Please help - child constantly having accidents

Sorry, also I had to teach my son to check in with his body. How does your body feel right now, name the emotion. Your belly hurts? Could you deacribe that feeling, where abouts, read a book from the library about the body paying particular attention to the poo side. Eventually, and it took a lot of time, he now says he feels he needs a poo, he checks in when he has wind, pain, a funny feeling. But my goodness it has taken a lot.of time.

Sounds like our situation, my son is 6, we are just coming out the other side but it has been around 1.5 years of it. His was constipation, then emotional I think because he was worried/scared, and also his ability to focus on one thing and nothing else, plus he became so used to the accidents he didn't remember in that emotional moment of an accident what to do and what to do before the accident was a thing, he needed retraining.

Is this problem at school also?
When he has these accidents is he focused on something? A screen, playing, whatever it may be?
Does he have just wee accidents too, or fine with wee and accidents always include poo?
Does he have contact with dad, is it the same at dad's?
Have you/school noticed sensory or SEND traits? My son possibly has adhd which we didn't consider at the start of our journey.

No judgement here, I've gone through the stage where refusing to tell me or go to the toilet was a thing. But in our situation the above questions made me see some patterns and it helped me understand.

With the toileting i had to give my son asked much control as possible. So we sat down at a time when he didn't need the toilet and we talked about a list of compromises. I placed the toilet blame on the toilet almost saying, 'the doctor said to do X, so mummy is trying to help. How can we make it easier for you?' Likely to say screen time, have a little basket of the screen, book, Fidgets, toys. It stays there at all times. My son needs the smaller seat and a stool too, so we left it ready on the toilet or he wouldn't use it or find that too much to deal with while panicking. So for every rule you put in, come up with a compromise. ' the doctor said we need to sit for X amount of time, could we use a timer that is left in the bathroom. As soon as you are off would you then like the option of a treat' have a treat basket. This means there is routine and pattern to the toilet which helped my son a lot. If my son gets upset I explain i am going to walk away and give him a minute, and then I return because I found my presence alone sometimes made his behaviour escalate. He still thinks he is going to get told off, despite it just not being the case, but I have to be positive/nonchalant/easy breezy with it all and while we are sorting it i talk about the most silly things, I even sometimes make up a dream I had that makes him laugh. These times have now become less friction and more about 1 on 1 time/connection.

Also, knock on the door before you go in to the bathroom. Privacy is big from 6 years and up from what I have read.

My daughter had the leaking poo thing - it was due to constipation. Essentially a hard dry poo is higher up and nothing can pass it, so anything less solid above it liquifies and runs down - it's like a discharge rather than a poo so he won't have any control over it. My daughter's resolved eventually with medication, and we were then able to make sure she drank lots and had lots of roughage so it didn't recur.

You have my sympathies, I’ve been there, it’s a nightmare. I recommend joining the Facebook group Movicol Mummies. I was amazed how common these problems are.

Where he’s crying about going on the toilet, and also about having to wash etc after an accident. I’m wondering whether he has other sensory issues generally.

Does he struggle with noise and lights? Take off shoes or clothes when he has a meltdown? Rock or rub his arms or flap when he’s agitated? Hide under things like blankets or tables when he’s upset? Have difficulty with the texture of foods?

If so it’s possible that he’s also having trouble with the feeling of having a poo which is causing the constipation and the accidents are occurring as the poo leaks around it.

The constant leaking like that (with that absolutely rancid poo smell) is b3cause of the movicol.

For it to do it's job, it also causes the leaking to happen.

We had this til my eldest was in year 7 or 8, by that point I was very awake to subtle signs he was heading for impaction and I'd give him a bisacodyl pill or two with a lot of water, and chuck fruit at him.

His eating habits weren't great and his water consumption wasn't adequate. So it was a case of me handling it when he was home (primary was pathetic with 'helping').

He's about to turn 18 now and is doing fine. He's autistic though, and has adhd. He wasn't getting the signals and was unable to sit on the toilet long enough to go, or fully empty.

Ok, you said liquid in your original post and bio liquid isn’t anywhere as good as powder.

If you are doing the proper wash routine then it won’t smell, that’s just in your head. I used washable nappies and wipes when DD was little so am used to the laundry routine for shit.

He should be having regular reviews though. We had to taper DD off periodically to see how she got on as you stop being able to tell what is leakage and what isn’t.

DD witholds because she doesn’t want to stop what she is doing and go. She is also poor at drinking fluids. If she goes regularly she is much better but she is rubbish at school. She has started to get some sensation back but it’s inconsistent. But we get all the lying, hiding pants and tantrums still. But the “poo nurse”
team have been very useful. I can see light at the end of the tunnel at least but we are 2 years in.

Are you getting support from school? If they are aware they should be ensuring he isn’t sitting in poo at all or for long.

