Parent Question:
My (almost) five-year-old is very capable and bright. But for 18 months now he frequently finishes the day with a smear of poo in his pants or having wee’d himself.

He doesn’t say anything to anyone. And even when he gets that “faraway” look in his eyes that means he is soiling himself. He denies anything is going on but he is very resistant even to the “tactical wee” (a great Blueyism) and it has become a thing. No doubt as parents we have probably reacted poorly in the past and create a shame spiral. How can we best help him?

Answer:
For children over five, the most common cause for day-time soiling is chronic constipation. Their rectum becomes so impacted with faeces that they lose control of it when they have a bowel movement.

The smearing or soiling is usually caused by the faeces leaking out as they don’t have full control. In addition, the constipation causes the child’s rectum to be expanded and this irritates the bladder to cause uncontrolled wetting.

As the wetting and smearing have a physical cause, it is important to realise that your child is in no way responsible for what is happening. Thinking they are “doing it on purpose” or are “lazy” are all inaccurate and make the child feel shamed and likely to hide the problem from their parents.

The good news is that chronic constipation can be treated though it requires an extensive use of laxatives and behavioural support for your child as they relearn to gain control.

I recommend the work of Dr Steve Hodges who provides a great set of parent treatment resources on bedwettingandaccidents.com, including books to explain what is happening children in a non-blaming way (eg Jane and the giant poop). The UK based children’s bladder and bowel charity – eric.org.uk – have a parent helpline and great resources for parents and children.

John Sharry is founder of the Parents Plus Charity and an adjunct professor at the School of Psychology, University College Dublin. This parenting Q&A was originally published in the Irish Times in December 2021. John writes in theIrish Times Newspaperon Tuesdays. His website is www.solutiontalk.ie.