Constipation is associated with hard, large stools (feces) in the large bowels (colon) and rectum, which become difficult and painful to evacuate (defecation). This leads to stool-withholding. A vicious circle ensues.

The rectum becomes gradually distended with accumulated stool. The distension causes a loss of sensation in the rectum. This leads to further stool-withholding, as the urge to defecate becomes more and more irregular.

Eventually, softer stools from higher up the bowels cannot be accommodated and leak around the bolus of hard stool (overflow). Due to the lack of rectal sensation, this is not noticed by the child until soiling has actually occurred.

Parents are under great stress, as they might think or suspect that their child is soiling intentionally and become irritated and even aggressive. They might have also been advised that their child is psychologically abnormal, which leads to further distress.

Both parents and child often suffer great psychological abuse. Soiling can result in a disruption of relationship between the parents as well as the parents and their child.

Children who soil then become very frightened as they are punished for something over which they have no control. Soiling results in a marked loss of self-esteem in the affected children. Behavioral abnormalities develop.

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