Fecal Incontinence: Potty Talk for Caregivers

The goal of Poop Group is to get caregivers of kids together who all have similar issues with stool incontinence. It’s an opportunity for them to learn from one another and to learn from us.

In partnership with our gastroenterology clinicians, we can come up with ways to help these kids develop continence so they can go to sleepovers and go to pool parties more comfortably. They’re making friends. They’re not getting bullied.

Dr. Jerson and I used to do a lot of this individually, where we would see one caregiver at a time. Then we realized that so many caregivers just feel so embarrassed about this and so alone. We saw the opportunity to bring folks together and recognize that there are a lot of other caregivers in the same boat.

We typically have four to six families. We run it over the noon hour via video, so some caregivers join from work. Some caregivers are joining from home. It runs for a month.

What causes fecal incontinence in kids?

The classic story we hear from a lot of families is that they had a stubborn 2-1/2-year-old who was potty training and then decided they were not going to poop in the toilet because they just weren’t.

And they start to get backed up, as happens when you hold your stool for too long. Then they have a really big, hard, scary poop that might hurt when it comes out, and they decide that they are definitely never going to do that again because it hurt last time.

So we get into this cycle of ongoing constipation and fear avoidance. If you’re 6 or 7 or 8 and it’s been hurting every time you’ve had a bowel movement for four years, that’s a lot of learning that we have to walk backwards.

How common is fecal incontinence in kids?

It’s a lot more common than folks think it is, but a lot of caregivers feel pretty isolated and very alone. Especially in that early school range, five to nine, it can be as high as 10 percent. So if you think about a classroom of 30 kids, there’s probably three or four kids in there that are having similar stooling issues.


 

Accidents happen sometimes—that’s to be expected—especially if your child is busy, distracted, or going through times of change. But if it starts happening more frequently, it may be time to see a pediatric gastroenterology team and talk about the possibility of fecal incontinence. We usually ask caregivers if their child has:

• Frequent accidents: once a month or more
• Large, hard stools that hurt when coming out
• Consistent or frequent tummy pain that comes and goes
• Fear or anxiety about going to the bathroom 

Is there a connection between stress, anxiety, and gastrointestinal conditions? 

Yes. There’s a really big misunderstanding of what happens when doctors say that stress and anxiety can be components of these conditions. Especially with disorders of the gut-brain interaction (DGBI)—things like irritable bowel syndrome (IBS) and chronic nausea—we know that stress and anxiety play a role in making those conditions worse. 

We know that stress and anxiety can change:

• Gut motility, or movement;
• Gut permeability, or how the intestinal wall allows substances to pass through, and how much things are getting absorbed; and
• How things empty from the stomach to the intestines. 

When families hear “IBS” or “functional nausea,” some hear that as, “We don’t really know how to help you,” because there’s not really a medication for this. 

GI psychologists are well equipped to treat those conditions. We know exactly what’s wrong and we know exactly how to help them. It’s not a pill, and it’s not a surgical procedure, but we do have good strategies. We can help their quality of life improve, reduce their symptoms, and get kids back to being kids again.

>Related: Tummy troubles: anxiety, or something more? 

There are several ways to help!

• Encourage regular bathroom breaks, especially after meals. You can even set a timer to remind your child to try going.
• If constipation is a problem, ask your doctor if stool softeners or other treatments could help.
• Stay calm and supportive. Avoid punishing your child for accidents, as this can make them feel worse and lead to more anxiety. Instead, praise their efforts to use the toilet, even if they don’t succeed every time. 

It’s also helpful to talk openly with your child about what’s happening. Use simple language and reassure them that their body just needs a little help to get back on track. If your child seems anxious or upset, consider working with a pediatric GI psychologist.

With the right approach, most children overcome fecal incontinence. It takes time and patience, but consistency is key. Follow your doctor’s recommendations, and don’t hesitate to ask questions or share concerns along the way.