Hello Mamas,
I'm at the end of my rope with my 5 year old daughter. We recently found out she has encopresis (withholding BMs). For those of you familiar with it, you know how frustrating the condition can be. We are Americans living in Germany until the end of the year and there is absolutely nowhere for me to turn to for advice.
Here's my question: Am I supposed to keep up the potty training every day? Diapers? I feel like I'm beyond training her because it didn't work the first time. My daughter will not poop in the potty and only sometimes will she ask for a diaper to poop. She goes about 1-2 times each week. We've been using reward charts but they haven't been too successful. She does okay in panties when she goes to school, but that's only for 3 hours a day. When she gets home she usually has an "accident" so I then put her in a diaper because I'm sure she has to poop. I feel like this is so counterproductive. I'm encouraging her to use the potty then I put her in a diaper because I'm sick and tired of cleaning up the accidents.
I feel like such a failure as a mom. This condition has brought out the worst in me because I'm so frustrated by it. I get so mad at my daughter but then I have to remember it's not her fault. Encopresis literally rules our lives. Any help / suggestions / support will be greatly appreciated!
I think the key to controlling encopresis is giving Miralax or similar. She's probably constipated with hard, painful stools?
My friend's pediatrician had her pick two days when they would be home and give the entire bottle of Miralax.....it seems to have regulated the constipation that accompanies encopresis. Now she makes him poop every morning on a schedule.
Our son has had encopresis off and on for a few years now (although off for a long time at this point). We finally found what worked. It wasn't the laxatives, suppositories or mineral oil. Forget the charts. It was giving him bribes and having him go at the same time each day. At the beginning, we offered him a huge bribe to go -- say, maybe $20 -- to get him to not focus on the pain of such a big poop and to overcome his fear. He was motivated for that incentive! Then, we offered smaller but still meaningful rewards to him as he went each day. For our son, the best time proved to be right before bath time, because we were in routine mode then. It took a while, but he started to associate going with bath time and his body became used to things, too. Now, it doesn't hurt anymore to go since he's not holding for days, so it isn't a crying battle anymore. He often goes on his own now, which is a major achievement!
My big tip is to skip the diapers and focus on routine, routine, routine. Come up with a significant bribe to motivate her the first try (whatever would motivate your daughter ... think "wow" factor that she can't pass up) and then offer smaller rewards until the fear subsides and it's routine. If she's going every day, there won't be the tracks all over her panties anymore.
Encopresis is no fun and unfortunately will be a part of your life for a while. Don't beat yourself up over how you've handled it so far. We used to get angry at our son for having accidents, too, but understanding that it's a medical condition and not deliberate helps.
Good luck!
My son doesn't have encopresis, but he did have a hard time regulating his bowel movements due to occasional constipation and hard/painful stools. We use Miralax everyday to keep his stool soft enough that he passes it easily. It has no adverse side effects, like excessive gas or cramping. It's gentle enough to be used on infants, and you can adjust the amount you use to the point where the stool is like soft serve ice cream. That's what our ped suggested. And he also said that you can use more at first to get him loosened up and empied out, then gradually reduce to the daily dose needed to keep him regular. It has worked like a miracle. He hasn't complained of not wanting to poop in at least a year (he's 4 1/2), and he used to go and hide, and squeeze the poop back in because he anticipated a painful bowel movement, which we all know only makes the problem worse. He has not done that since we started on the Miralax regimen.
I wish they had that when I was a child. Or if they did, I wish we knew about it. I withheld my bowel movements as a child because I had somehow found myself in the never-ending cycle of withholding followed by painful/large stools. It was a nightmare. I can relate.
I'd definitely try Miralax. They are now making generic substitutes also.
