Soiling or encopresis means having a bowel movement (BM) in the underwear. If your child has recurrent soiling, please collect the following information for three bouts of soiling before you call your child's health care provider to make an initial or follow-up appointment. This information may be very helpful to your health care provider in reaching a correct diagnosis.

Time and Place
 

Date:

Time of day:

Place (home, school, etc.):

People present:
 

Description of Soiling
 

How much? (1 = small smear, 5 = full bowel movement):

Consistency (loose or solid):

Who recognized it (you or your child)?
 

Triggers for Soiling
 

Activity at time of soiling:

Food eaten before the soiling (within 4 hours):

Was your child upset or angry before the soiling?

Had your child been corrected recently?

Was your child holding back before the soiling?
 

Use of the Toilet
 

Did the soiling occur while your child was on the way to the toilet?

Did it occur after he used the toilet?

Did your child use the toilet? If so, what were the results?
 

Your Observations
 

What do you think was the cause of the soiling this time?