Poop Accidents and Encopresis: Understand, Support, Don’t Punish

The other day, I witnessed a heartbreaking scene: a child being scolded for pooping in his pants. He was crying, visibly embarrassed and distressed. His mother looked overwhelmed and upset. That moment struck a deep chord.

It reminded me how important it is for parents to understand that when a toilet-trained child has a poop accident, it’s usually not their fault. In many cases, these accidents are caused by encopresis, a condition that many families haven’t heard of but is surprisingly common. With understanding and the right support, not punishment, children can move past it.

Understanding Encopresis

What is Encopresis?

Encopresis is when a child (usually over age 4 and already toilet-trained) passes stool into their underwear, often without even realizing it. It’s not laziness or misbehavior. Most of the time, encopresis is a symptom of chronic constipation leading to fecal impaction (a large mass of hard stool stuck in the rectum).

In fact, 80–95% of children with encopresis have a history of constipation or painful bowel movements. The condition affects about 1–3% of children, with boys more commonly affected than girls.

How Does Constipation Lead to Encopresis?

When a child holds in poop — whether due to pain, fear of the toilet, or simply not wanting to stop playing — stool builds up in the colon and rectum. It becomes hard, dry, and difficult to pass.

Over time, the rectum stretches and becomes less sensitive. The child may no longer feel the urge to go. Meanwhile, newer or softer stool from higher up can leak around the blockage, often without the child noticing.

This pattern is called fecal impaction with overflow incontinence, and it’s not something a child can fix just by trying harder. It requires understanding, time, and proper care.

Key Signs of Encopresis (and constipation):

Poop accidents: Frequent, involuntary soiling in underwear, often without awareness.
Constipation history: Infrequent, hard, or painful bowel movements.
Large stools: Very large poos that may clog the toilet or be painful to pass.
Tummy pain or bloating: From stool backing up in the intestines.
“Diarrhea” leaks: Smears of liquid stool that look like diarrhea but are actually overflow.

A Real-Life Example

A family came to me for help with their child’s bedwetting. They also mentioned he was having daily accidents that looked like sudden diarrhea — so they didn’t think constipation was the issue.

I suggested they speak with their GP to explore whether constipation might be involved. After a medical review, including an X-ray, it turned out he had a large mass of stool stuck in the rectum. The “diarrhea” was actually liquid stool leaking around the blockage — a classic sign of encopresis.

Once the impaction was cleared and the constipation properly managed, the soiling stopped. We kept working together on his bedwetting, and that began to improve too. It was a powerful reminder that what looks like a behaviour issue is often something deeper, with a clear path forward once you understand what’s really going on.

Poop Accidents and Bedwetting: How They’re Linked

Encopresis and enuresis can sometimes occur together — one involves stool, the other urine — but they don’t always have the same cause. It’s not that a child is being “lazy” — physical factors can play a big role.

Here’s how they’re connected:

Bladder pressure from a full bowel: A stretched rectum can press against the bladder, reducing its ability to hold urine. This can lead to urgency, wetting, or bedwetting.
Stretching of muscles and nerve involvement: When a child has been constipated for a long time, the muscles that help support bowel and bladder control can become stretched and weakened. This can make it harder for the body to hold in stool or urine. Over time, this also affects the nerves involved in bladder control, since the rectum and bladder share close nerve pathways. When the bowel stays full, it can interfere with the way the bladder signals are sent and received.

Sleep and missed signals: Some children with encopresis may also experience disrupted sleep or tend to sleep deeply. If their body is uncomfortable or their signals are dulled from chronic constipation, they may not wake when their bladder is full — which can contribute to bedwetting.

While encopresis and enuresis can sometimes occur together, they don’t always have the same cause. Encopresis is almost always linked to physical issues like constipation and impaction, not behavior. Bedwetting (nocturnal enuresis), on the other hand, may involve a mix of factors, including reduced hormone production at night or even enlarged tonsils or adenoids, which may disrupt sleep or affect bladder signals.

Many children are also helped by gently adjusting daily habits and strengthening the brain–bladder connection. That’s why a layered, whole-child approach often works best — one that explores physical contributors, supports emotional wellbeing, and builds new toileting patterns over time.

Support, Don’t Punish

How parents respond to poop accidents makes a huge difference. Most children already feel confused, anxious, or ashamed. Punishment only increases the distress and can even worsen the constipation cycle.

Instead, focus on calm, consistent support:

Get medical advice: A doctor or pediatrician can check for constipation or impaction and rule out rarer causes like Hirschsprung’s disease. Early diagnosis helps interrupt the cycle.
Encourage, don’t punish: Celebrate small steps — sitting on the toilet, trying to go, or telling you about an accident. Stay calm and kind.
Build healthy routines: Have your child sit on the toilet after meals to encourage regular bowel movements. Support this with a fiber-rich diet, plenty of water, and by limiting foods that may contribute to constipation — such as a diet high in pasta, white bread, or white rice, especially if not balanced with enough fruits, vegetables, and whole grains.
Offer emotional reassurance: Let your child know that many kids go through this, and that with time and the right support, it really can get better. Handle clean-ups calmly and in private to protect their dignity and help them feel understood and supported.
Ask for the right support: If needed, ask your GP or pediatrician for a referral to a continence nurse, pelvic floor therapist, or nutritionist. With the right tools and guidance, most children make excellent progress.

Conclusion

Seeing that child scolded for a poop accident was a powerful reminder: children need understanding, not punishment. Encopresis isn’t a sign of bad behavior — it’s usually a result of constipation or an overloaded system.

Recovery takes patience and support. This means getting medical help, following through with treatment (which may take months of routine and care), and encouraging the child every step of the way. With the right knowledge, gentle habits, and professional guidance, children can regain healthy bowel function, rebuild confidence, and leave the shame of accidents behind.

It might take time, but change is possible, and it’s absolutely worth it.

References

Mayo Clinic Staff. (2021). Encopresis – Symptoms & Causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/encopresis/symptoms-causes/syc-20354494

Boston Children’s Hospital. Encopresis (Soiling) in Children – Overview & Causes. https://www.childrenshospital.org/conditions/encopresis

Cleveland Clinic. (2022). Encopresis (Soiling). https://my.clevelandclinic.org/health/diseases/17849-encopresis-soiling

Mulhem, E. et al. (2022). Constipation in Children and Adolescents: Evaluation and Treatment. American Family Physician, 105(5), 469–478. https://www.aafp.org/pubs/afp/issues/2022/0500/p469.html

Ruwa, R. (2024). Constipation and Bedwetting: Can One Lead to the Other? Healthline. https://www.healthline.com/health/constipation-and-bed-wetting

Hodges, S.J., & Anthony, E.Y. (2012). Occult megarectum – a commonly unrecognized cause of enuresis. Urology, 79(2), 421–424. https://pubmed.ncbi.nlm.nih.gov/22173180/

Sydney Pelvic Clinic. (2023). Constipation in Kids (Children’s Continence). https://www.sydneypelvicclinic.com.au/constipation-in-kids

Ginny Laver

Ginny Laver BA (Hons), MSc, NLP, Dip. THP is a Clinical Hypnotherapist and Neuro Linguistic Programming (NLP) practitioner who specialises in helping children learn how to stop bedwetting naturally.