Behavior or Actually a Medical Problem

Look up the word Encoparesis on the web - your son might have this. This is a learned response (they learn to hold in their stool) very common in boys up to 10% have this. Miralax is not the solution!! (I think some of the ladies who responded previously may have kids who also have this very common disorder) My son had encoparesis and the long term use of laxatives do not work (may need them temporarily until he is retrained). Use the web and check out different websites on Encoparesis for solutions that work for you - I used: dump diapers.com
Children eating healthy diets with plenty of fruit and veggies should not have constipation and should not need to be on laxatives! Dump diapers.com
Has an excellent bowel retraining program that works -Laxatives just cover up the problem and cause the children to have accidents.
I am also a Registered Nurse - but didn't learn about encoparesis in Nursing School. If you can't find the bowel retraining program e-mail me back I will send it to you.

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Hi, felt compelled to respond to your situation. My son went through this during Kindergarted. I was beside myself. I would try rewards if he'd stop pooping in his pants. I tried discipline. Nothing worked. I just couldn't understand how he was doing this. If he could poop in his pants he could poop in the potty. How wrong I was! One night I sad down on the internet and learned about Encoparesis. My son had all this symptoms and he couldn't help himself. He was so backed up that he couldn't even feel when he was going in his pants. I felt like the worse Mom. I had been so hard on him, as if he were doing this to me on purpose. We went to the doctor, I explained what had been happening. He prescribed a fiber powder. I apologize, I don't remember what it is called. This was 2 years ago. This powder can be put in water, juice, anything. He couldn't taste it. Within a couple days he was back to normal. What started all this was him having hard stools and being afraid to poop. He didn't want it to hurt so he made himself not poop. When he finally starting going normal again. I explained to him that he can never hold back again or he will go through all this again. He was so happy to have it taken care of. He was no longer embarrassed anymore. I hope this helps!

3 moms found this helpful

Sounds Like a Control issue.

Offer him more control in his own life. Examine your family life to see if there is stress. (Kids know, even if you think they dont)

I agree with another person, benefiber! And be sure he is drinking lots of water. The benefiber is tasteless & no texture. I slip it into my 3 yo's drink when needed.

The laxative will screw him up pretty good.

SUGGESTIONS FOR OFFERING MORE CONTROL:
Set out 3 outfits (you approve) and let him choose the one he wants

Let him choose of he wants to brush his teeth before or after bath time.

Let him pour his own water to drink & stir in the fiber!

You can turn almost anything that is a struggle into a controlled "choice". With new-found control in his own life he will not have to create situations.

best of luck

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We had the exact same problem with our daughter. With her it started at age 4 and even taking the Miralax the doctor recommended, it was still a problem as she was going into 1st grade. We tried everything that has been mentioned in all the responses you've gotten and nothing worked. She is very well behaved and this had been the only problem we had ever had with her, so we were at our wit's end until I searched the internet for some explanation. What we came up with was a condition called Encopresis. Basically, it starts out with the constipation and the fear that it will hurt when they poop, so they hold it in, but then it does turn into a medical issue that they can't control. Being a pediatric nurse you may have already checked this out, but if not, it could make a world of difference. I took the information I gathered to our pediatrician and they agreed and we started on a course of action that did finally resolve the issue. Here's a webpage that describes it, or just Google it.

http://kidshealth.org/parent/general/sick/encopresis.html

Good luck. I hope this helps, I do understand the frustration.

2 moms found this helpful

We had a problem with our son afraid to poop on the potty also
he too was getting a little big I thought to have such a problem.
Our doctor said some kids are afraid of certain things and so we just had to keep working at it so we decided to put a sticker sheet on the wall in the bathroom and when he went on the potty he got a special sticker to put up there and after he went for a week on the potty he received a special reward.

