Enuresis and encopresis, better known as soiling one’s pants with urine or feces, can be the bane of caregivers’ existences, especially when they happen in older children. These children are technically “potty-trained,” so why do these accidents happen? Are they because of carelessness? Is it manipulation? Do these kids just want to disgust adults? Most of the time, the answer to these questions are a resounding “No.” Some children have physical issues that cause urinary and bowel trouble, and they need medical support. Other children come from hard places and have “accidents” because of exposure to early childhood trauma. These children need empathy, not public embarrassment.
Urinary and bowel issues can occur for many reasons. Studies show, however, that enuresis and encopresis are much, much higher in children who have experienced abuse and neglect. A 2022 study showed that 60% of its participants experienced abuse and struggled with one of these conditions (Dayan, Creveuil, & Bapt-Cazalets). The rates of encopresis specifically were seven times higher in the abused children. Why might this be? Children left in soiled diapers or underwear may have become accustomed to feeling wet and dirty, as they were incapable of changing themselves (The Child Psychology Service, 2025). Children who were punished for developmentally normal bathroom accidents may furthermore hide soiled underwear or bedding for fear of repercussions. Children who feared using the bathroom because of unsafe and/or abusive caregivers may have learned to urinate or defecate in their rooms to avoid those adults. Children who experienced sexual abuse may have dissociated from the feelings in their genitals to “escape,” since they were not strong enough as children to do so physically. These same children may have also purposefully soiled themselves to try to prevent sexual abuse. Correlation does not mean causation, so enuresis and encopresis do not prove experience of abuse as a fact. Rather, these behaviors should be a cause for curiosity, so that caregivers can recognize and tend to children’s underlying needs.
What is the best response to enuresis and encopresis when caregivers know that their children have experienced early neglect and abuse? It is not embarrassment, but rather empathy. These children need to know that their caregivers are now safe. They need to know that their caregivers can coregulate with them and give them the support they need (The Child Psychology Service, 2025). Instead of asking, “Why?” caregivers might instead show empathy by recognizing accidents in their children and teaching the children, as age appropriate, to clean up after themselves. They might provide strategies to help reduce impact and stress of accidents through use of products such as waterproof mattress pads. They might help children develop a schedule for using the restroom, to empty their bowels and bladders regularly. Caregivers can affirm and model healthy bathroom habits (Canadian Psychological Services, 2020). Children can overcome enuresis and encopresis, but they need the help of attuned caregivers to do so.
What about reasons for enuresis and encopresis outside of early experiences of neglect and abuse? Should caregivers still respond with empathy? Yes! Shame is never a good motivator, especially for children. Empathy, on the other hand, can be powerful, maybe not always for changing behavior, for certainly for building the kind of safe, healthy relationships that all children need to thrive.
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