"It Happens" - Fecal Smearing in Individuals with ASD - Autism Awareness
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Fecal Smearing in those with ASD

“It Happens” – Fecal Smearing in Individuals with ASD

I receive a lot of questions every month about toileting difficulties. One question I am asked is what to do about fecal smearing. It’s an upsetting behavior because of the smell, mess, and unhygienic situation. Parents worry that fecal smearing will happen when their child is outside of their home – at school, daycare, or in a public place. It can cause isolation because the family will be reluctant and fearful to go places. Siblings don’t want to invite their friends over. It’s not a topic parents are able to discuss with friends and family. They may not have the confidence to speak with a professional about it because they worry about being criticized or judged.

I can remember my mother issuing an ultimatum over my son’s fecal smearing – extinguish the behavior or no more weekly Sunday dinners at her house. We never went for regular Sunday dinner again because it took me years to get this problem in control. I wish I had the understanding of fecal smearing that I do now back when it was a daily occurrence. I used to get so disheartened over the mess, smell, and clean up. I felt I had no one to talk to and felt really alone.

There is very little research that shows how common this problem is with autism and other related disorders. Because you can’t find much information about smearing, parents feel that other children don’t do this, they feel embarrassed, or they feel it is a part of the disability and nothing can be done about it.

What Is Fecal Smearing?

Smearing covers a variety of behaviors such as:

  • Rolling feces in the hands, then hiding the pieces
  • Taking feces of out of the toilet to play with or smear
  • Choosing a spot in the house to play with feces
  • Undressing in the school toilet, smearing feces on themselves, then getting dressed again and returning to class
  • Using smearing as part of masturbation
  • Smearing and shredding diapers at the same time
  • Defecating in the bath, then smearing the surrounding area
potty training in bathroom

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Ideal for quickly grasping concepts and strategies for Toilet Training.

What Causes Smearing?

Smearing can be caused by a variety of things. Sometimes there is one than one cause, making it more difficult to resolve because the behavior is complex.

Some causes of smearing may include:

  • Medical issues (constipation, GI issues)
  • Psychiatric issues (OCD, exposure anxiety, mental health issues)
  • Sensory factors (interoception problems – not knowing you have to go, enjoyment of smell and texture)
  • Difficulties around teaching toilet training skills
  • Dietary factors (limited diet may lead to constipation)
  • Emotional factors (response to anxiety, the reward of a hot bath, sense of autonomy, understimulation/boredom, an expression of anger)
  • Sexual factors (gratification, a sign of abuse)

Managing Smearing

Smearing can be both emotionally and physically draining for parents and caregivers. They need support from professionals to understand and develop toileting skills for the individual. This is the most important step in reducing or eliminating smearing, after ruling out medical or psychiatric causes.

Smearing can be reduced or minimized no matter how long it has been happening or how much it has occurred. Strategies will need to be individualized as every person has their own reason for smearing. Parents will need to work with everyone who is involved with their child (school team, caregivers, family members) to get everyone using the same approach. There should be no punishment involved as this will not reduce smearing episodes.

Use low-arousal responses which involve being as emotionally neutral as possible. This means having neither a positive or negative reaction to fecal smearing.

Some ways to do this are:

  • Focus on your own breathing prior to clean up – calm, steady breaths
  • Clean up quietly with few or no words
  • Go somewhere alone to have an emotional reaction if there is the need to vent frustration, but make sure the individual is not present
  • Clean the furniture, floor, walls etc. when the individual is not there so that they can’t see or hear your responses to the cleaning.
  • When cleaning the individual, do so with as few words as possible or in silence. Keep your responses low-key and behave calmly so that your emotions don’t come through in your actions (like brisk scrubbing).

When Smearing Occurs

If you support an individual who smears, the first thing to do is seek advice from your family doctor. The cause of smearing has to be determined before any strategies can be put in place. We found out that our son was chronically constipated after having an abdominal ultrasound done. He had also experienced weight loss and vomiting with any increased food intake as a result of being constipated. Our son would dig in his anus and pick out bits of stool to relieve pressure and itching and that is why he smeared.

