J.N. asks from Mount Vernon, WA on October 28, 2009
6 Year Old Not Wanting to Use the Bathroomo (When He Needs To!)
Hi moms -
My 6 year old son is having some bathroom issues(only #2). This is not actually something new. He will sit (stand, run) there and make a mess in his undies instead of using the bathroom. He has always had this issue since he first was potty trained, but he's 6 now and that's plenty old enough to know when you have to go. Honestly, it's as if he just does not want to take the time to go because he might miss something so he's realy trying to hold it in, but you know that doesn't really work. I just feel so frustrated that I'm not sure what to do. It's gross and is getting expensive. We're not hard on him about this and really explain why he needs to use the bathroom (from his body needing it to cleaning his undies) but I'm at a loss as to what to do. Has anyone else experienced this? Thanks for your help.
1 mom found this helpful
M.L. answers from Seattle on October 29, 2009
My son who is now 9 has the same issue. I used to think that it was because he did not want to take the time until it was too late and he soiled his pants. I saw another post on Encopresis. My son has this problem as well. He has leakage around a big ball of poop that gets stuck in his colon and is either too large or will hurt too much to pass. He has them so big that they stop up the toilet!!! And now the sensors that tell him he has to go no longer work properly because they were stretched out for so long. Please check this out! We have a regimen of Miralax to help keep him more regular and it is working much better, but with the occasional oops!
2 moms found this helpful
A.B. answers from Portland on October 29, 2009
Don't be angry with him, it's not his fault,
This is from the American Academy of Pediatrics
Encopresis is one of the more frustrating disorders of middle childhood. It is the passing of stools into the underwear or pajamas, far past the time of normal toilet training. Encopresis affects about 1.5 percent of young schoolchildren and can create tremendous anxiety and embarrassment for children and their families.
Encopresis is not a disease but rather a symptom of a complex relationship between the body and psychological/environmental stresses. Boys with encopresis outnumber girls by a ratio of six to one, although the reasons for this greater prevalence among males is not known. The condition is not related to social class, family size, the child's position in the family or the age of the parents.
Doctors divide cases of encopresis into two categories: primary and secondary. Children with the primary disorder have had continuous soiling throughout their lives, without any period in which they were successfully toilet trained. By contrast, children with the secondary form may develop this condition after they have been toilet trained, such as upon entering school or encountering other experiences that might be stressful.
A frustrating condition
Children, parents, grandparents, teachers and friends alike are often baffled by this problem. Adults sometimes assume that the child is soiling himself on purpose. While this may not be the case, children can play an active role in managing the processes involved in this disorder.
The physical aspects of encopresis
When encopresis occurs, it begins with stool retention in the colon. Many of these youngsters simply may not respond to the urge to defecate and thus withhold their stools. As the intestinal walls and the nerves within them stretch, nerve sensations in the area diminish. Also, the intestines progressively lose their ability to contract and squeeze the stools out of the body. Therefore, these children find it increasingly difficult to have a normal bowel movement. Most of these children are chronically constipated.
With time, these retained stools become harder, larger and much more difficult to pass. Bowel movements then can be painful, which further discourages these children from passing the stools.
Eventually, the sphincters (the muscular valves that normally keep stools inside the rectum) are no longer able to hold back all the stool. Large, hard feces may be retained in the colon (large intestine) and rectum, but liquid stool can begin to seep around this impacted mass, passing through the anus and staining the underwear. At other times, semiformed or partial bowel movements may pass into the underwear, and because of the decreased sensation, the child may not be aware of it.
Some youngsters are predisposed from birth to early colonic inertia - that is, a tendency toward constipation because their intestinal tracts lack full mobility. Early in life these children might have experienced constipation that required dietary and medical management.
Some children develop constipation and encopresis because of unsuccessful toilet training as toddlers. They may have fought the toilet training process, been pushed too fast, or were punished for having accidents. Struggling with their parents for control, they may have voluntarily withheld their stools, straining to hold them as long as they could. Some children may actually have had a fear of the toilet, even thinking that they themselves might be flushed away.
A number of other factors can also contribute to the eventual development of encopresis. Sometimes children may have pain when they have a bowel movement due to an infection or a tear near their rectum. Emotional causes can include limited access to a toilet or shyness over its use (at school, for example), or stressful life events (marital discord between parents, moves to a new neighborhood, family physical or mental illnesses or new siblings). While most children with encopresis are also constipated, some are not. These children may refuse to use the toilet and simply have normal bowel movements in their underwear or other inappropriate places. In general, these children are demonstrating their attempts to control some difficult aspects of their lives. Professional help is advisable for these children and their families.
