Hi, I had gone through your question and understand your concerns. You should be worried but not too much. There are two causes: first can reflects problems with stooling, relatively common constipation and less frequently occurring encopresis (also known a fecal incontinence or soiling). Other points of view: at the children who refuse to use the school toilet due lack of privacy,parental stress, abnormal stretching and enlargement of the rectal area that reduces the reflex, semisolid stool,intestinal infection, passage of painful or hard bowel movements. Hope this answers your question. If you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions. Wishing you good health.