DS 9 soiling: Behavioural?

[ForMellowGreyOrca]

I originally posted this in child’s health but didn’t get any responses so have posted here as well.

Oldest dc who will be ten next week is having soiling problems. He was slow with potty training (he still isn’t dry at night as well) and always had the odd accident since his younger years where he would get caught up in his activity and leave it too late but nothing out off the ordinary so I assumed he would grow out of it. However around a year ago it started to happen a lot more frequently when now it’s happening multiple times a week at home school, and out and about where he soiled himself at the cinema a few days ago, despite him being adamant he didn’t need to go before.
I spoke with Eric on the helpline a while ago, who explained it was caused by constipation leading to an overflow and to see a GP which we did. GP seemed sure he was constipated and prescribed him Movicol, which we used for a few months and increased the strength but did absolutely nothing! He’s since had blood tests and X-rays all of which have been inconclusive to a cause, where we are directed from referral to referral without any results.
I really am fed up with it and sick to death with the laundry as it isn’t just little smears or ‘skid marks’, but it’s often full on accidents. I am constantly finding dirty underwear hidden around his room and sometimes after even after it’s very clear it’s happened from the smell he will deny it getting very defensive, until I force him to go the bathroom to change. I never imagined having to deal with this at his age especially when dd (5) is completely clean and dry at night as well. My sister mentioned to me it could be behaviourally linked which I wasn’t sure about, but really am unsure on next steps to take.
If anyone has experienced anything similar or hase any advice it would be a bloody godsend.

Book to read in the loo is better than a gameboy. Wimpy Kid is good. Comic books.

Why are you wiping his bum for him?

Make him wipe it, pick up his pants, put them in the wash, Wipe the floor

IF it is laziness, it will stop, because the cleaning up thing takes longer than actually going to the toilet
…….

How long does he spend gaming?

He may need sodium picosulfate as well as movicol.

Can he have an audiobook or something while on the loo? Also, a toilet stool and some bubbles or balloons to blow up.

Sounds like his playstation is quite a big part of his problem.

I can assure you I’m not ignoring them and I am fully aware of the issue with constipation but was talking about how ds sometimes has a lazy attuitide towards fixing the issue, often not telling me it’s happened and carrying on with his activity.

I wouldn’t be so quick to dismiss autism. Soiling is more common in autistic children as they may have a poor sense of interoception which is how we recognise our internal senses. That might include soiling or wetting yourself because you can’t feel that you need it, not knowing if you’re hungry or thirsty, being unable to tell what your emotions are. You say that he wants to keep playing his video game. It could be that he struggles with transitions from one task to another.

One of my dc used to have accidents, once in about year 5 and we did go to the doctor about constipation a few times. She also needed to wear a night nappy til quite a late age and couldn’t go on sleepovers. She grew out of it but did get diagnosed with autism.

I should have clarified that DS will normally clean himself at home as I know he can shower after. if he has an accident when we are out I will always wipe him to be sure he’s clean, having learnt from previous experiences! I have cut down his gaming hours significantly especially now it’s half term and he will inevitably spend all day on it if he could.

Does he seem embarrassed at all?

Have you tried a step at the toilet so his legs are raised higher when he goes to the loo so he can open his bowels? Look up “squatty potty”.

Some people find it hard to poo sat on a loo - our bowels are designed to open properly when we squat rather than sit upright.

A previous poster mentioned salicylates and constipation. Have a look through this website for information. https://www.fedup.com.au/

Probably because he doesn't realise it's happened, it leaks out.

For what it's worth I don't think helping him clean up when you are out is any bad thing, but he's getting a bit old to be taken into the toilets with you, he needs to be doing it himself.

My DD is 9 and it has been a long hard road with constipation and soiling too. She has been on movicol practically since birth (was one) and it has really helped us being under the care of bladder and bowel service.

I have a teen DD who was dry at age 2, so it has been really hard so I do understand. In my experience Chronic constipation is complicated- and can cause real anxiety about even going to toilet for them.

He may soil himself not long after sitting on the toilet because maybe sitting on loo causes him anxiety, so it sort of comes out when he is relaxed again? Children can't express themselves in the same way and he may not understand himself. We got a wee alarm for night and dd is in week 9 and doing brilliantly and finally out of pull ups at night.

It does go hand in hand though with the constipation.

Patience, never getting angry at your child is so important to be able to have conversations about it. As she got older my darling dd would cry and say sorry, she hated it. But as another poster said stacks of pants, movicol, and total patience. It's so hard for them. Also my dd still needs help wiping even if we have it under control as movicol poo can be messy!