Many parents are astonished that their child with encopresis may not even be conscious of the odor emanating from the stool in his pants. When this odor is constant, the smelling centers of the brain may become accustomed to it, and thus the child actually is no longer aware of it. As a result, these youngsters often are surprised when a parent or someone else tells them that they have an odor. While the youngster himself may not be bothered by the smell, the people around him may not be sympathetic to his problem.
Exasperated parents often place great pressure on their child to change this behavior - something the youngster may be incapable of without help from a pediatrician. While family members may have ideas on how to solve the problem, their efforts generally will fail when they do not understand the physiological mechanisms at work.
Encopresis can lead to a struggle within the family. As parents and siblings become increasingly frustrated and angry, family activities may be curtailed or the child with encopresis may be ostracized from them. By this stage, the problem often has become a family preoccupation.
As the child and family fruitlessly battle over the child's bowel control, the conflict may extend to other areas of the child's life. His schoolwork may suffer; his responsibilities and chores around the home may be ignored. He may also become angry, withdrawn, anxious, and depressed, often as a result of being teased and feeling humiliated.
Management of encopresis
Encopresis is a chronic, complex - but solvable - problem. However, the longer it exists, the more difficult it is to treat. The child should be taught how the bowel works, and that he can strengthen the muscles and nerves that control bowel function. Parents should not blame the child and make him feel guilty, since that contributes to lower self-esteem and makes him feel less competent to solve the problem.
Parents often use a behavior modification or reward system that encourages the child's proper toilet habits. He might receive a star or sticker on a chart for each day he goes without soiling and a special small toy, for example, after a week. This approach works best for a child who truly wishes to solve the problem and is fully cooperative in that effort.
Some youngsters have significant behavioral and emotional difficulties that interfere with the treatment program. Psychological counseling for these children helps them deal with issues like peer conflicts, academic difficulties, and low self-esteem, all of which can contribute to encopresis.
Throughout this treatment process, parents should remind the child that there are other youngsters who have the same problem. In fact, children with the same difficulty probably attend his own school.
Children with encopresis may have occasional relapses and failures during and after treatment; these are actually quite normal, particularly in the early phases. Ultimate success may take months or even years.
One of the most important tasks of parents is to seek early treatment for this problem. Many mothers and fathers feel ashamed and unsupported when their child has encopresis. But parents should not just wait for it to go away. They should consult their doctor and make a persistent effort to solve the problem. If the symptoms are allowed to linger, the child's self-esteem and social confidence may be damaged even more.
When encopresis is occurring in a school-age child, a physician experienced in encopresis treatment and interested in working with the child and the family should be involved.
The treatment goals will probably be fourfold:
To establish regular bowel habits in the child;
To reduce stool retention;
To restore normal physiological control over bowel function; and
To defuse conflicts and reduce concerns within the family brought on by the child's symptoms.
To accomplish these goals, attention will be focused not only on the physical basis of encopresis but also on its behavioral and psychological components and consequences.
In the initial phase of medical care, the intestinal tract often has to be cleansed with medications. For the first week or two the child may need enemas, strong laxatives or suppositories to empty the intestinal tract so it can shrink to a more normal size.
The maintenance phase of management involves scheduling regular times to use the toilet in conjunction with daily laxatives like mineral oil or milk of magnesia. Proper diet is important, too, with sufficient fluids and high-fiber foods. These steps will keep the stool soft and prevent constipation. When improperly supervised, these interventions have potential dangers for the health of the child and so should be done only under the supervision of the child's physician. The maintenance phase will usually last two to three months or longer.
2 moms found this helpful
R.M. answers from Medford on October 29, 2009
I am an R.N. not that that matters really. I think you should take your son to his M.D. right away. It may be physical, emotional or the way the problem is being handled.
Go ahead asap and gather some new tools because he is 6 years old and waht you have been doing is not working. No use continuing to do the same things expecting different results. I am almost certain there is something behind this as this is not something a child would do if he was able to control it . For what ever reason. The sooner the better with starting with the M.D.
