Any suggestions for my son's soiling problem?

Discussion in 'Fibromyalgia Main Forum' started by TNhayley, May 18, 2003.

  1. TNhayley

    TNhayley New Member

    My 7 yr old is having a soiling problem. It happens every day. He says he just can't control it. I can't find a pattern as to *when* it happens. It's gotten to the point where he's hiding his underwear and/or throwing it away. He won't talk to me about it anymore or let me know when it's happening. He has had an autoimmune blood disorder, many strep infections and chronic ear infections. He has, in the past, complained of stomach aches, but not in a long time. He has gained weight this year ... is always hungry.

    Our doctor said it could be the reflex that babies have after eating (goes right through the chute) and that it can come back in some people (didn't offer any suggestions as to what to to that that!). He also suggested OCD. He did not do any type of test or take a sample. He did feel his abdomen (I suppose looking for chronic constipation).

    I'm just not sure what to do next. Take him to an alergist? I dunno ... what type of doc should I try? This has got to be affecting his self esteem on some level. Thanks for ANY suggestion!
    Hayley
  2. Mikie

    Mikie Moderator

    Your child needs a specialist and your doc should have suggested this.

    Love, Mikie
  3. goingslowlycrazy

    goingslowlycrazy New Member

    ...my son suffers from this too and it drives me nuts (it doesn't seem to bother him, which is half the problem).
    He has always been this way and we have been to a specialist clinic. That didn't work because they had a great play area and he got to have the afternoon off school to go. He was clean for six weeks in a row (which was Heavenly) and then the Nurse told him that if he kept up the good work, he wouldn't have to come any more...so guess what - he started soiling again. What kid wouldn't want an afternoon off school and a great play area!!!
    But all this shows me that he does have control - he just picks and chooses his times.
    He's always clean at school and at friends houses, only does it at home...we keep trying to address it but things only change for a short time...
    As you have probably found, help for this area is sadly lacking and it seems to be a taboo subject.
    If you want to email me at any time it is faeriesong@skyesprit.com
    hugs
    Mary x
  4. Copper2002

    Copper2002 New Member

    Hi Hayley,

    I agree with spacee and mikie. His dr. SHOULD have ruled out any medical problems himself, or recommended a specialist to do it! If there turns out to be no organic cause, THEN look for an emotional (OCD) cause, or simultaneously, if YOU feel it's warranted.

    Don't attach too much importance to each episode, either. If there's a medical reason, he has no fault in this. If there IS behavioral involvement, attaching too much energy (pos. OR neg.) to it can trigger/perpetuate the episodes. The good news is that there are MANY programs and interventions you can use to help him through this tough time.

    Best of luck to you,
    Copper
    Let Miracles Replace ALL Grievances
  5. Mrs. B

    Mrs. B New Member

    We had a similar problem with our 6 yr. old son recently. It was not a medical problem, just that he was playing or whatever and didn't want to go or take time to use toilet paper if he did go to the bathroom. We tried EVERYTHING; talking, grounding, "telling" his grandma, and even spanking. What FINALLY worked was having him pay us. He has money saved from birthdays and things and I told him he would have to pay me back for the dirty underwear because I wasn't going to wash them anymore. The jar sat in our living room and each time he did it again I would just make him count out what he owed me. ($2.00) We also charged him if it was such a mess that we had to clean him up. As my jar got heavier and his got lighter he soiled himself less frequently. It has been almost a month now since he had to pay me for more underwear. The jar still sits on my table and I will give him the money back sometime but, realizing there was a consequence helped him to be more aware of when he had to go and not waiting. Maybe this or something similar would help your son too.

    Lisa
  6. MemoryLane

    MemoryLane Member

    Celiac sprue (aka) Gluten-sensitive Enteropathy


    From the website of Jewish Hospital in Louisville, KY:

    Celiac disease

    Alternative Names
    celiac sprue, nontropical sprue, sprue, gluten-sensitive enteropathy, gluten intolerance

    Definition
    Celiac disease is a malabsorption syndrome. The intestine is not able to absorb vital dietary nutrients from foods containing gliadin, an alcohol-soluble portion of gluten.

    What is going on in the body?
    Nutritional considerations are important for persons with celiac disease. People with celiac disease are sensitive to cereal protein found in wheat and other grains. But they are more sensitive to the protein in wheat than the protein in other cereals such as rye, oats, and barley. The protein causes a reaction in the person's small intestine that prevents absorption of essential nutrients from the diet. The defect in absorption leads to the symptoms of the disease and malnutrition.

