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Please help. 6 year old still poops his pants



 
 
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  #1  
Old January 6th 05, 02:28 AM
SJP
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Default Please help. 6 year old still poops his pants

From the wiggle it's usually apparent to everyone on the room that he's
pooping his pants except him. Other times he'll come in the room with poop
on his hand crying. See, he checks himself and appears to be surprised when
he finds something there. Every time he does find something he bursts into
tears because he knows we're going to take away TV privilages or something.
We really don't know why he does it, and we're really tired with the whole
issue. The boy is six years old now. When he does go, he generally has
disturbingly large bowels - larger than that of your average adult (I guess
I'm about average). The doctor has us giving him laxatives every day
because he holds it in otherwise. I don't know what to say to him after
each episode except that I'm extremely disappointed... We don't know if
he's really aware of it or not, but I can't imagine how he wouldn't be. Has
anyone any experience with something similar? The kid is also skin and
bones and I"m afraid that the daily laxative is keeping him from getting the
nutrition that he needs to grow.

Thanks, Steve


  #2  
Old January 6th 05, 02:35 AM
Nan
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Default

On Wed, 5 Jan 2005 20:28:54 -0500, "SJP" scribbled:

From the wiggle it's usually apparent to everyone on the room that he's
pooping his pants except him. Other times he'll come in the room with poop
on his hand crying. See, he checks himself and appears to be surprised when
he finds something there. Every time he does find something he bursts into
tears because he knows we're going to take away TV privilages or something.
We really don't know why he does it, and we're really tired with the whole
issue. The boy is six years old now. When he does go, he generally has
disturbingly large bowels - larger than that of your average adult (I guess
I'm about average). The doctor has us giving him laxatives every day
because he holds it in otherwise. I don't know what to say to him after
each episode except that I'm extremely disappointed... We don't know if
he's really aware of it or not, but I can't imagine how he wouldn't be. Has
anyone any experience with something similar? The kid is also skin and
bones and I"m afraid that the daily laxative is keeping him from getting the
nutrition that he needs to grow.

Thanks, Steve


First of all, I'd stop with the laxatives. Chemicals as a means to
move bowels can cause a lot of harm to children.
Fruit (not bananas), juices, prune juice, dried fruits, etc. are a
*much* better way to help him.

Second, I'd stop punishing him. It's likely the laxatives are causing
him to pass the stools without knowing, or having any type of control.
Punishment for accidents don't work, as you've noticed.

Once he's off the laxatives, I'd have a (hopefully different!) doctor
check him for any possible bowel problems. If there is nothing wrong
medically, I'd start working with him on the with-holding issue.
There are various reasons kids will hold it.... having a BM is
painful, they're afraid of it, or too busy to bother with stopping an
activity when they feel the urge.

Some people don't like the idea, but I've had good luck with rewards
and bribes, if necessary. I used a star chart for my 4 year old and
it worked very well. Same for my now 21 year old, when he was 3.

Good luck,

Nan

  #3  
Old January 6th 05, 03:45 AM
SJP
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Default

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.


"Nan" wrote in message
...
On Wed, 5 Jan 2005 20:28:54 -0500, "SJP" scribbled:

From the wiggle it's usually apparent to everyone on the room that he's
pooping his pants except him. Other times he'll come in the room with
poop
on his hand crying. See, he checks himself and appears to be surprised
when
he finds something there. Every time he does find something he bursts
into
tears because he knows we're going to take away TV privilages or
something.
We really don't know why he does it, and we're really tired with the whole
issue. The boy is six years old now. When he does go, he generally has
disturbingly large bowels - larger than that of your average adult (I
guess
I'm about average). The doctor has us giving him laxatives every day
because he holds it in otherwise. I don't know what to say to him after
each episode except that I'm extremely disappointed... We don't know if
he's really aware of it or not, but I can't imagine how he wouldn't be.
Has
anyone any experience with something similar? The kid is also skin and
bones and I"m afraid that the daily laxative is keeping him from getting
the
nutrition that he needs to grow.

Thanks, Steve


First of all, I'd stop with the laxatives. Chemicals as a means to
move bowels can cause a lot of harm to children.
Fruit (not bananas), juices, prune juice, dried fruits, etc. are a
*much* better way to help him.

Second, I'd stop punishing him. It's likely the laxatives are causing
him to pass the stools without knowing, or having any type of control.
Punishment for accidents don't work, as you've noticed.

Once he's off the laxatives, I'd have a (hopefully different!) doctor
check him for any possible bowel problems. If there is nothing wrong
medically, I'd start working with him on the with-holding issue.
There are various reasons kids will hold it.... having a BM is
painful, they're afraid of it, or too busy to bother with stopping an
activity when they feel the urge.

Some people don't like the idea, but I've had good luck with rewards
and bribes, if necessary. I used a star chart for my 4 year old and
it worked very well. Same for my now 21 year old, when he was 3.

