SJP wrote:

Hi Nan, thanks for your reply.

The laxatives started because he used to get horrible stomach cramps. We
had to take him to the hospital more than once... The last time we were
there and they did x-rays on his abdomen they found that he was horribly
backed up. The hospital doctor recommended the laxatives and our pediatric
doctor concurred. As for him not knowing... Sometimes he's wiggling around
and everyone seems to know that he has to go to the bathroom but him. This
is what I fail to understand. He's struggling to physically hold it in, yet
insists that he doesn't have to go. Minutes later, the crying starts.
Another big surprise.

You may need some better medical advice than you've
been getting--perhaps to deal with the emotional as well as
physical issues. If he's had a history of constipation and
obstruction, his bowel may be messed up enough that he no
longer has good control and he may not be receiving appropriate
signals from his body when he needs to go. Leaking is not
uncommon. Between the physical pain of previous constipation and
the emotional pain from fearing the physical pain and the
punishments, the poor little guy may be having a really
rough time. It may take quite some time for him to get
back to normal physically and emotionally--not to mention
some more appropriate help. I don't know if the laxatives
are the right answer or not, but I would probably be seeking
a second opinion from a specialist. You're already in a
deep enough hole. There's no room for mistakes in treatment,
as every wrong turn will set him back even further physically
and emotionally. I would give up the idea that this is just
about him being stubborn and unwilling to cooperate. Odds
are that this is not well under his control at this time,
and the shame and pain of the situation is likely compounding
the issue.
How involved are his doctors with this? Are they
aware of the extent and duration of this problem? How long
has it been going on? If it has been going on quite some
time, and their recommendations are not working (as they
obviously have not yet), then unless they have some additional
ideas, it's probably time to seek a second opinion.

Best wishes,
Ericka