    What are the signs and symptoms of the disease?
    The symptoms of celiac disease are:
    diarrhea and foul smelling stools
    weight loss
    abdominal bloating
    vomiting
    difficulty in concentrating
    irritability

    What are the causes and risks of the disease?
    Celiac disease is suspected to be a genetic disorder. But exactly how the genetic changes cause the sensitivity to gluten is not known.

    Celiac disease, for example, is common among people from northwest Europe. The frequency among the British is 1 in 1,000 to 1 in 2,000. The frequency among the Irish is as high as 1 in 600. Relatives of people with celiac disease are at higher risk than others in the same population.

    What can be done to prevent the disease?
    There is no way to prevent celiac disease. Genetic testing may be useful in some cases.

    How is the disease diagnosed?
    Celiac disease may be diagnosed by observing the symptoms after an infant begins eating cereals. More often, however, it is diagnosed during the second year of life. The age and onset of celiac disease can vary, though. A blood test may show impaired levels of carbohydrate absorption.

    Stool may be examined for excessive amounts of fat as this is a common sign of celiac disease. A healthcare provider may also order a barium enema x-ray study of the small bowel to check for increased intestinal secretion and clumping of the barium in the bowel. When celiac disease is suspected, a biopsy of the small intestine may be done. The biopsy shows an abnormal inner surface of the small intestine.

    What are the long-term effects of the disease?
    The long-term effects of celiac disease include:
    anemia, which is a reduction in the number of red blood cells circulating in the blood
    delayed growth
    bone loss. Bone loss can cause osteomalacia in adults, with bone pain and tenderness. Bone loss in children is seen as rickets, with bowlegs, a protruding stomach and a pigeon breast in children.
    defects of the nervous system
    inflammation of the skin
    malignant lymphoma

    What are the risks to others?
    Celiac disease is not contagious. It is an inherited disease, but the way it is inherited is not clear. Genetic counseling is useful for those at risk of passing it to their children. The risk for identical twins may be as high as 70%. The risk for other brothers and sisters is 10%. The risk for children of parents with celiac disease is 5-10%.

    What are the treatments for the disease?
    Many of the effects of celiac disease can be minimized with a special diet. People with celiac disease learn to avoid the proteins in cereal. The proteins in wheat, rye, barley, and oats cause the symptoms of the disease. A healthcare provider may recommend a gluten-restricted and gliadin-free diet. Gluten is found in wheat, rye, barley, oats, corn and rice. Gliadin, the substance that seems to cause the symptoms in celiac disease is not found in corn or rice. People with the disease cannot tolerate wheat, rye, barley and oats or any products made with these grains. They can eat corn and rice because these grains do not contain gliadin. Some people may be able to tolerate oats, but this should not be tested until initial recovery has occurred. Some people do not respond to dietary limitations, and may need steroid therapy.

    What are the side effects of the treatments?
    Use of steroids may cause memory loss, bone loss, weight gain, congestive heart disease, or high blood pressure.

    What happens after treatment for the disease?
    Dietary restriction or drug therapy will be needed throughout the person's life.

    How is the disease monitored?
    Celiac disease is monitored by simple observation of symptoms.


    Author: Ronald J. Jorgenson, DDS, PhD, FACMG
    Date Written: 05/23/00
  7. AC77

    AC77 New Member

    very tough problem. It could be organic or psychological. You may want to rule out with a neurlogist any organic brain issues--which i doubt it is. Or a psychologist may be helpful, if its psyhological. For urinary incontience, the standard treatment has been imipramine. I would say in the case of your child a 3 week trial of either, imipramine, elavil or even better Anafranil (clomipramine) @ 10mgs at bedtime and working up to 50-75mgs may help some. I could explain the reasons how it would work but it would take a LOT of space. Even though though problem invloves feces and not urine, it may help. This is just one approach. I wish you luck.

    Also not to point fingers at anyone but disregard Mrs B's advice until it is ruled out if it is a psychological issue. Spanking will not help the behavior, nor will the money jar. You will have a child that grows up with more issues than orinially started, if you do this. Especially if it is an organic medical condition. I am not judging her or anyone's advice....but in my professional opinion it is wrong medically and morally. Please seek alternatives. Having him clean up his own mess was a good piece of advice she gave, and I commend her on it.
    [This Message was Edited on 05/18/2003]

