Families Bowel problems Poo problems - where to start? Constipation, withholding, soiling, mega poos, runny poos, encopresis... There are lots of different ways that children can experience a poo problem. You're in the right place to find out why and how to help them. The majority of children will have a bowel that should work properly, but they find it hard to poo normally. For some children it will be due to a condition they are born with like Hirschsprung’s disease or Spina Bifida. Children with additional needs such as autism are also more likely to be affected by bowel issues. Callers to our helpline say things like: "My son can't be constipated because he leaks runny poo everyday..." "My daughter is autistic and really struggles with her bowels. How can I help her?" "My toddler is so scared of sitting on the toilet that they end up withholding their poo for days at a time. I don't understand why they won't just go?!" Poo problems can take lots of different forms. This can make it confusing to work out what’s going on inside the body. Some children will pass huge, infrequent poos which can make them scared of sitting on the toilet. Others may leak soft poo into their pants or little hard pellets despite passing some ‘normal’ poo each day. This is referred to as 'soiling' (also known as 'encopresis' in some places). Or they might do lots of little poos each day and find it hard to empty their bowel in one go.Take a look at our Poo Checker to see what different types of poo can mean.Our glossary has more information about different terms used for poo problems. Poo problems come in all shapes and sizes and affect children in many different ways both physically and emotionally. It can be a really stressful thing for children and their families to deal with. How poo problems can affect a child's behaviour: Hiding their underwear - it’s very common for children to act as if they’re not bothered by their poo problem because they find it embarrassing and feel guilty. Becoming angry and defensive - not knowing how to resolve a physical problem such as soiling can cause children to feel stressed and sad. Seeming untroubled despite it being obvious to others - some children may not even be aware they have a problem because to them it feels ‘normal.’ Plus, we don't always notice our own smell. Watching Sam's Story about a boy who soils or reading our kids pages together with your child can help provide reassurance that they're not alone and it's not their fault. There are things they can do to help manage their poo problem and places to get help. It's important to remember that poo problems happen for a reason. This doesn’t mean that there’s something badly wrong with their bowel, but it’s really important to work out what’s going on and get it treated. One in three children will struggle with constipation growing up. It doesn’t mean that you’re a bad parent, your child is lazy or doing it on purpose. It can be very stressful to deal with for everyone. Take a look at our tips for caring for yourself. Poo problems won’t go away on their own without the right treatment. The sooner you get to grips with it with the better. Watch our short animation 'The Pooper Highway' to understand how constipation can affect children and how it should be treated. Why do some children get constipated? The biggest group of children affected by a poo problem will have what's known as functional constipation. This means there's no underlying physical cause of their poo problem. They've been born with everything in the right place and it should work properly but for some reason they've become constipated, A much smaller number of children will have an underlying organic problem. This will usually picked up soon after birth, but not always. Download our Guide for Children with Complex Bladders and Bowels to find out more about how these children manage their bowel condition. All children with constipation should be assessed by a doctor to rule out an underlying cause. Having an additional need or learning disability can affect a child's bowel function. There can be a range of factors which result in a poo problem for these children such as their sensory needs, environment or diet. More help and information can be found in our sensory needs factsheet and smearing factsheet. (Smearing is when a child puts their poo in places where it shouldn't go.) The constipation flowchart of our Children's Continence Pathway has been designed to inform parents and professionals about the assessment and intervention a child or teenager with a poo problem needs. It might start with a child being frightened of the toilet or not understanding what's expected of them when they start potty training. This can easily lead to withholding behaviours which can in turn lead to constipation. What is withholding? Withholding happens when we use our anal muscles to stop a poo from leaving the body. In young children this behaviour normally starts because of previously passing a painful poo. Delaying poo being released can quickly lead to constipation because the longer the poo stays in the bowel, the harder, drier and bigger it gets, making it more and more painful to pass. Liquid poo can then leak round these lumps and bits can break away (this is known as soiling). It can be a very tricky cycle to break without the right intervention. Laxative treatment can help to keep the poo soft and easier to pass. Watch the Poo in You video for an excellent explanation of how withholding can lead to soiling and worsening constipation. The blog 'Stool withholding: Learning lessons and passing them on' by Sophia Ferguson gives the personal experience of a mum whose son became constipated through withholding his poo and went on to write a book for other parents. Why should constipation be treated? Whatever the reason for constipation starting in the first place, the main thing to remember is that poo problems won’t go away on their own without the right treatment. The sooner you get to grips with it with the better. You might think that treatment includes changing their diet, increasing fluids, getting plenty of exercise or sitting on the toilet more often. HOWEVER, these are all ways to promote a healthy bowel - not treatments for constipation. What to do next: Read our advice sheet for children with constipation. This explains how to recognise the signs of constipation and what to do next. Keep a poo diary for a week or two and note down what each poo looks like. The sweetcorn test can be a helpful way to assess the time it's taking for food to go from your child's mouth to bottom (also know as 'transit time'.) Your child needs to be seen by a doctor. Take the poo diary with you and tell them about any other symptoms. They should assess your child for any underlying physical cause to rule this out. If they are diagnosed with constipation, the first line treatment is macrogol laxatives as recommended by NICE Guidelines. Simply adjusting their diet or waiting for them to get better without intervention won't work. Treating and managing constipation: Macrogol laxatives (such as Movicol, Laxido or Cosmocol) help to soften poo and keep it moving along. Macrogols must be mixed with the right amount of water first before you add anything else. See our factsheet on preparing macrogol laxatives for more help with this. Most children will need to follow a disimpaction regime using macrogols first to clear out their backlog of old poo. Read our guide to disimpaction and then talk to your doctor about this. Your child may need to stay on laxatives for quite a while to help their bowel recover and work normally again. This won't hurt them and is much better than leaving constipation undertreated. The right toilet routine: The best time to try for a poo is 20 - 30 minutes after eating. Placing feet flat on a footstool so that knees are raised higher than hips in a natural squat helps poo to come out. Children need to feel relaxed on the toilet. Get lots of ideas and tips on making toilet sits more fun in this blog but most importantly productive! You may like to use a reward chart to motivate your child. More help and resources Translate me!