1 mom found this helpful
E.K. answers from Portland on October 29, 2009
My cousin had this issue when he younger (potty trained until 7ish). We all road him pretty firm about his "accidents". When my aunt and his pedi finally figured it out it wasn't deliberate, he actually had developed a condition that he had little to no sensation in his bowels. The doctor thinks it developed over the years because he was prone to firm stools and they possibly hurt him enough for him to want to hold them in and eventually lost the pain and the sensation that told him he needed to go. Basically, his bowels would fill up until there was no room left and it would push itself out. Now at 17 he's perfectly fine, but please have this issue looked at.
1 mom found this helpful
C.S. answers from Seattle on October 30, 2009
My son has seen a GI because he has actually had problems since 6 mo, but one suggestion they say if a kid is w/h or not going because they are too busy to play is that 10-15 min after each meal make him sit on the toilet for 15 min and read a book or something, but they have to sit there. That is usually when our body natuarally wants to go. I know this is hard to do and I admit I didn't try it because my son after having 2 enimas (that was fun;)) and being on medication is finally regulating and is better about going now.....
1 mom found this helpful
A.M. answers from Seattle on October 29, 2009
My daughter had a similar issue when she was 4. She would go get a pair of pull ups, put them on, and stand next to the toilet to poo. It was right before she started school and I was worried she wouldn't be able to start. I also thought she was doing it on purpose or because of some fear of the toilet.
So, I finally sat down with her and asked, "What's going on, why don't you just use the toilet?" She told me that it hurt. So after racking my brain as to what could possibly hurt, I found the problem! She would sit there so long, tiny bottom hanging down into the toilet that the backs of her legs would get awful red lines. The seat was sort of "cutting" into her legs! I ran out and bought one of those squishy kid size inserts and she was fine! She is now 11 and hasn't had a problem since then. My son who is 7, never had the problem because we already knew what to do.
So, even if this isn't the problem for your son, talking to him about what's going on can get to the root.
Oh! I almost forgot! My son did go through a spell of accidents in his pants around 5-6 years old. I found that certain foods were the culprit. Carrots- almost straight through, Bananas- maybe a day later, citrus- straight through! Since limiting these foods, he's been fine!
1 mom found this helpful
L.G. answers from Eugene on October 29, 2009
I have treated children homeopathically for this condition. It is not uncommon just people do not exactly tell it to their friends and colleagues. If you choose to go to a homeopath find a really good one as experience counts in these situations.
Both girls and boys suffer from this problem.
One mother had her boy schedule his BM's right after breakfast as he would not sit on a strange toilet or one that was not clean. He could keep to the schedule and during treatment he was able to overcome his difficulties with going on his own to the toilet (#2) at other people's homes and at the after school care he attended.
Every child requires a remedy suited for their constitution so there is no way to recommend one publically.
You could get in touch with Homeopathic Educational Service in Berkeley for a recommendation they are aware of who the best practitioners are.
G.R. answers from Spokane on October 28, 2009
Hi J. - I totally understand!! I have an 8yr old who hates to leave what he is doing to go #1. He has had accidents with #2. For us we tried several different things (rewards, consequences, cleaning up, schedules, pull-ups, etc) to help him get to the bathroom on time & they are starting to pay off.
First I would call the peditrician's office & talk to the nurse for ideas & then make an appointment to see the peditrician for an exam & have then run a urine test (this can check for any medical issues including: how his hydration is, sugars are, etc. This is a standard test and is a very good tool to give early warning signs for diabetes, urinary tract infections, etc.). Then have the peditrician talk with your son (this is what we did) to talk about what the function of our bodies are & why we need to do some things. The DR was also able to share with my son some ideas on how to empty his bladder better (using counting games, etc), since your son's is more #2 the DR can give more specific advice including setting a schedule to do potty time (this has helped my son). My son listened to the same advice from the DR that we had told him but it did not sink in until he heard it from his DR.
Another thing to do is observe how your son reacts to having the accidents. Keep a record of when & how often he goes as well as his reaction. If it does not seem to bother him much then you might even have some sensory issues going on - again this is where a very good peditrician (not a general dr as they are more than likely not up-to-date on the latest things) can help. If all of this does not help (or if you have already tried it) ask your peditrician for a referral to a specialist who can work with you to see if there is an underlying issue. More than likely he is just fine but it is good to rule it out.
Good luck & God Bless!