It didn't take him long to catch on and once he received his special reward we took the sticker sheet down and let him have it to keep in a special place

1 mom found this helpful

J.,
I would not use the dr. to scare him b/c when he does go to the dr. he will think it's a scary place. However I can only tell yo what I did as a nanny, I went and got a white board (the kind for science projects ) and I took a marker, their fav. color and make the month calender on it. For every day they use the potty correctly and no accidents they got a sticker and with every sister they got a quarter. @ the end of the week we would cash in the quarters for candy or save to add next weeks with and go get a toy. It worked for me and the child. I was teaching potty rules along with what money can and can;t buy and even @ 3 she was able to see that saving for a bigger item was better and would last longer than candy. I don't know if this will help you but I do wish you a lot of luck.
T.

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Hi there-- I found this thread very interesting. I have an 8 year old daughter who has struggled with daytime wetting for many years. Most recently, we were told it's due to constipation and she should be on Miralax daily for the next year.

A lot of children struggle with this sort of thing-- in fact so much so that the Children's Hospital of Denver puts on a twice monthly free seminar about this very issue. That's a good place to get some professional advice.

After making many errors and having many people tell me that it's psychological we found out that it was indeed a medical issue. I know how frustrating this all is-- it's very hard. But please be very careful about instituing any form of punishment for this problem. Just like punishing or rewarding your child with food can cause eating disorders later in life and, so can punishing your child regarding elimination issues can cause continued problems in that area. I'm off to look up some links from this thread. Best wishes to you.

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I have a cousin that has 3 boys under the age of 6. The oldest child was still messing his pants and they were so agrivated that one day they told him to get to the bathroom and clean it up himself. They told him they were tired of cleaning it up. That he made the mess and dont come out till it was cleaned up. He quit after cleaning up the mess a few times. I can tell you that I did make my 3 yr old boy change himself completely and take care of his undies when he made messes and finally he has caught on that it is easier to just go to the potty. I was never mean about it. I just told him "you made the mess so you have to clean it up." Trouble with constipation may be some of the issue but if he has went and realizes it does not hurt now he should be ok.

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First of all tell him, Mommy knows you are a big boy now and know how to go on the potty. I will no longer ask you constantly if you have to go potty. I do not like cleaning your poop up anymore. So, for now on, when you poop in your pants instead of the potty, YOU will clean it up from start to finish, including washing them out in the toilet taking them to the washer and then to the dryer. You will not play while the undies are being cleaned. Also I will clean the poop off of you with a cold shower. Do you understand?"

Now, I know it sounds harsh but it works, The shower thing is only long enough to get the poop off of him and clean him (2-3 min) its mostly to make him uncomfortable.

I also WOULD NOT use the doctors as a threat. They are there to help him, not hurt him and I am sure you don't want him to be afraid of the doctor. Also don't ask him anymore if he has to go. Wait till he does poop in his pants tell him, he now has to clean it up and give him the cold shower!

I tried everything on my son too, this was the last straw, when I was buying more pullups than newborn diapers, there's a problem! This worked on my son after a week of cold showers we no longer had accidents!

1 mom found this helpful

Hi J.,

You've gotten good advice, and I hope all the info helps you with the problem. I just thought I'd mention that perhaps he's taking a little too much Miralax. If it makes his poop very soft, he might not be able to make it to the toilet in time, and so he soils his pants. Certainly this doesn't take away the complication of the other parts of the equation, but I just wondered if you might want to lower the amount of the Miralax and see if it helps a little.

All my best,
D.

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I am a licensed psychologist, with a specialty in child clinical issues. DO take your son to a psychologist with expertise with children and parents. There will be things that both you and he can do to solve this problem.

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Not sure if this has anything to do with it, but when I was taking miralax (and other various stool softeners/laxatives) on a regular basis I found that I had very little warning about when I had to go. I felt normal, then all of a sudden I had to GO and GO immediately. There was very little 'sensation' that I might need to go soon, it was just very sudden. I have since had surgery to correct some problems, but I found out that there are two different sets of muscles that can control gas/bm's and it's possible to lack 'full sensation' in those muscles. Maybe your son is not getting enough warning or sensation about when he has to go. For constipation you could try some more natural stool softeners, and I found that pears and applesauce are great for and also try prunes that are packaged individually like little fruit roll up candies. It could also be a control thing with 'mom' if it's not happening with anyone else! Good Luck.