Constipation happens more often than we realize in people with ASD due to low fiber diets and limited fluid intake. You can keep a stool diary using the Bristol Stool Form Scale to record what bowel movements look like. This information is helpful for physicians to determine what is going on.

If underlying medical causes have been ruled out and the root cause is sensory (enjoys the smell, texture, feel of feces), you can try offering substitutions for the feces such as:

Touch – warm play dough, pudding, toothpaste, shower gel, clay, sand and water mixture

Visual – finger painting, shaving cream, clay, bread dough

Smell – Marmite, vinegar, essential oils, spices, scented lotions

Sound – the texture will tell you the sound the material will make when squeezed

Substitutions should be offered throughout the day and consistently used until they become routine. Have them accessible where the individual usually smears.

Toilet Training Skills

I have written numerous articles on toilet training and recommended books on the subject. Difficulties around acquiring toileting skills can be part of the reason a person fecal smears. Impairment in interoceptive awareness may be the reason someone doesn’t know they need to defecate.

I am a proponent of getting rid of diapers when toilet training. Using diapers can prevent a quick response to the urge “to go”, some may not even know you use a toilet to eliminate in, and remaining for any length of time in a soiled or wet diaper can cause the anal area to become sweaty or damp leading to anal itching, then picking and smearing.

You can learn everything you need to know about smearing by reading Kate E. Reynolds book, What to Do About Smearing. It is a highly accessible book that explains all aspects of smearing and provides answers to questions so many of us are afraid to ask. The important points for each chapter are summarized at the end and there is an extensive reference list provided for further study. I wish this book had been written years ago because it would have saved me much heartache. It is Kate’s book that I used for the basis of this post as well as my own firsthand experience.

 

 

 

 

 

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  1. Jazmin says:

    My 8 years old son just started smearing 2 weeks ago. I’m not sure what has changed to prompt him to start doing this and I honestly feel lost and alone. First, thank you for this article as it clearly means I’m not alone. I’m curious….if my son is smearing would this be a sure sign that there is some sort of mental illness? He has never been diagnosed with anything…So I started to see smears of this brown stuff in some areas like the living room floor (obviously not knowing what it was), then more a few days later with chunks. Finally when I saw smears within the toilet (like he was picking it out) it all came together for me. His father and I have truthfully lost t the first couple times thinking he would realize it was a problem and then stop. we have tried educating how this can make us all sick and even talking nice to him. Nothing worked, and we just caught him sneaking in a corner, bending over with his fingers in his bum. He says he likes the feel of it. I’m so worried….again, is this a sure sign there is a true mental illness? 🙁

  2. TM says:

    I have a 17 year old foster son who a year ago started digging (maybe originally constipation but has been treated and cleared) and is now smearing more and more. It has been on and off for over a year, sometimes stress induced but is increasing so now it is every time he goes to the bathroom. He smears on himself or anything around him. He is so mildly autistic he’s barely on the scale. He is ID and has mental health diagnoses for anxiety, also treated by psychiatrist. He does not have a history of abuse or significant trauma. We’ve tried reward systems for a year and it is only getting worse. Any advice?

    • You say he is a foster son with no trauma. I am wondering if he has been in the foster system. I ask because there may be some trauma there. You say it is increasing every time he goes to the bathroom. I am wondering if there is still constipation present. Please read the book I have recommended in this blog post called What to Do About Smearing. You will have to be a detective and read about all the reasons this may be happening. It is hard for me to pinpoint. If it is connected with a mental health issue, you may need to consult with your mental health professional. When you say this is only connected to the bathroom, there is always the possibility that the feces are being used as lubrication for masturbation.

      Reward systems generally don’t work for this behavior. If you do find out it is connected to masturbation, you may want to offer a lubricant and explain how it is used.

