Child soiling himself - at my wits end!

[DoeIdea]

I have two boys, one 9, one 6.

The youngest has been having soiling issues for a while now. He's been to the GP a few times who said constipation and gave us laculose which he's taking daily but he's still soiling. I'm trying to get him back in but I'm struggling to get an appointment and tbh the GP hasn't really been helpful.

I'm sitting in the car and can smell he's had an accident and know it's going to be a fight to get him sorted because he just doesn't care and will happily go around in shitty pants. Everything stinks of shit despite washing daily, using bio detergent, using laundry sanitizer.

Timers and sending him to the loo do nothing - he'll "go" to the loo then ten minutes later have an accident. Not sure if he's actually using the loo because he doesn't want me in the bathroom with him.

I'm buying packs of pants every week and it's costing me a fortune. I've never told him off for it - I just clean him up and move on but I honestly didn't expect to still be cleaning his bum at 6yo! He's also started denying having an accident even when it's clear he has had one and it's turning into a fight every time to make sure he's clean and not getting sore.

I'm waiting to hear back from ERIC but I genuinely don't know what else to do. I'm so fed up of it I could genuinely sit and cry.

Why comment when you have such a blatant lack of understanding on this situation?

I thought it was a nice thing to.

I’d say that in all likelihood he’s impacted, probably withholding too. It becomes a vicious cycle and is very hard for them to get out of - the harder the impacted poo gets, the less he wants to go due to pain and then the ‘newer’ soft poo simply leaks around it which he will have no control over.

DD (around age 9 at the time, no SEN) had a very severe case of withholding in which we ended up having to involve a child psychiatrist.. It was absolutely awful for all of us so I can really feel your pain OP. GP first thing in the morning and don’t allow them to fob you off. The longer the cycle goes on for the harder it is to break

This!

Join movicol mummies it’s SO helpful.
Im in a similar position with my 5 year old. We’ve been doing the disinpaction over the summer hols. Following the Eric guidance and also advice from the group.

Our youngest has been constipated since she weaned (she's 2.5 now). Movicol is great stuff, and whether your ds is impacted or withholding (this is our issue), get enough movicol in each day and it'll pour out. Sorry to be graphic!

Have you asked him if it ever hurt when he pooped? My 5yo did this for a little while after a painful poop, held it in. Fortunately with him it was shortlived and we just used movicol for a month to show that it doesn't hurt always. And he agreed to eat fruit after that because he understands now.

I'm yet to find someone that luctulose works for which doesn't also cause intense gas pains (including me).

Also don’t stress too much about diet. I’ve read and been told now my several medical professionals that it’s not always caused by this. My friends child has what you could call a perfect diet and she suggested until she was 10.
Do make sure they are drinking enough though.

I put pantyliners in my dd pants when she suffered with constipation and this saved a lot of underwear.

I have lived that.
I was fobbed off with constipation and cosmocol. Years later find out he has slow transit colon, he's had surgery, he's been hospitalised and has regular xrays. It's a nightmare. It's sort of managed now with combination of laxatives and picosulphate, we also tried daily enemas and he's on the list for a mickey button.
All I can suggest is push gp to refer to continence clinic, good luck.

Very aromatic(!) stool is old stool that has been in the bowel and colon too long.

So he's clearly still backed up and has lost control of the excretion that can make its way around.

Agree with everyone else you need a disimpaction routine.

You said on another post that you don’t have children so please refrain from offering incorrect and unhelpful advice from a position of ignorance. It helps no one.

This happened with my DC at a similar age. It’s really difficult. I had to put them in pull ups on a night and they’d do it in them. We went to the specialist nurse who asked about diet etc and gave some stickers and hints and tips. To be honest I didn’t find it helped. DC would hold it in.l and it went on for a long time. I thought we’d be in the same situation when they were 10!

The good news is, what did help was when DC went in to year 1 and realised the social stigma of the situation, then started going on the toilet at home, then realised it was fine and doesn’t hurt etc and then that was that,
problem solved. I totally empathise as you feel like there’s no end to it.

I dont have children.
But i have been around children what i know is very little but what i know i can share.
Am i not allowed to comment because i dont have children.

We had a similar experience and it turned out to be a reaction to a specific food - Quorn. So it may be worth keeping a good diary to see if there are any patterns? Once we identified the suspect food and excluded it from the diet the problem was solved - overnight. This was at the GP's suggestion.

With 99% certainty he is severely constipated, with faecal impaction.

Think of the rectum, the last part of the colon, as a stretchy squeezy hosepipe held closed by a donut at the end. It's meant to sit empty, then when some poo comes along, that's when you feel the need to go to the loo, and empty it out again. When a child is becoming constipated, not all that poo has been pushed out before the next poo comes along, so it starts to build up. As it builds up, the gut sucks more water out of it making it harder. Then the hard poo starts stretching the wall of the rectum, which stretches the muscle fibres, making them much less good at pushing poo out. There is a constant sensation of needing a poo, so the brain subconsciously (and NOT on purpose) turns off awareness of the signal of the need to poo, so they don't know when they need to go. The hard rocks of poo pressing down on the donut at the bottom of the rectum (the anus) open it up, like the head on the cervix in labour, so if they're about to desperately need a poo they can't hang on. All this time, there is still food and drink going in the top end, making more liquid poo that hasn't had all the water sucked out of it yet. This gloopy poo reaches the blockage of the old hard rocks of poo, but is still being pushed down, so leaks round the edges, and causes completely unexpected accidents.