Get a referral to bladder and bowel if you can, they literally spent hours on the phone with me listening to me cry!

Hugs hugs to you, you are welcome to PM me if you like xx

Also we used to ask DD after an accident if she felt it coming. This helped us understand. Sometimes she would sit down for a poo and there would be some soiling and she would be surprised as hadn't felt it.

Also urge to poo can come on very fast and she might not quite make it.

We found talking lots about it with her, and having more and more conversations around it (as a medical issue) has helped. She is slowly learning how to manage it herself.

It has been a long, hard road and it can feel so isolating as people don't talk about it much, we all assume children are dry at night with no issues which leads to all the embarrassment. Xx

He is always honest that he feels the mess in his underwear and knows he’s had an accident. Ideally he would be wiping himself but sometimes it just really isn’t feasible if it’s a bad accident, or he has spent a while in dirty underwear.

Yes that makes a lot of sense! I don’t think he feels comfortable on the loo so am working on trying to help him feel relaxed as you say. A few people have mentioned using a stool to raise his feet which I will definitely try.

Haven’t even thought about his nighttime issues for a while now as trying to deal with daytime accidents is bad enough! He still soaks a a nappy every night and we recently had to change from drynites to tena slips, as the drynites kept leaking. He was prescribed desmopressin last year, which didn’t help at all. I haven’t used alarms with him yet so that will probably be the next thing we try but for now he is already a bit stressed about his soiling so don’t think it would be good to to put more pressure on trying to get him dry at night.
Don’t evenget me started on the movicol accidents! First few weeks he was on it was like having a toddler in the house. It felt like I spent more time wiping his messy bottom then I spent doing anything else!!

Ik how bad he feels about it so am being fully supportive and patience with him even through the hard times. Have stacked up on cheap pants, and come across underwear pads if anyone has any experience with them? Think they could be useful in helping him change at school and saving laundry.
GP has put a referral in for the child’s continence service so waiting to proceed with that. Thanks so much for the support x

I always ask him he felt it and bless him he is always honest and says he could feel it happening but couldn’t get to bathroom in time or forgot to go the toilet so couldn’t control it coming out. As you say with your DD sometimes the urge for him comes on very quickly making it stressful to get to the bathroom and sometimes he would prefer to try to hold it in resulting in an accident.

Sorry you’re both going through this. A distant relative who is very emotionally distressed due to a very dysfunctional family situation has this so could be emotional. Another closer relative had chronic constipation and used to leak/had no sensation so the short answer is it could be caused by a whole host of things. You need to push the GP for more help/referral to bowel specialist. Good luck.

This is the result of years of withholding. You are not the first parent not to realise how to use movicol or realise how much chronic constipation affects the bladder an bowel.
He needs to be completely disimpacted and it will take months and years for hi bowel to shrink and for him to get the feeling back.
If it any reassurance you are not alone.

Your poor boy.

You've had some good advice on here and I don't have much to add other than to say that it really doesn't sound behavioural to me. Particularly the fact he's trying to hide it.

Hopefully it can be resolved with movical or similar.

Good luck.

@ForMellowGreyOrca just to say, my DS had chronic constipation that was identified age 5 (but looking back, there were signs of it age 2). He initially went onto Movicol, but it didn't really work for him for maintenance (only for disimpaction) - he got moved onto sodium docusate, which worked really well for him. Age 12, he is now off his medication entirely. He has autism and therefore issues with interoception.

The movicol accidents are the movicol working. It's hell on a stick but you need to persevere with getting the impaction clear things have absolutely no chance of getting better until you do.

We had a brilliant poo consultant and continence nurse both of whom we saw for years. So a referral into those services will help you and your DS get specialist help.

Forget the nighttime wetting for now, we had medication for that too - didn't work at all, because the bowel issues weren't sorted.

You are absolutely not alone. I'm out the other side but in the eye of the storm thought we'd never get to where we are now. You'll get there.

He needs to keep taking movicol, every single day. Prune juice or tinned prunes might be good?
He's not doing it on purpose as he's really chronically embarrassed about it.

Thanks everyone for the guidance and support. We are persevering with the movicol and had a good chat with him about how important sitting on the toilet is to help him and we’ve established a routine which he’s been good at sticking to so far.
I have put him back in pull ups during the day as it’s just overall easier for both us, especially if he has an accident at school. I did explain to him that it was not a punishment but was to help him which he didn’t initially take well but eventually agreed to try it for a week, after a lot of convincing. Once again a big thanks!