When children 4 years+ old who have already had toilet training have stools on panties, it is called incontinence. Parents need to pay attention to it cause it might indicate diseases.
Incontinence is not a disease, but a symptom from multiple possible causes. It happens to boys slightly more than to girls.
Incontinence is related to constipation in many cases. When constipation occurs, the stool is often hard to drain. Sometimes soft stools or loose stools in the upper intestine are inadvertently drained from the edge of the dry and hard stools.
Bowel movements vary among people, from 1 to 2 times a day to 3 to 4 times a week. Even if a child has defecation once in three days, there is no need to worry about constipation as long as the stool is soft and medium in weight. On the other hand, some children defecate daily, but the stool is hard; some children defecate daily, but only “small hard balls”, usually there is not exhausted stools accumulate in the intestine, there’s still possibility of constipation.
Causes of constipation include diet, illness, drinking less than enough liquid. Some children may have “flushing fear” that occurs during toilet training, some may deliberately forbearing for certain reason. Some children may even experience chronic constipation due to stressful life events (such as divorce or death of parents).
Bowel surgery or congenital diseases
After bowel surgery or congenital diseases (such as congenital megacolon or spina bifida) constipation may occur, but the proportion is low.
How constipation-related fecal incontinence occurs
When constipation occurs, the feces accumulate in the rectum, or even return to the colon. The task of the colon is to absorb its moisture before the feces are excreted, so the longer the excrement stays in the colon, the more moisture is lost, and it will become drier and harder, make it even harder to drain. Coarse and hard stools can make the colon expand, loosen the muscles of the colon and affect the function of the nerve receptors.
Colonic peristalsis can cause pain when it pushes and excretes dry stools. Therefore, a child will continue to tolerate pain, parents may notice cross-legs, walking on tiptoe, unusual facial expressions from the child.
Eventually, the stools in the lower part of the rectum and colon build up more and more, the sensitivity of the rectum decreases, the ability of the anal sphincter to control, and the softer stool on the upper part of the colon can leak out to the edge of the feces and contaminate the underwear.
1. Empty the colon and rectum – laxatives, stool softeners can be used, depending on the child’s age and condition
2. Develop the habit of regular bowel movements
3. Diet and exercise – more liquid, ideally water, fruits and vegetables, and probiotics may help. Let the child exercise for at least one hour every day.