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Sounds like a behavior/control struggle to me. Do you have that book "Everyone poops?"
http://www.amazon.com/Everyone-Poops-My-Body-Science/dp/0...
It's great! Kids think it's hilarious, and, well, I think most grownups do, too. Maybe that could help some of his fears. Good luck!

1 mom found this helpful

My daughter went through this from potty training age until 5 years old. Since Dec. 2007 she has had no problems, this all after seeing a specialist and diagnosing her with Encopresis. We too had to do Miralax daily but not until we cleaned out her system. I won't go in to all the detail here, if you click on my name you can see my many responses regarding this condition. All I wanted to add was if your son is still having trouble, please see a GI specialist or a Ped. that knows about Encopresis. It is very common, especially in older boys.

I'm glad your son is doing better,
M.

1 mom found this helpful

Are you kidding!? Watch him ESPECIALLY when he's playing! That's when they "forget" to go ! -S

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I have 4 1/2 year old twin boys..one became constipated, oh about 4 months ago and that ONE incident scarred him ( so to speak)It has been just within the last few weeks he has been going "#2" without stress or spending 20 minutes on the toilet bowl. I started adding FIBER-SURE on his food to make sure that his stool would become VERY soft ( never did it get loose, just softer)I called it "special sugar". There is not taste or texture to worry about..... and everytime he would go to the bathroom I would tell him , " I want to see a BIG long snake in there when you are done" After about a week and a half w/ the fiber-sure he began giving me "snakes" in the bowl and not little pinched off pieces. I don't think it's a medical problem..just a control thing and not wanting to have to be in pain trying to pass a hard, large stool.good luck!
A. K

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Hi J.,

I had the same problem with 2 of my 3 boys. (and they are almost 10 years apart.) I took the oldest to the doctor, and with no "results" it was determined to be...(quote from doctor)..."The last area he has to control, because this is the only area where he actually has all the control." Patience, perseverence and lots of prayer. I had to get my boys to help clean their clothing. They don't like the smell either. And I had to let them know that others could smell them when they were *dirty*, and that no one wanted to play with someone who smelled like poop. It will finally happen. But I pray that it goes quickly for you.
God Bless,
~T.

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My sister went through this a long time ago with her son. Instead of cleaning his poop for him, make him do it. Don't give in either. He won't walk around long with it on him. My sister would put her son in the bathroom and tell him to clean himself or not come out. It only took a couple of times before he stopped. It seems kind of cruel, but the child is old enough to know better and he is getting exactly what he wants, which is your attention, when he does it in his pants.
Hope it helps and let us know.

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When I tell you this, you may think that I am a terrible mother and terribly mean but this is what I did with my now 22 yr old. When he was 3 he was doing the same thing. He would hold it so long it would get hard and then he was scared to go. I did, like you, everything that I knew. Finally I just got tired of cleaning poop. He caught me on a really bad day and I didn't have time for that and when he pooped I made him take them off by himself, I made him wipe himself the best he could, and best of all, I made him put his training pants in the commode and wash them out with his hands; he did everything all by himself. I was so angry at him because it was at the most UNconvenient time. I yelled at him and told him that he could do this everytime he pooped in his pants because I was tired of doing it and it was his poop not mine so he should have to clean it up.
Do you know that child did not do that one other time. He pooped in the potty from them on.
It sounds mean but Hey....... IT WORKED.

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What started as a medical issue (constipation) now appears to have elements of psychological distress as well. I would definitely take him for a child mental health evaluation. The professional can find out your child's unique underlying issues resulting in the encopresis. This is one of those situations where the advice of others may be quite off track for your son's unique situation, and following well meaning but inaccurate suggestions can do more harm than good. Please let a professional evaluate him to determine how to best handle this.