Good luck,

Nan



  #4  
Old January 6th 05, 04:08 AM
Ericka Kammerer
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Posts: n/a
Default

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

  #5  
Old January 6th 05, 04:49 AM
Beth Kevles
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Posts: n/a
Default


Hi -
Here's what may be going on:

At some point, perhaps when your son started school, perhaps at another
tim,e he started witholding his bowel movements. After a while, this
caused his body signals to get confused, to the point that now he
doesn't actually know when he needs to move his bowels. The result is
that his colon gets VERY full (which is why you see such large poops)
and he has accidents.

The standard treatment for this problem (which is not that uncommon) is
to dose with mineral oil 2x/day (am and pm) and also to have him sit on
the toilet 2x/day, for as long as 20-30 minutes, to try to produce a
bowel movement. The goal is to have him produce a bowel movment EVERY
day for 30 days in a row. By the end of that time, he should have
regained his body signals so that he can control his bowel movements.

You may also wish to discuss more serious problems with your doctor,
such as "occult spina bifida", where the boy wouldn't feel the signals
at all because of a slightly exposed spinal cord, and various other such
possibilities. None are likely; the scenario I've explained is far and
away the most common cause of the problem you're experiencing.

You should also make sure your son has a very high fiber diet, since
constipation would get in the way of producing consistent bowel
movements. Also he should drink plenty of water.

Beyond that, offer rewards for bowel movements that occur daily, and
bigger rewards when they occur in the toilet. and offer a treat after
the mineral oil; it's nasty stuff.

I hope this helps,
--Beth Kevles

http://web.mit.edu/kevles/www/nomilk.html -- a page for the milk-allergic
Disclaimer: Nothing in this message should be construed as medical
advice. Please consult with your own medical practicioner.

NOTE: No email is read at my MIT address. Use the AOL one if you would
like me to reply.
  #6  
Old January 6th 05, 05:06 AM
Nan
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Posts: n/a
Default

On Wed, 5 Jan 2005 21:45:02 -0500, "SJP" scribbled:

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.


Then clearly he's not getting the right body signals. Ericka
responded with some great advice, as well.

As a former child that withheld and had my share of 'accidents', the
negative effects overall can be very damaging. Please try to get in
the mindset that he probably doesn't 'know' he has to go.

Nan



  #7  
Old January 6th 05, 03:28 PM
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Default

Steve, you need to do some research on "withholding" or encoporesis.
You should not be punishing this kid - at this point, this is not
something he has control over, and what you are doing is not helping.

One of my sons got into this (its surprisingly common) and it is a very
difficult problem to resolve and once its established, it can also take
quite a long time to correct - expect the majority of kids who have it
to the point our sons have/had it to take a YEAR to totally resolve it.


How it gets going in the first place is that at some time, the kid had
a painful bowel movement and got into a pattern of fear where he
anticipated pain and tried to hold bowel movements in. It becomes a
pernicious cycle. The kid holds it in, his bowel gets distended and
stretched and over full....it hurts to go so they withhold more and
more, and ultimately he can no longer tell when he needs to go. Normal
bowel function AND sensation is compromised. The kid really can't help
it anymore at all. One of the signs is frequent tiny movements into
their pants - caused by the fact that the bowel is so full, that the
natural peristaltic action forces out bits of excrement (hey, it has to
go somewhere, and peristalsis is something we have zero conscious
control over, so your kid really, really CANNOT stop this).

What we had to do (with the help of a ped our family doc sent us to) is
get him on laxatives, just as your doctor has done with your son. We
had to carefully titrate the dose until the kid was having at two good
movements a day. We tried at first with mineral oil, and ended up with
ducolax (we had to call in the bigger gun since mineral oil just wasn't
doing enough)The goal was to get his bowel empty and keep it empty, so
it would SHRINK back to a more normal size, and normal function AND
sensation returns. It can take months and months.

Not only does the sensation need to return, but the kid then needs to
learn what the sensation means and learn some new toileting habits. It
took MANY months before our son was able to consistently stay clean,
and many more before we were able to slowly wean him off the laxatives.
LIke I said, this is not a problem that you can cure quickly, and it is
not something you will get anywhere with by punishing the kid (in fact,
if you read some articles on the subject, you are going to make it
worse by doing that).

http://www.post-gazette.com/pg/04160/328357.stm
http://www.aboutencopresis.com/
http://kidshealth.org/parent/emotion...ncopresis.html

Mary G.
Mom of three (been there, done that, and I know its really frustrating).

  #8  
Old January 6th 05, 04:31 PM
Rosalie B.
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Default

Banty wrote:

In article .com,
says...

Steve, you need to do some research on "withholding" or encoporesis.
You should not be punishing this kid - at this point, this is not
something he has control over, and what you are doing is not helping.

snip

Another way it gets started is - some of us can't defecate whenever we need to,
like one can usually urinate when one needs to. I had this problem (not nearly
this bad, though) as a kid, and my son has it somewhat. (I think he has it much
less than me because I understand it and don't hassle him about it, and deal
with an occassional minor plumbing problem.)