In order to treat this there are a number of vital steps:

1. Clear out all the old rocks of poo, emptying out the rectum. This is generally best accomplished with movicol/laxido. You need to give absolutely shedloads of this until they have been pooing liquid, in vast quantities, for several days. Do not stop early just because they've started pooing. Usually need to miss a few days of school to achieve this.

2)Once the old poo is cleared out, you need to keep the rectum either empty, or only containing soft poo. This means you must not stop the movicol/laxido, but only reduce gradually, aiming for daily pain free passage of soft squidgy poo.

3)Encourage the poos to go down the toilet. Sit on the toilet for 5 minutes after every meal. Use a foot rest to get knees above hips. Encourage relaxation of the anus by blowing bubbles.

4)Encourage fruit/veg/lots of fluids in order to gradually come off the movciol

5)Behavioural. Star charts/rewards for things the child can achieve with difficulty. So don't offer rewards for clean days when he doesn't know how to do that. Rewards for cooperating with clean up. Rewards for taking the movicol. Then rewards for toilet sitting. Then for poo going down the toilet. Then work up to rewards for clean pants.

It's actually a really common problem, and not his fault, but this is eminently sortable. Oh, and lactulose is bloody useless for this. We used to use it before movicol was invented, and no one ever got better.

As an adult that was once a child that experienced this, I can bet he will feel shame no matter what you do and this could be part of not wanting to get changed. What would have helped me would be if someone had explained exactly what was happening and precisely why it was no more my fault than someone who had car sickness or hayfever! And not using the word accident either because it's not really an accident, it's literally unavoidable. I'd try sitting down with him and having a proper chat about the biology of what is happening and why and explaining why he does need to change after it's happened (germs, rashes, comfort etc) maybe you could have a silly codeword you can both use for if it happens and he needs to change and treat him more like you would a child who has just been sick e.g. oh dear are you ok etc. it's a tough journey but best of luck.

No, of course not. That’s not what I’m saying at all.

Posting supportive comments to an OP who’s clearly frazzled is far more helpful. Saying something like ‘sorry I can’t offer advice but that sounds quite stressful and I hope you can get some help from your GP etc… is much better than a post blaming the child or the parent when you don’t really know what’s going on.

Hopefully, you’ll have read some of the posts on this thread and now realise that this is actually a recognised and not uncommon medical issue and nothing to do with a child’s poor behaviour.

No it's not a boy thing.only.

Your son is probably impacted he needs the right stuff to "clear him out ".

You can't do this with diet only.

Make GP appointment ASAP.

This is pretty common in autistic children. I do think this is relevant because it will affect the kinds of strategies you try and the way you understand his behaviour

Hmm, my daughter withheld getting to the loo as the descending poo felt 'nice', then she'd have 'accidents' as she'd left it too late. But perhaps other posters are more experienced if they think it sounds like impaction.

Loads of great advice about how to clear the impaction. In terms of ongoing management once that's done, most useful stuff for us has been dried prunes/apricots every morning (my kids like them as much as sweets) and having a word with class teacher to get them to remind kiddo to drink, as gp told us not drinking enough is one of the biggest causes of constipation.

We had this pretty recently with our 4 year old. After a lot of googling, it seems like if the constipation is really bad, they sometimes can damage their muscle that helps keep the poo in/out and cannot feel the accident happening. We found that our daughter was really bad at drinking water, so along with eating well (nearly impossible with our beige loving one), the softeners and the water and a lot of coaxing to get her to get the poop out we did eventually clear it, but it is an ongoing battle that we need to keep reminding them of. We did a temporary solution of getting some very thin menstrual pads and used them until the blockage was cleared. I was at my wits end cleaning poop of underwear/binning the really bad ones. It made things a little better I think. Good luck.

The school nurse was able to refer us to the continence clinic.

Ps. It did turn out that my child was autistic. Looking back this was one early sign I didn't recognise

Incorrect, ill advised assumptions are not nice, nor are they helpful.

Poor kid. I feel for you too. Was in this position last year, dd was 7. Taking movicol daily but still messing her knickers everyday, like 3 times! Gp kept fobbing me off, keep giving the movicol.
One morning she couldn't wee, said her tummy hurt. Hadn't had a proper poo in weeks. Gp didn't give a toss. I took her to a&e. She was impacted so badly they said it's the worst they'd seen. No amount of movicol would have shifted it. She had 2 enemas and the nurses had to physically chip away at the mass that was holding everything up. Eventually she passed the biggest mountain of poo I've ever seen. Her maintenance dose of medicine wasn't enough, causing her to back up severely.
Ignore the gp, if you're worried just go to a&e. They tore strips out of me for not taking dd sooner, but you trust the gp so?