Initial work-up

• History of onset, course and pattern of soiling.
• Associated history of constipation, wetting.
• Developmental history, toilet training history.
• Associated behaviour patterns.
• Parent and child's attitude to problem.
• Dietary history (rarely the main cause).
• Physical exam including spine, abdomen and perineal, perianal area.
• Rectal examination is NOT routinely recommended.
• Abdominal x-rays rarely change management and are NOT recommended

Recommended pre-referral treatment

• Explanation/ demystification of faecal retention and soiling, minimize blame and shame.
• Behaviour modification diary (regular toileting, star charts, rewards).
• General management, including Laxative use, found at Constipation Clinical Practice Guidelines
• Encourage a healthy diet, adequate clear fluids.
• Treatment and monitoring often required for months.

When to refer

• Soiling is prolonged, treatment resistant.
• Associated significant behavioural problems.
• Soiling associated with day or night wetting.
• Soiling not associated with faecal retention and overflow.

Resources

• RCH Constipation Clinical Practice Guideline
• Making a referral to Specialist Clinics 
• Melbourne Health Pathways (password protected for GPs)

Parent Information

• Kids Health Info
• Raising Children Network

References and more reading

• Paediatric Handbook (2015) Ninth Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia.

Guideline developed by RCH Gastroenterology, reviewed by RCH Centre for Community Child Health. First published Jan 2008. Reviewed August 2018. Please read  Copyright and Disclaimer