February 28, 2008,
S.J. asks from Waxahachie, TX on February 26, 2008
I Have an 8 Year Old Step Son - Who Is Still Not Potty Trained!!
If any one out there is a doctor about internal health or types of problems with children not caring that they soil themselves - I need advice!! My step son is 8 - he does not live with my husband and me - he continually soils himself both fecal and urination. He has been to some abdominal doctors and they keep him on a stool softner type medication which is also a diruetic - His bladder lining is thick and enlarged - Is there a possibility he does not have nerves that let him know that he is going to bathroom? Is there a way to test this? If this happened to be the case is there something that can be done about it. This child did not have a very nurturing mother when he was young - could that have some physcological development issues? I am at a loss as how to explain or teach an 8 year that it is inappropriate to just sit around and soil yourself.
S. answers from Dallas on February 26, 2008
I am so glad you are concerned for your stepson, rather than angry at him. It is a fairly common problem. The fecal soiling is called encopresis, and the urination is called enuresis. Most pediatricians don't seem to have a real thorough understanding of the problem or a solution.
My daughter has struggled with encopresis, and it has taken me a long time to grasp it (I would get mad at her, bless her heart). When I realized it was beyond her control, I found a great source of help, via the internet. Go to www.soilingsolutions.com and read the website. I ordered the book for encopresis and we've used the program - it helps tremendously! There are still setbacks...I think personality plays a role, in the sense that my 6 year old would rather play and play and not take time to go to the bathroom. She then becomes constipated, then leaks around it but doesn't feel the leakage. So it is a matter of retraining her bowel muscles as well as retraining her behavior. It takes consistency and patience, and I have to admit I don't always have those qualities myself! (so I shouldn't blame her!) At any rate, I recommend you approach this matter-of-factly. Make him sit on the potty every hour or so, so he can begin to get in touch with the sensation of needing to go and the self-discipline to go before urgently needing to! And matter-of-factly have him clean himself up and wash out his soiled underwear, then run them through the washer. It will take lots of time - just as if you're potty training a toddler, because you are, kind of. But also consider looking at the website for soiling solutions, because the program works very well. It doesn't get into all the possible psychological issues, which I think is good. It just addresses the behavior and retrains the child. God bless you both!
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C.P. answers from Dallas on February 26, 2008
another suggestion... has he ever been to a chiropractor? 'pinched' nerves and subluxations can have big effects in our abominal area. and you're right to suspect that he may have psychological develompent issues. It's good that he has you now.
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J.S. answers from Dallas on February 26, 2008
Is it possible for you to make a consultation appt with your children's doctor to ask these questions? (which are very valid, by the way) You said your stepson was not nurtured by his mother when he was little ~ was he abused by her, in addition to the neglect? And, yes, the neglect could very well be a large contributing factor in this situation. If he was abused, nerve damage could also be your "key" in this. If nerve damage is the cause, then I'm afraid you will just have to have him wear "Good Nites"-type underpants, because he honestly *won't* know that he is about to go/has gone in his pants. Under NO circumstances should you or your DH ever make him feel "bad" about what is happening, because in all honesty, none of it is *his* fault. (I know you already know this; just a reminder.) :) Your children's dr should be able to refer you to a qualified urologist.
If he is still with his mother, have you and your DH started trying to get custody of him, possibly without visitation from her?
Good Luck with all of this! Let me know how everything turns out.
Keeping you in our prayers ~
L.N. answers from Dallas on February 28, 2008
I have a 10 year old son who is also having a BM problem. He has NEVER had control of this. A urologist told us that it probably started as a constipation when he was very young, and being so little it would obviously hurt so he would try to hold it, well eventually it begins to stretch out his intestines and then from my understanding that kind of takes out that nerve (or sensor) that tells him he needs to go. It was very upsetting and frustrating that he wouldn't get it because I was amazed that he couldn't even smell it I thought he was just being lazy (how awful that sounds but it's true). But they also told me that he was just basically totally oblivious to the whole situation. After that I eased up on him a lot....but it still is very frustrating to deal with. I am happy to say though that in the past two weeks he has had 2 "accidents" which is amazing. His new pediatrician had gave me this advice: Citrucel or Metamucil in 8oz of water (or fav drink) 1-2 times a day then on sat & sun Miralax 1 capful in 8 oz drink twice a day. He also needs to limit dairy and meats. I don't give my son milk instead I give him yogurt or other foods that supply calcium (he also takes a vitamin daily). He needs more leafy and green vegetables, apples, pears, peaches, and organges the doctor also suggested foods high in fiber so I read labels for that now too :). Of course every child is different so you should ask his doctor if this would be good for him. Also if he is really backed up he might need an enema. It would be really good to get with whoever he does live with and try to work together on a good schedule for HIM. I have found that being on a schedule has helped a lot with my son about 10 min after every meal we would have him sit on the toilet for about 15 min. I actually had a book put together for him with crossword puzzles and word searches and stuff like that to keep him on the toilet but keep checking on him that he is making an effort to push. He doesn't go all the time when he is on the toilet but it gives the routine to go to the toilet. Also before play time or whenever I think he's about to get involved in something like games or a friends house he has to go the bathroom first and when he does go to a friends house he can only go for a short time so he can come back and use the toilet again. Also when he does make a mess HE has to go outside with the water hose and wash his stuff off no matter what time it is then come inside and take a shower. It's a gradual LONG process and it will not happend right away. But with CONSISTENCY it will get better. Like I said earlier my son has been doing awesome these last two weeks. We have been working on the routine thing without laxatives or a diet for about 2 years and we just started the laxatives about 3 weeks now. It has also been a great self esteem booster for him. Oh yeah 1 more thing... we tried the "good nite" diapers with him and that didn't work for him at all, in my situation that only prolonged things and made it just easier to deal with rather than trying to fix it. It's hard and frustrating and sometimes I felt defeated and overwhelmed but not giving up and a lot of prayers for my sanity and my son has helped us get where we are. Good Luck and God Bless!!! May you have patience, undertanding, and peace for this situation you are in. Take care.
Sorry I just remembered 1 very important thing. Ask his doctor to get a brain scan. Through the years we have had different pediatricians..... well about 4 years ago we had told one of them the situation and he had put a request in for a brain scan for whatever reason we did't get one and about a year later with a new pedatrician she also wanted a brain scan done.... I can't remember the details of why but I know she wanted to make sure all the sensors in the brain were connecting to eachother (or something to that nature). So that is something definently you want to consider and look into. Longer story short VIP to request one from his pediatrician.