  3. Mrs S says:

    My Son is three, and is in the process of being diagnosed with Autism. He has started to smear poo on and off for about six months. He will hide when he needs a poo and will take it out the nappy and look at it and wipe it on his clothes or surrounding areas. Sometimes I cant help but get shocked when I see it and he will look very guilty. He does do this more when he is constipated. Do you think he is ready to be toilet trained. Feeling really deflated today.

    • Sabah, you have to get the constipation in control before you start toilet training. You also have to look for signs of toileting readiness. I would highly recommend that you watch the webinar I gave on toilet training – https://autismawarenesscentre.com/shop/webinar/teaching-toileting-to-individuals-with-asd-webinar/ . I address constipation and smearing in it. You have to become the detective for your own child as no one child presents exactly the same in this process nor are the reasons the same about why they do what they do. With smearing, you have to see what he does with the poo – does he smell it, taste it? When does he smear? Does he get a diaper on his own or asked to be changed? Toileting is a complex process and can’t be mastered in a few steps.

  4. Shannon searle says:

    Hello, my son is 2.5years old and he is always picking his bum when he is about to or is pooping, sometimes he wipes bits of poo on things or he smears it on the walls/bathroom tiles. Can someone please give me some reason why he may be going this. Its a long term thing and it’s getting so much.

  5. Monica says:

    My son has been smearing his whole life. I thought it was something he would out grow.  It seemed more of an attention seeking thing when he was a toddler. It isn’t as drastic now that he is now 8. It could be more now that he gets it on his hands when wiping and isn’t cleaning them well. I‘ve gone over how to wipe properly several time’s. His stool doesn’t seem to be hard but I have spoken to him about constipation and spoke about diet and he has opted to eat bran cereal  everyday now so maybe he does have some issues getting it out. He doesn’t really want to talk about it he seems embarrassed. I have being trying not to shame him but I have to get him to wash his hands constantly as they smell and have told him off in the beginning when I though he was doing it more purposely . Is there any tips on where we go from here?

    • You need to do more in-depth reading on this topic. Please read the book What to Do About Smearing which I have linked in this article. You will have to be a detective and get to the bottom of this. If your son has had years of constipation, he may have poor colonic motility. You may have to look at using something like PEG-3350 but please talk to your doctor about this. I would also introduce wet wipes for bowel movements as they do a better job of cleaning than toilet paper. Just make sure he puts them in the wastepaper basket and not in the toilet. I have a feeling there is a constipation issue here.

  6. Bruce Graham says:

    My son is now 27 years of age. He started touching his poop last November. He and his mother were in a very low speed accident in October 2019. He is autistic but was pretty high functioning. He has lost a lot of ground over the last year. It’s not constipation. He has a good diet, some food issues have come to light in the last year or so. He is off gluten, sugars, processed foods. For the life of me I don’t know why he started doing this? Very taxing on family right now. He does bio-feedback once a month. Mother is trying natural remedies, but I am open to anything?

    • Bruce, what does he do with the poop? Is it rolled into a ball in between his fingers for example? Is he smearing it on to something? It helps me to know this. This activity may be used as a calming strategy connected to a traumatic event such as the car accident. I would highly recommend reading the What to Do About Smearing book that I mention in this article as it does have a lot of trouble shooting ideas that go quite in depth.

  7. Elsa Berndt says:

    I noticed that you referenced a webinar that was done on the 21st, and I wonder if it is available for viewing. I am a psychologist who is supporting a family who is dealing with smearing. I had already suggested many of the behavioral strategies that you reviewed in your article, and am hoping to share the webinar with the family if it would provide more ideas to the family. Thanks!

  8. Kay wilson says:

    Good evening/morning my son is 5 and smears and his poo. It mainly seems to be at bed time after he has been put to bed. I ask him if he needs to poo and says no. Recently his sleep pattern has not been good so I hear him playing in his room way after bed time I go in and can smell and see poo. I ask him where the poo is and he will show me where its hidden. He gets upset straight away mainly because he think he is going to loose his stuff as punishment. This has been going on and off for over 2 years

    • Kay, when you ask you son if he has to poo and he says no, he may truly not feel the sensation that he has to go. This is called interoceptive awareness and this 8th sense is often impaired in people with autism. I would be interested to know what he does with the poo. Does he smear the poo on the walls or does he actually manipulate it in some way?