    Until the problem is solved, disposable underwear or an adult diaper is an option. Are his stools, hard, soft or diahrrea? and under what circumstances does it happen?
    [This Message was Edited on 05/19/2003]
  8. sofy

    sofy New Member

    That is many years ago I had a neighbor whos child had this problem. They ruled out all medical causes and the doctor told her how to cure it but she would have to be firm and not let her heart wimp out. The cure was that any mess whe caused whe was responsible for ALL cleaning up. She said she had to hide cuz the sight of her 7 year old struggeling to hang sheets on the line was too much for her. It did work for her. She was not scolded just told she had to clean up if she didnt make it to the potty. It took 2 weeks. I am not qualified to comment on any long term psych. effects of this "cure" but forever it is worth it worked for this family and they had a big celebration for her when she conquered her problem. It was never handled as punishment just responsible for ones self.
    Good luck
  9. kgg

    kgg New Member

    it was caused by a corn food allergy. I took him to a pediatric gastroenterologist. He tested him for food allergies with a rast test. He eventually did an endoscopic exam. But the main issue was a corn food allergy. The corn was removed and the accidents stopped.

    Please don't punish for the messes. I was very matter of fact, specifically not shaming him. He acted like having the incontinence didn't bother him, but that was just a coping strategy.

    Keep looking for an answer. And thank the Lord he hasn't had an accident in front of his friends, they can be unmerciful. -Karen
  10. starstella

    starstella New Member

    when my son was young. i was going crazy trying reward charts, losing my temper at times and blaning my son for his actions, etc.
    finally his doctor ordered a lower spinal x-ray and it turned out that he had spina bifida occulta-- a very small defect in the tail end of his spine in the area that controls bowel function.
    he had soiling problems until he was about 13. he is 16 now and all is well. it just took awhile for him to gain complete control.
    try to remain as matter of fact about this problem while you search for the answers.
    you may want to give him a plan of action for what to do with his underwear when the soiling occurs and offer whatever assistance he needs in a calm way, so that he is not either shamed or made to feel that his bowel accidents are a way of controlling you.
    reassure him and yourself that there is a reason for this and be persistent with getting medical evaluation.

  11. TNhayley

    TNhayley New Member

    I will seek out a pediatric specialist. Luckily, with our insurance, we don't need a referral if we stay in network, so I will get out the directory today.

    I try to not make a big deal about his problem. He started hiding it when I suggested it may be something medical ... after what he went through with his ITP, a stay in the hospital and then weekly blood tests, I think he will do anything to stay away from doctors. (sigh) I was hoping that suggesting it might be medical would alieviate some of the anxiety he must feel about it. Such a sensitive area.

    I'm pretty sure he has fibro. Autoimmune problems, ADHD type behavior at school, doesn't sleep well and grinds his teeth at night, pains in his legs, general decreased stamina, last week he started complaining about pain between his shoulder blades ... and when I rub his back I can feel the ropy bands in his muscles. I would give ANYTHING to know it's not FM. (another sigh) He does seem to crave carbs and sweets. It's time to look for some professional answers. Again, thanks for all your suggestions ... I'm writing them all down. Hugs,
    Hayley
  12. Lachesis

    Lachesis New Member

    He is getting better w/age. If he has set times to go he does much better but still can have leakage through out the day. It isn't something he is proud of :( believe me.

    Please give your child the benefit of the doubt... it's only more damanging to tell him he can control it... :(

    Fecal Soiling
    by Warren P. Silberstein, M.D.
    07/14/97

    Most children are bowel trained by 3 years of age and many are trained before that. Occasional accidents occur as children try to gain greater control and wait too long to go to the toilet. If an older child continues to soil his pants, he requires medical evaluation to determine the cause. Less than 5% of children who soil have a medical condition contributing to the soiling. Neurological conditions that interfere with bowel and/or bladder control are rare, but must be considered. Children with chronic diarrhea from colitis or infectious diseases may have accidents; however, on occasion, a child who is having diarrhea may actually be severely constipated with leakage of liquid stool from higher up in the intestine. I have on occasion had a patient who just didn't have the patience to sit long enough to empty his bowels, and even though he had small bowel movements regularly, the excess gradually filled his intestines and resulted in accidents. These children were anxious to end their embarrassing problem and were cooperative with a program of regular and more prolonged sitting aided by reading material or hand-held electronic games. An older child who was previously fully trained who develops soiling may simply be one of those impatient children, but if the child appears distressed, sometimes soiling may be an indication of a psychological problem or the result of a psychic trauma such as sexual abuse. The most difficult children to manage are the ones who have never been well toilet trained and are resistant to sitting on the toilet. The medical term for fecal soiling is encopresis. If your child is encopretic (soils his pants) the first step in treatment is evaluation by your pediatrician.
    If your child has been examined and nothing has been found to be wrong with him, then his soiling is most likely the result of stool withholding. Often, especially when these children are younger, they appear to be struggling to have a bowel movement, when in reality, they are struggling to hold it in. The reasons that stool withholding develops are complex. For some children it may start with a painful bowel movement. After that, they become fearful of having bowel movements and hold it in. No amount of reasoning can help a young child understand that if he holds it in, the stool will become harder and even more painful to pass. Young children only understand and deal with the fear and the pain of the moment. Some children start withholding stool when toilet training begins. For them there are not only issues of control, but also, fear of the unknown and comfort with the familiar. A child who has not experienced staying clean prefers his familiar dirty diaper to the scary toilet. And some children have great difficulty having a bowel movement on the toilet, especially if they are constipated. And so the vicious cycle begins.

