Dear Kirsten,

My husband and I have three children, our youngest is ten. When he was six, he started having soiling accidents at school and during the night time. We have watched him lose confidence over the last few years, children will often make fun of him and he is often anxious and doesn’t want to attend parties in case he has an accident. We have been to see our GP who has said it’s very common and that he will grow out of it. He will transition to big school next year and we are worried about the problems it might cause for him.

Firstly - thank you for writing in about your son. I feel as though I want to tackle this in three parts: medical, psychological and then to think specifically about school.

Your GP is right to say that soiling (encopresis) is common in children and young people. It’s estimated that one in 12 children aged between 5 and 16 will have some form of bowel or bladder leakage issue. Some children will initially toilet train and start having issues later in life (secondary encopresis ) whereas some young people never master toileting (primary encopresis).

The good news is that there are steps you can take to get support for the both of you. The first place to start is to speak to your GP again, there are a number of reasons why a young person experiences difficulties in this area and it might be that they need referring to a specialist to determine the root cause.

Toileting issues can often be caused by impaction ( hard stool that gets impacted and is unable to move) looser stool then leaks around it: if this type of toileting problem becomes a chronic issue it can cause further complications for the bowel. 

If you imagine continuously having an impaction in the colon, the wall of the the colon stretches, and the nerves can start to lose sensitivity.  Over a long period of time this can result in the young person not being able to feel when they need to use the toilet.  It’s important to make sure your son’s issues aren’t caused by constipation and this is something your GP can help with. Keeping a stool diary and looking at hydration and fibre intake in the diet are also two important areas to consider. 

It can be an incredibly frustrating for parents who often don’t realise that their child doesn’t always feel when they have had an accident and very often don’t have control over their bowels. Having a thorough assessment by the GP can help you determine what is happening and the best way forwards.

Psychologically for young people with encopresis (soiling issues) the process can be devastating, imagine trying to navigate school, friendships, relationships , forming your identity all while having  toileting problems. 

Many young people can feel very ashamed, disconnecting from  their body sensations even further. Some young people will hide any evidence that there is a problem and some can find it very difficult to talk about and mask it with other emotions such as anger. 

Making it ok to talk about, normalising it by reassuring your son that it’s common can really help. 

It might be worth thinking together with your son about how things were when he was 6. Were there any emotionally stressful events happening? There can be a pattern of holding in the stool when things feel emotionally difficult, this can lead to constipation and then into a pattern where going to the toilet hurts and is avoided - starting a vicious cycle. 

Getting as much information as you can about the issue and feeling empowered in your understanding can help with your anxieties. Schools usually have good pastoral teams and it is likely they will have supported young people with similar issues before. Making a plan with school to manage any accidents and to have a clean up kit if needed in a private area can be useful. Working with your chosen secondary school letting them know in confidence the issues you are facing at the moment is a good idea, they will be respectful with the information you share and support you in making sure his transition goes well.

In summary, your GP should be able to refer your son for additional tests to start with, however if you still feel you are struggling to get support, ERIC ( ) is a brilliant resource for parents, they have a great helpline and a range of tried and tested devices that can really make a difference.

Some young people do grow out of their toileting issues, however it’s always worth getting as much support as you can to make sure anything medical like impaction is ruled out.

All best wishes


Kirsten Antoncich is a UKCP accredited Psychotherapist, neurofeedback practitioner and a fellow of the Royal Society. She works with children, young people and adults from her base in York.

To ask her a question in complete confidence, please contact her via