J.,
I completely understand. My 4 yr. daughter has experienced the same problem since 2 1/2 years old. She was also receiving Miralax every day and sometimes twice a day. I spoke with a Pschologist and received so much help. My daughter has sensory integration disorder which is difficult for most people to identify. The medical community has very little experience or knowledge, etc. When I meet with Child and Family Development - we found so much help to various different behavioral, emotional, and physical relief for our daughter. She has received occupational therapy and music therapy since March 2008. Her bowl movements have changed between night and day. She honestly could not process cognitively that her body needed to dispose of the poop. She would be in so much pain and would avoid poops all together. Give them a call and take time to read up on Sensory Integration. The more informed you are the more you will learn how to advocate for him. Trust me it is worth it! Please email me if you'd like to discuss in greater detail.
C.

J.,

I hope that I am not too late. My 5 year old daughter would hold her poop because it hurt to come out. I started to watch her and asked if she had to go and she would say no, but you could tell. I could smell the flatulence and would comment that it smelled so bad she might want to check her panties. She would be going in her panties and still crying that she did not have to go. Still she insisted she did not have to go. So I would make her go and sit on the toilet. On one occasion I saw her soiled panties in the trash can where she changed herself and dumped the panties with the smear. ***I finally started giving her apple juice and told her that it would make it soft and it would not hurt.*** It worked. Her stools are soft and she ask me for apple juice everytime she needs to go. She will take a glass and sip it while sitting on the toilet. I tell her now that she does not need the juice, but she wants it, so I give her a glass and off she goes to the bathroom. I would try the apple juice as well as watching him. Good luck.
Note: The results and behavior change was instantaneous.

Hello, I know your frustrations! I have two children in diapers ages 3 and then my boy who will be 6 in November. He does have a condition called VATER syndrome and has had several surgeries so definitely not your same situation. But I can vouch for tons of hands on experience with bowel management! We have had to do alot of experimenting trying to get him regular. Such as enemas, laxatives, and miralax. It sounds like your poor little guy has had some painful bowel movements and is a afraid for more. Maybe the Miralax dosage your son is using needs to be adjusted. This could be causing some incontinence making it hard for your son to now control his bowels. This is such a sensitive issue with children. I would be very careful of not making him feel any shame. I definitely wouldn't scare him of doctors. It may be a good idea for you to seek professional help from a good ped doctor and see if he is having some sort of problem with regularity etc. (also for your own sanity) :)Im betting this will just take a little time and lots of hugs. I hope this helped. Good luck! Janae

Hi! I'm A., a stay at home mom of a 5 & 8 year old. I've had several friends and my sister who has had this problem. My doctor always told me, "they won't go to Kindergarden wearing a diaper". So I tried not to stress about potty training. However, two of my best friends and my sister had kids that occasionally pooped their pants even in Kindergarden. None of them have accidents now, but they did in K. I think that it is something that they will grow out of. I remember my sister being at her wits end. I will pray for you that God will give you the strength to get through this. I think that this is very normal behavior. I can't image so many people that I'm close to going through this same thing and it not be normal. I hope that this was helpful and that you are able to kindly remind him to try to use the potty next time and that he won't see the stress that it is causing you. Good luck, hold your breath and it will be over soon. With Love, A.

If it's a control issue maybe you're giving him too much attention. If he is pooping him his pants at 4 1/2, he's old enough to start cleaning it and himself up. You have to change YOUR response to get a different reaction.

Good luck!

I know this sounds mean but my ex-sister-in-law swears that it works. Her son who is now 13 was going in his pants at 5 after one very frustrating day and another accident she took him outside no yelling or anger or anything but very calmly she took all his clothes off in the yard and hosed him off with cold water. The embarassment of being outside naked and cold fixed him and he never did it again. The important thing is no anger it is not a punishment you are just cleaning him off and letting him think about the consequences. It might work for you.