Good luck.
www.darshaksanghavi.com/columns/ConstipationParents2010.pdf
This was a great article in Parents magazine from a doctor and his son. Very "real world, real solution" advice. You are not a failure and neither is your daughter. Once you get the pooping more "comfortable" inside her body, you could work on comfort outside RE body position -- do you have her place feet on stool, could you get her a comfortable potty seat or small potty? You cannot "reward" or "punish" for a health issue, just ride it out with as much style and finesse as you can:)
GOOD LUCK MAMA!
Man! I'm sorry about your situation and I'm sure it's that much harder that you aren't close to family to lean on. Still, I'm sure you are not alone. I expect you can find other moms in your situation in the area -- you can talk to/with them about things you've tried and what works/doesn't work... Is there a pediatric GI you could see there?
From what I understand, really, stool softeners are the best way to go. Like Miralax maybe, in a glass of juice when she gets home from school? My niece has a similar situation. I think this becomes a vicious cycle because when they "hold it", it dehydrates the stool which then makes it harder and more painful to push out. Which makes it unpleasant. Which makes them not want to. Which makes them hold it. Which causes the problem... So, it is in her head -- whether she knows it or not -- maybe counseling or just talking to you, even. Keep it positive, talk about what she feels in her tummy, how good it feels to have the stool out of her tummy...
Good luck! I know it's frustrating and I don't know if I had anything to say that was even remotely helpful.
If you haven't found these, maybe some of these ideas will help:
http://www.keepkidshealthy.com/welcome/conditions/encopre...
http://www.medicinenet.com/encopresis/article.htm
and for her:
http://kidshealth.org/kid/stay_healthy/body/bowel.html
http://kidshealth.org/kid/htbw/digestive_system.html
I like the idea of taking a whole bottle of laxative and "getting it all out" and then using strong laxative every day to force a routine of daily bowel movements. As a previous poster said, withholding causes pain, and pain causes withholding. There needs to be a dramatic cycle-breaker. I mean, have you ever heard of any kid withholding a glycerine enema? Give her one every morning until she can go on her own. Sounds dramatic but so his refusing to poop until your poop is so hard and big that it tears your rectum and makes you bleed on the way out!
My niece who lives in England was taken to a child psychologist when she was 5 or 6 for a similar issue (extreme fear of using any toilet outside her own home) and it worked brilliantly. I believe in the end she only required a few sessions. Perhaps you can get a referral for someone good over there. Good luck, I'm sure this is challenging, esp being away from home, but you are not a failure! Things will work out eventually.
My son has the same problem, my doctor has prescribed that he take a stool softer.Since Encopresis causes the stools to be hard and the kids become impacted. My son would tell me that he could not feel it when he would have an accident ,and the doctor told me that what has happen is that all the stools that have been impacted have caused his colon to stretch and my son really good not feel it. Start your child on the stool softener but this is something that is not going to be fixed over night, it will take a while for her muscles to shrink back to normal size. Remember that this is not your fault or your child's.I felt the same way that you do until I found out that this is a very common for kids. My doctors said not to put my son back in diapers and this would hurt ego and make him feel like a baby when he is not. Just always carry extra clothes and try and reminder her to try and poop when ever she sits down on the potty. Good luck!
The first course of action is to look at diet and physical reasons for retention. If changes in diet and a physical indicate that those are not the issues, then focus on the social, emotional piece. A five year old may feel her world is out of control and her bowels are all she can control. A play therapist may be of benefit in finding out how she feels. Increasing her play time with peers may also help in terms of modeling behaviors. The more you make this a battle of wills the longer she will continue the behavior.
I understand your frustration. My son would not consider the toilet until he was about 5. My daughters trained early one at 18 months and one by 2.5. Working full-time I did not have the patient to keep cleaning up the mess so I just kept him in pull ups until school started. We barley made it into school but we did finally master it. Be patient with your daughter and yourself. She probably does not like being rushed into change and will do it when she is ready. I know it is expensive to keep them in pull ups but it will pass. (3 deep breaths and repeat) "this too shall pass." It gets me through a lot of frustrating moments. Best wishes!
