
places, including underclothing. On the basis of a careful history and
physical examination, it is usually possible to identify the type (or types)
of soiling and so formulate an appropriate management plan.
Types of soiling and their management
The five types of soiling do not always occur in isolation. Children
seen clinically commonly have hybrid presentations, showing some of
the features of more than one type of soiling. For such children, the
different components of their soiling each need to be addressed by the
overall management plan. When the symptoms are severe or complicated,
or when the soiling does not respond to standard treatment, it will be
important for both paediatricians and child mental health workers to be
Child and Adolescent Psychiatry, Third Edition. Robert Goodman and Stephen Scott.
©c2012 Robert Goodman and Stephen Scott. Published 2012 by John Wiley & Sons, Ltd.
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