Hi J.
I too have a son (6yrs old) that was soiling his underpants. He was on Miralax at the time. I was stressed out all the time. So I difinitly feel your frustration. I purchased the manual from soilingsolutions.com that recommends you to get them off laxatives such as Miralax (top down laxatives) and into a bowel routine. As soon as he stop taking Miralax he stop soiling his pants. (It is not his fault that he is soiling his pants, they don't know when the poop is going to leak out)The soiling you see in his underpants is the part that breaks away from the large mass that is forming in his intestines. You may need to use a bottom-down laxative. My son still has issues with letting go of his BM's. (he is still afraid it is going to hurt) The GI says it can take years for him to get the sensation back, since he has held his BM's for so many years. Work in progress. You have to have him sit everyday for at least 2-3 mins after every meal. If he doesn't go the first time, say it is ok give him 15 mins to relax off the toilet and try again for another 2-3 mins. The manual can be very successful if you have the time to dedicate to it. Hope all goes well for you. You are not alone.

In case you're still reading responses I just wanted to 'chime in'. I'm a grandmother to 3 and 'mom' to 4 (grown) kids.

RELAX!! Back off!! You say (a couple of times) that you've 'tried everything'. Well, I think you're 'trying' WAY TOO hard. Why would he quit something that's getting him all this attention? This is HIS responsibility, not yours, but it is your responsibility to MAKE it HIS responsibility.

I'm sure someone has suggested that you have HIM clean it up if he does it in the wrong place -- consistently! IT WORKS!! And that's about the only time he needs ANY attention over the whole matter. Put the responsibility in his hands. Everyone who's ever lived has had to poop, so quit making such a big deal over it.

Quit asking him all the time if he has to go. Simply stop it. He eats, he poops, he's responsible for making sure it goes where it's suipposed to go and to take himself there when he needs to.

He's probably holding it in because of the attention he gets about this issue, and holding it isn't healthy. He's in control, here. I'd even stop with the Miralax. If he eats properly and drinks plenty of fluids (and this is also 'Mom's responsibility), he'll develop his own natural cycle of elimination. I don't go every day and haven't since I was little (and I'm almost 51). My mom made quite a deal of it because she'd had hemmorhoid surgery and didn't get to go back for check-ups and her rectum would only pass very small stool, but on my dad's side we all inherited long (and wide) colons and it takes longer to process everything (and it comes out pretty 'fat'). I always felt like I was doing something 'wrong' when it was simply my body's 'natural' --albeit slow-- cycle.

Don't sweat the small stuff (and it's all 'small stuff'). Pick your battles and don't make a battle out of something that's not worth it. Many kids just naturally have a desire to challenge adults' authority and patience, and they get very proficient at it if the parents keep playing along. If he's pushing your buttons at 4-1/2 over such a trivial issue, what strong tactics will he be capable of using to 'win' when he's 14 (and bigger than you) or 17 (and driving!) -- just because he can?

Hello J.
My niece and nephew had the same problem and I kept telling them that it has to be physical. They finally took their daughter at 10 yrs old to the University of Los Angeles and they took sona grams of the girl to find that she had a blockage way up inside her bowls. They started her on a reutine of some kind of laxative and they finally broke through but by then it was too late. she got into the habbit of pooping her pants cause her parents wouldn't help her to begain with. Think about having your child checked out all the way up inside to find out what the problem is. Hope you get some answers. My family also went to Physoologists for help and after all this time, the girl is 18 now, she is finally going to the bathroom regularly. God Bless

Hi,
I don't have time to read the other responses, but look up "encopresis" and see if the symptoms match. If they do, go to soilingsolutions.com. Good Luck.

Read/research about encopresis...the info may help. It is a sort of control issue sometimes...D.

We have a similar issue with our 3 1/2 year old daughter, the difference is she wont go in her pant, she just has wee bits of leakage if she waits to long. We have the "OMG you're a horrible mommy I dont wanna poo!" screamfest at our house as well though. And afterwards she always says it didnt hurt. Our pedi says she is anal retentive, and I believe it.