      You need to keep an elimination chart for two weeks to confirm what time he has his bowel movement everyday. I would also want to know where his stool is on the Bristol Stool chart. If he is Type 1 or 2, you have a constipation problem. I would highly recommend that you read the book “What to Do About Smearing” that I have referenced in this article. It is a very comprehensive book on the subject.

      Don’t ask your son if he needs to poo before bedtime – take him to the toilet and have him sit for 10 minutes. If nothing happens, take a 20 minute break but keep watching him for signs that he may be pooing like squatting. Take him back to the toilet again if you see signs. The fact that he is not going to sleep and playing with his bowel movement tells me he is not aware that he has to go, then playing with the poo becomes an alerting activity, not a calming one.

  9. sarah says:

    thank you

  10. Katy says:

    Hi! My name is katy and I have a son who is almost 7 that plays in poop he is deaf with sensory issues he might have autism. We take him potty every 30 mins but he still pees and poops himself even with me there in the room to teach him how to go potty and wash his hands and flush. He smears his poop on the walls of the bedroom at night or sometimes during the day in his room trying to get a bath out of it or because he just wont tell me that he has to go potty and its really stressful on my end I need advice or he will do this during his school years and won’t have friends and I worry about his daily life..

  11. Monique says:

    My son is 10 years old and has high functioning autism and ADHD. He is on medication. He also is asthmatic. We find him smearing every single morning. He wakes up very early puts the TV on and sits in his bedtime nappy and the plays with his feces. He then hides it under our TV canbet couch or smears it on the blankets or couch. When I get up the entire area is covered. He immediately runs to his room when I come into the area and hides his hands. I will then tell him to go wash and start cleaning up. When I ask him where did he hide it all as we can’t always find it but can smell it. He says he doesn’t know. He does this very often. We have tried hiding the TV remote so he can’t watch TV but that didn’t help and he done it while reading his book. When I ask him why he says he likes the feeling. We have given him prestik and soft ball to play with and explained to him it is not good to play with his stools and he must use toilet but the next day he does it again. I am at my wits end and have no idea what to do. He wears a nappy at night or else he wets the bed. He doesn’t do these things at school only at home. Please some advise. Thank you

  12. Sarah says:

    I have an 11 year old son that is smearing.  I noticed it a handful of times at home, I would use the bathroom after him and notice poop on different surfaces.  Recently I got a call from sons school saying that someone had been smearing poop on bathroom wall and finally caught my son.  He has adhd was diagnosed when he was 6 and been taking medication ever since.  Nothing really is new, wondering what could have prompted this and why?? And what to do about it, kind of lost.  Help!

  13. Allison Baker-Thiessen says:

    Will you be coming to Winnipeg?

  14. M says:

    Thank you so much for this information.
    My loved one started around age 4 and 12 years later, I think it is still going on.
    How can I help a teenager with this?

    • I would need a lot more specific information to help you troubleshoot like where he is at with toileting skills, where and when does the smearing occur and in what context.

  15. Pauline Lee says:

    I hear you! My son picks at his anus and then smells the feces, and I noticed the behaviour was increased during parasite infections. He picks up parasites from drinking pool water. He twerks (moves his hips) and bounces a lot before a poop. Sometimes I can see the eggs and the worms in his stool. Being diligent about parasites (we use herbal remedies and probiotics have been helpful) especially around the full moon has helped reduce this behaviour, which used to escalate to smearing. Oil of oregano is great for removing the smell and is a good disinfectant for surfaces–not for skin because it burns. I practice qi gong which helps (in many profound ways) to foster a calm environment…shame doesn’t help. The situation is up and down, but it’s been a lot better with the strong probiotics (Custom Probiotics d-lactate-free which is for autism).

  16. Jennifer says:

    Thanks so much for this informative post!

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