Still having accidents at the age of six?

Your child was completely potty trained since the age of three, but now they are having accidents?  This can be extremely frustrating as a parent. Is it a behavioral issue?  It may not be. If your son or daughter was doing well with potty training and now has starting soiling or not making it to the bathroom on time when having a bowel movement, they may have a condition called encopresis. This comes along with constipation, which is caused by voluntary withholding by the child. Their intestines becomes so full of stool that they eventually lose the urge to have a bowel movement (Altschular & Liscouras, 1998). 

Voluntary withholding could be due to fear of having a bowel movement because of pain associated with constipation or they are “too busy” to take the time to go. Encopresis usually affects children between the ages of 4-11 years old, with the highest prevalence being 5-6 year old boys (Hay, Levin, Deterding, Abzug, & Sondheimer, 2012).  When they say “they didn’t know that they had to go”, they may be telling the truth.

This is a real medical condition that will take time and patience on your end to help correct. It’s important to get your child evaluated by a medical professional. You need to evaluate your child’s diet to make sure they are getting an adequate amount of fiber. This is found in whole grain cereals, breads, fresh fruits, vegetables, and nuts.  This will add roughage to their diet and help to increase bowel motility, while softening the consistency of the stool. Decrease foods high in fat and sugar as well as excessive dairy, bananas, caffeine, white rice, breads, and applesauce as these can be constipating.

 Increasing physical activity will also help.  Staying active and getting exercise helps to stimulate the intestines and keep your bowel movements regular. Getting enough fluid is also necessary to prevent constipation. Water is the best source of fluid intake and helps to soften the stool to allow for easier passage.

Punishing your child for having accidents is not effective.  It will become a family effort to correct. This will consist of having your child sit on the toilet twice daily for 5-10 minutes to try and have a bowel movement. They should be rewarded for sitting, not only having a bowel movement. This can be done with a sticker chart so that they have a visual aid.  It’s best to sit about 30 minutes after a meal and have their feet placed on a stool if they cannot reach the floor, as this aids in proper positioning to make the stool come out easier. It can take a full 6-12 months to regain full bowel control.

Your medical provider may also recommend daily medications to promote 1-2 soft stools per day until routine bowel movements are established (Coehlo, 2011).  Frequent follow-up visits with your provider should occur so they can track the progress of your child. There is hope, just remember, time and patience are required.

Kelly C. Medure is a Registered Nurse with more than 10 years of experience.  She is currently finishing her master’s degree at Carlow University for Family Nurse Practitioner.  She is also the mother of two soon to be three children and resides in the Pittsburgh area.

Altschular, S.M.  & Liacouras, C.A. (1998). Clinical pediatric gastroenterology. Philadelphia, PA: Church Hill Livingstone.

Coehlo, D.P. (2011). Encopresis: A medical and family approach. Pediatric Nursing, 37 (3), 107-112.

Hay, W.W, Levin, M.J., Deterding, R.R., Abzug, M.J., & Sondheimer, J.M. (2012). Current diagnosis & treatment: Pediatrics. New York, NY: McGraw Hill Companies.