So, does he tend to poo at the same time each day? Obvious guestion I know, but if he does I would pick that time of day to stick him on the potty. My daughter tends to go in the evenings and so I watch for the signs and stick her on there. What I do is sit in there with her, grab a book and wait. When she gets over the top I calmly tell her "you have to go poo, and you're not getting down until you do.". It takes around 15 minutes usually before she gives up the struggle and goes and then life is normal again.

Since your son is now four, you might want to tell him that if he cant poo in the toilet like a big boy then he will have to wear pull ups again. Seeing as how he is about to start school and more aware of social interactions and that other almost 5 year olds dont have to wear pull ups, that might be an incentive for him.

But the biggest thing is to remember that this too shall pass, and I can almost guarantee you that he wont be doing this all through his childhood ;).

Stop talking about it, Period! When he poops, clean him up and keep going. When he sits on the pot, reward him with a sticker or 2 m&m's, nothing much more than that. Give him a very high veggie, fruit diet, low carbs. In other words, get off his case. He is getting lots of attention from you right now.
I really feel for you, this is a heck of a thing to deal with, but it will resolve. You need to speak with a psychologist, it will make you feel a whole lot better, and they will give you sugg on dealing with this. I know you are very stressed. Good luck.

I know I'm a little late in responding, but i thought I should since it sounds a lot like what I went through with my grandson. What happens is they have a bad experience trying to have a bowel movement (pain). They then decide they don't want to do that again, and start holding it. Sounds like your sons associates his "bad experience" with sitting on the toilet. He has to work through it and have enough painless bowel movements to get over it. It's not that he's trying to be difficult - he's afraid of the pain! Also, when they hold it eventually it stretches his bowel and he won't feel like he has to go for longer periods of time. This is not good as the function of the bowel is to remove the liquid from the waste so it forms a solid waste product which we then eliminate. If the waste is in the bowel too long because the bowel is stretched, then the waste becomes quite hard and dry thus resulting in pain. the best solution we found is mineral oil. It will coat the waste and make it softer and slide out easier. After a few times of no pain, he will get better. Also, try putting a stool under his feet when he's on the toilet. It makes them feel more secure when their feet are touching and not dangling and it will give him some help if he does need to push. Also, with the mineral oil, you will find that he can't hold it because the oil will make it slide out. It's a good time to do this - prior to the start of the school year. We had to do it with my grandson when school was in session and had to bring the school folks in on it because he HAD to be allowed to go to the bathroom any time he asked as the oil made it IMPOSSIBLE for him to hold it until recess/lunch. Good luck to your little guy. This is a hard thing for them and I feel for you and he!

My youngest son had a problem. He would hold it-not poop for what seemed like forever and then it would be large and hard! It then hurt when he would finally go! Not to mention leaking out and having a permanent skid mark on his underwear and smelling really bad....This child has some other quirky behaviors-time heals though!!!! There is hope! Having the child clean up after themselves will either clear up the problem rather quickly or it will reveal to you if he has a physical or mental problem.....DRUGS are always my last option. They always create another challenge or problem. From the beginning of time children have displayed quirky behaviors or had health/mental problems to overcome. I don't think it is so unusual! You will solve this problem and you will move on.....GOOD LUCK

this is my unexperienced advice :) my son is only 2.

I'm not sure that I would punish him if i were you. That may make it worse. my nephew (now 5) had the same trouble but it more to do with his home life (teenage parents, divorced, drugs ect...) but when he was at his dad's, if he had an accident, his dad would yell at him and then he was afraid to go.

Does your son clean himself up when he goes in his pants. Maybe try making the responsibility all his. If he makes a mess, he needs to clean it up and anything else he may have gotten messy. Maybe that will make him want to go in the potty

Instead of Miralax (which says "for occasional constipation" right on the box) try Benefiber. I mix the powder into my son's and my own drinks, you can't even taste it. Laxatives are ROBBING him of the nutrients he gets from food. My friend has been giving her daughter Miralax every morning for years, she's pooped in her panties in Kindergarten this past year, on numerous occasions, probably because she didn't have enough time to feel the warning signs that she has to go. that's 2 for 2; 2 kids I know getting Miralax every morning and both of them poop in their undies. Laxatives are dangerous, but you can never have TOO much fiber in your diet.