Thank you, thank you. For the first time, I understand. I never
realized that this was not uncommon for other people.

My dad used to call our BMs ostrich eggs. We had an untwisted wire
coat hanger by the toilet so that we could break up the BM before it
went and clogged up the plumbing.

My mom said once that they had a sticker chart at school (this would
have been c 1915 I think) for them to report that they'd had a BM
every day, and she didn't, so she didn't get the stickers on her chart
which really got her goat because she wanted to be perfect in
everything, but she only had a BM once every other day or so.

My dh though has trained himself to have a BM every morning, and he
doesn't see why I can't do the same.

So for us, *urge denial* is a
problem. That is, if there is an urge to go, but I'm a bus, I can't
necessarily go the next time I find a bathroom. If that happens too much, then
there's a problem with constipation.

When school starts, suddenly a kid like my son or me *has* to deny urges for a
while. Then, there's these little 10 minute intervals when we're all supposed
to do our thing and in a somewhat socially exposed setting (even if you ask to
be dismissed in the middle of class, there's pressure not to take too long, or
there will be knocks on the door). So we try to wait until we get home. And
that may work, or not. And so on and so on.

My point being, it doesn't necessarily start with pain.

My son still won't go at school. I understand why - times between classes are
short (he's in 7th grade), people are really strange sometimes about noting and
commenting about things like how long one is in a bathroom stall. He has a BM
every three or four days, and has had all along.

For me to get over this, I did have to train myself to be a bit more assertive
about excusing myself, when *I* need to go, and to respond to my bodily signals
more even when I'm alone.


Since my dh has been so adamant about the need for me not to plug up
the plumbing on the boat (which is way more hassle than on land), I've
become a bit paranoid about this. I just didn't realize that not
everyone had a bm every day.

Hassling a kid about his, and any hint to him that he's doing it to get anyone's
goat, is absolutely destructive. Believe me.

Banty


grandma Rosalie
  #9  
Old January 6th 05, 04:51 PM
Banty
external usenet poster
 
Posts: n/a
Default

In article .com,
says...

Steve, you need to do some research on "withholding" or encoporesis.
You should not be punishing this kid - at this point, this is not
something he has control over, and what you are doing is not helping.

One of my sons got into this (its surprisingly common) and it is a very
difficult problem to resolve and once its established, it can also take
quite a long time to correct - expect the majority of kids who have it
to the point our sons have/had it to take a YEAR to totally resolve it.


How it gets going in the first place is that at some time, the kid had
a painful bowel movement and got into a pattern of fear where he
anticipated pain and tried to hold bowel movements in. It becomes a
pernicious cycle. The kid holds it in, his bowel gets distended and
stretched and over full....it hurts to go so they withhold more and
more, and ultimately he can no longer tell when he needs to go. Normal
bowel function AND sensation is compromised. The kid really can't help
it anymore at all. One of the signs is frequent tiny movements into
their pants - caused by the fact that the bowel is so full, that the
natural peristaltic action forces out bits of excrement (hey, it has to
go somewhere, and peristalsis is something we have zero conscious
control over, so your kid really, really CANNOT stop this).


Yep.

Another way it gets started is - some of us can't defecate whenever we need to,
like one can usually urinate when one needs to. I had this problem (not nearly
this bad, though) as a kid, and my son has it somewhat. (I think he has it much
less than me because I understand it and don't hassle him about it, and deal
with an occassional minor plumbing problem.) So for us, *urge denial* is a
problem. That is, if there is an urge to go, but I'm a bus, I can't
necessarily go the next time I find a bathroom. If that happens too much, then
there's a problem with constipation.

When school starts, suddenly a kid like my son or me *has* to deny urges for a
while. Then, there's these little 10 minute intervals when we're all supposed
to do our thing and in a somewhat socially exposed setting (even if you ask to
be dismissed in the middle of class, there's pressure not to take too long, or
there will be knocks on the door). So we try to wait until we get home. And
that may work, or not. And so on and so on.

My point being, it doesn't necessarily start with pain.

My son still won't go at school. I understand why - times between classes are
short (he's in 7th grade), people are really strange sometimes about noting and
commenting about things like how long one is in a bathroom stall. He has a BM
every three or four days, and has had all along.

For me to get over this, I did have to train myself to be a bit more assertive
about excusing myself, when *I* need to go, and to respond to my bodily signals
more even when I'm alone.

Hassling a kid about his, and any hint to him that he's doing it to get anyone's
goat, is absolutely destructive. Believe me.

Banty

  #10  
Old January 6th 05, 05:21 PM
Brian
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Posts: n/a
Default

Nan wrote:
Some people don't like the idea, but I've had good luck with rewards
and bribes, if necessary. I used a star chart for my 4 year old and
it worked very well. Same for my now 21 year old, when he was 3.


Hi Nan -

Thanks for a very thoughtful post. I'm curious about this paragraph.
Why are other parents wary of rewarding their kids during training?
It worked extremely well for my son, resolving the entire issue in
just a couple of months.

Brian


 




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