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Early childhood risk factors for constipation and soiling at school age: an observational cohort study
  1. Jon Heron1,
  2. Mariusz Grzeda1,
  3. David Tappin2,
  4. Alexander von Gontard3,
  5. Carol Joinson1
  1. 1 Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  2. 2 Department of Child Health, School of Medicine, Scottish Cot Death Trust, University of Glasgow, Glasgow, UK
  3. 3 Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
  1. Correspondence to Dr Jon Heron; jon.heron{at}


Objective Constipation and soiling are common in childhood. This study examines the comorbidity between childhood constipation and soiling and early childhood risk factors for these problems.

Design The sample comprised 8435 participants from the Avon Longitudinal Study of Parents and Children with maternally reported measures of constipation (six time points between 4 and 10 years) and soiling (five time points between 4 and 9 years). We used latent class analysis to extract longitudinal patterns of constipation and soiling. We examined whether the latent classes are differentially associated with maternally reported risk factors in early childhood (stool consistency, breast feeding, socioeconomic background, gestation, birth weight, developmental level and age at initiation of toilet training) using multinomial logistic regression models.

Results We extracted four latent classes: ‘normative’ (74.5%: very low probability of constipation or soiling), ‘constipation alone’ (13.2%), ‘soiling alone’ (7.5%) and ‘constipation with soiling’ (4.8%). Hard stools at 2½ years were associated with increased odds of constipation alone. Developmental delay at 18 months was associated soiling alone and constipation with soiling, but not constipation alone. We found limited evidence of associations with socioeconomic background and no evidence of associations with age at initiation of toilet training, breast feeding, gestational age or birth weight.

Conclusion Constipation alone was the most prevalent pattern in this cohort. Treatment for hard stools in early childhood is needed to prevent chronic constipation at school age. Constipation with soiling was less common than soiling alone. Further research is needed into the causes of non-retentive soiling.

  • gastroenterology

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  • Contributors Secured funding: DT and CJ. Study design: JH, DT, AvG and CJ. Literature search: CJ. Data analysis: JH and MG. Data interpretation and writing:JH, MG, DT, AvG and CJ.

  • Funding The MRC and Wellcome Trust (grant ref: 102215/2/13/2) and University of Bristol provide core support for ALSPAC. This publication is the work of the authors who will serve as guarantors for the contents of this paper. This work was supported by the MRC (MR/L007231/1) and NHS Greater Glasgow & Clyde Health Board (Stephen McLeod, Head of Specialist Children’s Services).

  • Competing interests None declared.

  • Ethics approval ALSPAC Law and Ethics committee and local research ethics committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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