My son did this when he was 5 yrs. After 2-3 months of this, we asked a child pschologist (a friend) she said have him clean it up himself and explain how unsafe it is to not clean it well --- give him a procedure -- make him stick to it. I did this --- and it worked!!! We have a green bucket, some cleaning solution, and after a few times of this ritual, he just never did it again. Simply put, he started paying more attention to his body --- and would rather go in the toilet --- than use the green bucket.
good luck!

Yes, take him to a psychologist who specializes in children's health and behavioral disorders. There is a clinic in Charlottesville Virginia and probably in other towns with medical schools. Just because something is "behavioral" does not mean he is doing it on purpose. Sometimes, especially in children who have experienced painful constipation, they "withhold" BMs for fear of pain. Then they can get impacted and create situations in which there is speepage around the hard BMs still in the rectum. I have seen this even in pre-adolescent boys who will hide their soiled unserwear in shame. Please do not use fear or shame, as this might backfire. Like with bedwetting (which often brings up the same response and feelings in parents), behavioral interventions can help him learn some self-control and master this problem. Good luck.

J.,
My sister had this problem with her son at that age. I told her to inform him that she would no longer clean him up when he soiled himself. That he would be responsible for his own clean up. He would clean up his body himself and then take his clothing that was soiled outdside and clean it up before it could be laundared. She supervised him once and never soiled himself again.
C.

I have a son with irritable bowel syndrome (Encopresis).and your son sounds like he has it. My son started out having it early in his life with constipation this is a very hard disorder that can affect him for life or until his body out grows it!It is not a attention getter the children that has it is deeply self consious about it & they could be deeply hurt when they start to school where they can be teased by other students. Its very important that you keep him assured with this situation by maybe using an under garment when he does go to school or take extra underwear with wipes & ask the school to let him go to the restroom whenever he needs to without him raising his hand to draw attention to him so that he could just go clean himself up. My son is 16 and still has this problem. I've been to specialist and they tell me it can get to the point that he may or may not know he's having these accidents due to thier maybe damage nerve ends that are located in the colon and its sometimes hard for them at a young age to smell themselves too. Also that sometimes his bowel will flow without him wanting it to which is too late to go to the restroom which then causes an accident and then thier too embarrasing for them to tell you plus thier scared thier hurt your feelings or make you mad. Also doctors told me that the child is so scared that it'll hurt that they will hold it but the meds that you have him on right now should help greatly with having non painful stools my son is using the exact med at this moment this med is very important & should not be discontinued for if you do it can cause other problems like blockage to back up into his stomach and can cause him to throw up & choke if his condition gets worse. I can remember that my son had to be rushed to the ER for his bowel backed up into his stomach then into his throat so please think about it. Signs of concern: he's very tired & wants to lay around, complaining of a headache, not hungry, belly budging if he has any of these signs he could be backed up with an x-ray it can determined if he needs a cleaning out process or other to get him back on track. Miralax should be used everday to work properly it can make thier bowels runny & not solid which can still cause some irratation so I would recemend some kind of lubication to keep chapping down or moisture to the area then white cotton loose fitting(not too loose) underwear with no dyes with plenty of exercise so that it'll work his bowels. I'm sure you have already get him to eat lots of foods with fiber that helps his bowels. Whatever you do do not give him karo syrup that is pure sugar & it will crystalize in his colon and cause blockage use minerial oil instead for a bowel relaxer if you think he needs it to help lubicate his bowel so it won't hurt. I know how frustrating it can be at times i've been on my last nerve with my son at times for its a terrible disorder to handle & I know my son is very upset about it too. I would just discuss it with a specialist that deals in this type of bowel disorder and he'll advise you on some tecniques that will help mentally & physically for your son. Just remember you're son & you are not alone! God Bless you!