Encopresis
A British mum at the end of her tether with her 5.5 year old son's pooh soiling.
I am from London, My son is 5 1/2 years old and for the past three years has consistently soiled himself. We have been to our local child developement centre and have gone down the road of behavioral charts, rewards etc.. with them but none of this has worked. We think the problem started when he was made to sit on the toilet by his grandmother at the age of about 2 1/2 to do a pooh and it hurt and frightened him. Since then, he has been chronically constipated which led to him becoming impacted. He has been xrayed on three consecutive days to ensure that his system was working ok ,which it was, but the problem has never gone away. We try and get him to drink water but he flatly refuses and he has plenty of weak squash and apple juice as we need to keep him properly hydrated. Up until the last five weeks he has been prescribed Movicol, Senna, Lactulose, supposateries and Sodium picosulphate in varying amounts , at one point he ended up in A&E with chronic stomach pains! The confusing thing is that he is no longer constipated or afraid of going to the toilet and when told to do so will do a normal pooh but he has to be told, not asked and, even though I decided to wean him off the laxatives over a month ago, his bowel habits haven't changed at all. my son is still soiling himself constantly during the day, he has spare clothes at school but unfortunately the teacher does not have the time nor inclination to continually check him, he therefore comes home every night with dirty underwear and has to be changed at least twice more before bed. This happens every day without fail. The only time he doesn't soil himself is when he is asleep. I am now worried that he may need surgical help as his colon has become so 'loose' that he can no longer go to the toilet normally. I realise that we still have work to do phsycologically but I am at the end of my tether and nobody has ever mentioned Encopresis to me at all. I am now in the process of getting a hospital appt. but would appreciate any help and advice you can give me. Does this sound like Encopresis?
Help!!!
Lisa (mum)
Lisa—I love the Briticisms of mum and pooh! Yes, this is indeed encopresis which is really a behavioral definition of BMs in inappropriate places, e.g., clothing, bed, etc. Since fecal incontinence is so malodorous and a biohazard for the child and others it is not surprising that you are at the end of your tether! You noted a concern for his physical health related to his colon which becomes enlarged with the reflexive overholding reflex. This is a real issue and his colon may take a long time to return to normal, if it ever does, but his age suggests that you may be catching this problem early enough. Lest I create panic for other parents, the colon may continue to be functional even if caught much later in the teen years, but why continue to live with it and take a risk? Also, why should you expose yourself and your child to more visits to an Accident and Emergency (A & E) Center? Adequate treatment should no longer be delayed even for your young child and frankly it requires a more aggressive approach which today only exists as a home-based treatment based on my Soiling Solutions (SS) Protocol which is explained and detailed in the Clean Kid Manual (CKM). You will have more of a sense of that protocol by reading more of my answers below by others, including your countrymen, and by going to the www.soilingsolutions.com website. The CKM and the exclusive SS email forum participation which comes with its purchase is only available from the SS website (or loaned by your health service if they can be persuaded to purchase it at steeply discounted prices—see the Professional option at the SS store). I will send you an attachment of my recent medical journal article on SS in a separate email.
My protocol is not widely accepted as a default treatment to the approaches which you have already attempted, ad nauseum. In fact, the physicians are “stuck” and just repeat instructions for their top-down oral approach, pat you on the head paternalistically or maternally, and assure you that he will “grow out of it”. That is it, except maybe for biofeedback which requires specialized equipment and personnel outside of the home. Even though your child appears to be compliant with demands to sit and pooh, that clearly is inadequate and he needs to recognize and respond with a voiding habit which can become more reliable, complete, and connected to sitting on the toilet in an efficient manner. My protocol only requires 2-3 minute sitting trials. This certainly is more likely to become automatic than asking a child to wash their hands or brush their teeth. However, many children may have to be reminded and closely observed for months after success with the SS protocol to firmly engrain the voiding reflex.
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