    No matter what initially causes the child to withhold stool, the end result is the same. Stool that sits in the rectum becomes harder with time. And as time passes with out a bowel movement the child becomes more and more constipated. It becomes more painful and more difficult for him to have a bowel movement voluntarily on the toilet. Eventually there is no more room in the rectum to hold stool and liquid stool begins to leak out around the hard stool in the rectum. As a result, even though the child is severely constipated, he starts to have diarrhea in his pants. In addition, some formed stool periodically escapes into his pants when he has a cramp, but only enough stool comes out to relieve the pressure because the child is still working so hard to hold it in.

    One of the biggest puzzles for parents is that children who soil themselves often insist that they didn't feel it come out. They act like they don't even know they have a mess in their pants. They don't smell it. They don't feel it. They're oblivious to it. How can a child not feel it or smell it when he sits in a mess in his pants?!? The answer is simple - denial. Denial is one of the most potent of human ego defense mechanisms. If he believes that he can't feel it and he can't smell it, then he doesn't have to deal with the problem. And he is not lying to you. He believes it. If you can't imagine anything much worse than dealing with the constant mess in your child's pants try to understand that to your child there is something infinitely more frightening and awful, namely, sitting on a toilet and having a bowel movement.

    The treatment is difficult. But if your child has been soiling his pants for a long time you couldn't have expected a simple solution. You must be prepared to devote an inordinate amount of time to the solution, and you must be committed to sticking with the program, even when it doesn't seem to be working. You will need the guidance and support of a pediatric gastroenterologist or a child psychologist who deals with encopresis (fecal soiling). He will set up a treatment program which he will constantly review with you to provide reinforcement for you. The elements of the treatment will most likely be as follows:

    An enema may be necessary at the start to clean your child out. This may need to be repeated periodically.
    Your child will need to take a stool softener like Senokot and a lubricant like Mineral Oil. This will make it more difficult for him to withhold stool. This is often the most difficult step for the parents because at first it will increase soiling and it will cause oil staining of the underpants. Many parents can't understand or accept the concept of giving these medications to a child who is already soiling and will give up at this point.
    Your child needs to become acclimated to the toilet. Sitting on the toilet several times a day must become a regular part of his day, even if he doesn't have any bowel movements on the toilet. This must be done with no pressure to perform. For some children it is necessary to start with the lid down and the pants up.
    You must positively reinforce your child's successes. At first success will be nothing more than coming into the bathroom with you willingly. Eventually it will be sitting on a toilet with his pants down and the lid up. Even when he is finally having bowel movements regularly on the toilet you must continue to focus on his success. Failures, accidents, messes: they are not important. Success is important. Reward it with praise. Keep track with stickers or stars in a calendar or log. Plan a celebration for big steps or multiple successes. Don't let any messes distract you from his successes. Your child would like nothing better than to please you. But he doesn't even try because he doesn't believe he can succeed. It may seem a simple matter to you to poop in a bowl. You see younger children than your child do it. But you are, after all, an adult who probably doesn't remember the last mess in your pants. He is a child whose mess is so much more comfortable to him than the toilet that he is willing to risk your anger and disappointment.
    Few things can be more exasperating to parents than dealing with soiling in an older child. It's a disgusting mess, and we all expect our older children to be toilet trained. An understanding of the problem can help parents handle it more calmly and lovingly. But encopresis is a difficult problem to manage alone. Parents dealing with this problem need the help and support of their pediatrician or gastroenterologist.
  13. Esoteric

    Esoteric New Member

    First and foremost, a complete medical for your son is in order to determine whether the problem is a medical or emotional condition.

    If it is determined the problem isn't medical, having your son handle the issue, by cleaning himself up and washing his clothes etc. may help. My friend had a son who did the same thing (it turned out he would just wait too long to go and didn't want to stop playing). Once medical conditions were ruled out, she was advised to have her son 'take responsibility' for the problem. She didn't get upset with her son, but simply had him clean up any messes, himself and his clothes.

    This worked for her and he soon stopped messing. But each case and child is different so have a complete medical examination first to determine the source.

    Good Luck,
    Esoteric