Hey OP, Paeds doctor here. It really sounds like your little boy is still constipated and that he has never been fully disimpacted. I would ask for a doctor to feel his tummy and possibly an XR, we can see faecal loading on them.

there are a couple of well boys I have looked after into early adolescence who needed to be admitted to the paediatric unit for dissipation every few months. One 11 year old literally blocked the toilet he used there was so much poop.

it sounds like it’s really impacting your lives so I would really push to be investigated

My 7yo is in nappies for poo but he’s autistic and non verbal so I know it’s different, but it sounds like he’s feeling pressured and overwhelmed.

What is his cognition like? Does he have additional needs? Have you had a conversation with him about it?

Without being graphic…is it full on accidents or just leakage/stains? My child had the latter for years and it was due to constipation. Even now he produces the most humongous turds I’ve ever seen. But at that age the doctors said it was because poo was sort of leaking around the big blockage. It’s unpleasant for everyone, especially him so I would just keep up with the gentle reminders and try not to get too frustrated. I’m led to believe it’s quite common.

I don’t have a lot of advice, but sympathy as I have one who is similar and is 7 in a few months. She does dribbles of wee and small amounts of poo sometimes. I recently felt it was worse and did an incentive thing where if her pants were dry by the end of the day she’d get a prize, and discovered she really can’t do this, she hasn’t had one day, she got one prize when I reduced it to a half day. So concluding that she would do it if she could. I think til now I’d not felt it was a big deal but am on the stage of feeling this needs looked into. In her case she seems to struggle to identify needing to go until things are at an urgent stage, and she describes it as ‘too painful to hold’ when it is urgent. She does little dribbles at school but never enough to smell and teacher unaware. Anyway, solidarity. The shit is the worst. I agree with pp they feel the frustration, even when we don’t say it. But be kind to yourself; it’s not an easy thing to accept. And personally, I just buy cheap pants and chuck them if they are too pooey. I know wasteful but keeps me sane.

If he is crying when sitting on the loo, it could be that pooing is v painful. Might he have an anal fissue? They are v v painful and can cause a child to become afraid of pooing and then become constipated.

if he does poo on the loo, is it soft? He may need more movicol.

Are children never referred for a colonoscopy?

Is he sitting on the loo regularly for 20 minutes to poo properly? With a footstool for support? We had to bribe DD with iPad games to sit on the loo but it made a difference.

and keep up the movicol. You may need to do another big disimpaction and then keep going with a maintenance dose for a long time (years) to fully retrain the bowels.

Is your son doing "full" poos in his pants or is it more like "fart with follow through"? If it's only a small amount, could you put small panty liners in the back of the pants to collect the worst? Obviously that might not help if it's a full poo.

My daughter had issues which were not due to ongoing constipation, though may have been caused by that initially when a baby - resulting in a stretched bowel and huge poos, meaning she would not always feel when it was coming and a bit of soft (healthy) poo would come out first. She was on the laxatives for ages which I think made things worse sometimes, and I got the impression that the continence nurse (as lovely as she was) was only really focused on constipation.

However, now at age 8 it is mostly under control except occasionally when she eats badly if we're away from home - other than her body growing up to catch up with the size of her poos, the thing that has made the most difference is being allowed to have her water bottle on her desk at school so she will drink enough on school days (only kids with medical issues are allowed that, the others have to leave them on the side). Also getting her to drink weak squash at home as she'll drink more of that than she would water.

We put a Natracare Mini pantyliner in her pants on school days (we buy multi-packs on line), just to be on the safe side - they're small and not full of the scented stuff in some of the mainstream brands that might cause irritation.

I feel for both of you.

Even if you've never told him off he's going to feel your frustration. He's old enough to feel ashamed and that is likely why is reacting so badly. He may also have pain if he's trying to hold it back and then again when it leaks out.

Most soiling is a combination of physical and mental/behavioural issues.

Absolutely agree with the ERIC helpline.

Also contact your GP on Monday. I know you've got an appointment in a month with the continence team but it sounds like you need help now - they might be able to send a message asking for advice.

Have school mentioned anything? Is the soiling happening at school or is he holding on there? Do they have any other concerns about him, his behaviour or development?

Have you done a diary looking at when this happens, what is happening beforehand - do you see any signs of discomfort first? How far away from a meal is it? Any clues might be helpful.

Would he talk to you about it, how it's making him feel and reassure him that you know it's difficult and you're going to try and get him help? Ask if he thinks there is anything that makes it better/worse - he might have some ideas to explore or at least listen to. He might have ideas that are wrong - that it's his fault/ he's dirty that you need to let him know are not the case.

I was also going to suggest the ERIC helping but another resource I was given by my health visitors was The poo nurses https://www.thepoonurses.uk/

Their website has some good advice on it and there's an email address you can email them on too. Wishing you the best of luck.

It’s good that you’ve been referred to the right medical team. Continence nurses are also great if you have the service in your area.

On how to clean this: rinse the solids out (in the loo) 60 wash with a capful of zoflora instead of fabric conditioner.