Soiling in a 6 yr old - at wit's end - please help

[HopingThisIsJustAStageBut]

DS has been soiling for 3 years, since potty training. He has never really got the hang of it, but is worse now than he was 18 months ago.

He soils daily at school at the moment. He was slightly impacted and is on Movicol at the moment (only 1 sachet a day). I think when he was younger he was so loose that he couldn't control them and this has led to trying to withhold and impaction. Sometimes I think it is a physical problem and other times I think it is emotional. Sometimes he feels he needs to go - other times he claims not to (but is fibbing a bit at the moment so I am not sure which to believe really). Today we had 8 accidents . We have tried charts (sometimes the stress of trying to achieve the treat at the end makes him worse) etc. He goes on the loo after each meal with a balloon (which is meant to help).

He had started potty training well and then a particularly bad accident set us off on this horrible trail.

There is so much more I could write here, but I don't want to bore you to death. Has anyone any success stories - please? When I have googled this I keep reading stories of boys of 16 still with this problem and it is thoroughly depressing.

I don't know I'm afraid but I wanted to bump for you!

Sounds like DD. I would say if he is soiling his pants then he is still constipated. When DD restarts the sioling I double her dose of Movicol for a week to 10 days till she clears the back log so to speak (excuse the pun).

At the moment she is on one sachet per day. So I give her two a day and that usually clears it. If you are unsure try phoning your Doc to check they are happy with this. My GP told me it was fine.

IME the dose required does vary over time.

Has he been seen by the peadiatrician at the hospital?

Hoping, I really know what you mean here...my ms has just started reception, and is nearly 5 and we have real issues with soiling and him even do a poo on the potty, at this age, never mind a toilet....He is also on Mvicol and gets bwtween 1 - 2 sachets...like your lil one, he most certainly has always had issues with bowelmovements. I really don't kow what to do, and if we can ever hope that he stops soiling himself, and I know that sounds melo dramatic...but well....it feels so ongoing, sigh!

My dd has been on Movicol for several years now. She never really potty trained. However, she is now 7yo and we rarely need to use the Movicol. The majority of the time she is okay. We just have the occassional setback.
Given my experiences with my dd, I think it's likely that your ds really doesn't know when he needs to go or when he has already soiled. My dd just didn't seem to have any sensation at all as to whether she had done anything or needed to. It really is as difficult for the child as it is for us. Keep going with the Movicol (marvellous stuff) and eventually I think your ds will be fine. I feel that our dd is almost there. But it's been a long (smelly) road and we're not quite there yet.
You might find this website of use to you.

Thanks all. TBH that Enco website is very helpful but a bit depressing . It helps to know I am not the only one.

Ds is seeing a Paed but am not convinced that she knows much more about it than I do ...

Can I ask whether all your children who suffer with this are all the same tempermentally? DS is bright and sensitive, and generally a sunny little chap but with quite a thin skin.

Sorry, let me clarify that. For those of you who think the problem may be in part behavioural, are your children sensitive in general?

DD is shy but happy if that makes sense

My ds started on movicol and laxiberal when he was 4 - he'd had chronic constipation from before starting potty training partly due to low muscle tone - his colon was stretched so much with impacted poo that he couldn't feel when he needed to go, and we were getting constant soiling from the liquid poo further up his system which was seeping past the blockage (yeuch)

Eventually we got an appointment with the paediatric nurse specialist at our local hospital's paed incontinence clinic (otherwise known as the 'poo lady' ) and she started him on treatment. First of all he had massive doses of movicol every weekend to soften everything up and the laxiberol to help his gut to spasm properly. For the first year or so we still had frequent accidents but gradually it started improving. After a year he was weaned off the laxiberol, for the next year he was on a steady dose of movicol (1 sachet a day) and for the last few months he's been on 1 sachet every 2 days. He's now 7 and is pretty much ok, he recognises the feeling both of when he needs to go and when he's constipated and crucially doesn't like the constipated feeling. He can be thown off course as it were pretty easily e.g. if he's slightly dehydrated, or has a tummy bug then we know to up the movicol for a while but mostly it's fine now - and there was a time when I thought he'd be soiling for ever.

The 'poo lady' told us it would take at least as long to fix the problem as it took to develop, so if he's been soiling for 3 years then allow 3 years or so for it to get better.

Personally I'd lay off charts/rewards etc as he's really not doing it on purpose, although I understand that it feels like that at times. I don't believe that this is behavioural at all - although being chronically constipated can have a huge impact on behaviour - ds has changed dramatically since his constipation has been cured - he's now back to being the sunny, outgoing little boy he was as a baby. Once you get the drug treatment right, it should start falling into place.

oops that was a bit long, but this is one of my hobby horses

Mimsmum - thanks so much for that, I really need these success stories to keep me going as some of the specialist sites are populated with parents of much older children, which is all pretty depressing stuff. I don't think our Paed is a specialist in this area and this is really frustrating. She has only mentioned movicol, no other medicine. What is laxiberal? how does it work? We now use the charts to encourage him to sit on the loo as he has been getting a bit fed up with the whole process and refusing to even sit on.

Juuule - I'm glad your daughter has recovered - what a great success story

Do you all find that movicol makes the problem worse if you increase dosage? We find that if we reduce it then he hasn't got the bulk to push anything out so has more accidents. But, if we increase they it is too fluid and accidents are more fluid. We kept him off school for a week last year to try and have a flush through (only couple of sachets a day though), but I am wondering if that is enough as he was still mildly empacted a few months ago.

Thanks again all.

My dd isn't fully okay, yet but we do feel that we are nearly there. As with mimsum ds, she can still get thrown a bit by some change. We have only used Movicol so don't know anything about the laxiberol. We also used the high dose initially to flush the blockage and then went on a maintenance dose of two sachets a day down to one sachet a day and then half. Now she has none unless we hit one of the hiccups and then we have to start with one a day again to get things moving.

Laxiberal is a liquid medicine which makes the gut contract more efficiently - basically if you remember your school biology the gut has to spasm in order to push the poo along and out, but in some children with chronic constipation, the muscles have been stretched so much they've temporarily lost their elasticity so children don't get the message from their bodies that their rectum is full and therefore need to go to the loo. Laxiberal just makes the process more efficient and in conjunction with the movicol softening everything up it did the trick for my ds.

Obviously I'm no expert, but it sounds to me like your ds is still bunged up.

As well as the medication, we were told to completely take any pressure off him - so if he soiled, just to clean it up without making any negative comment, and no star charts. The thing about star charts is that the behaviour has to be within the child's control, as basically what you're saying with charts is "I know you can do this, but at the moment you're not motivated enough, but here's some motivation - now perform!". But if it's not physically possible yet for the child to comply then the chart's not going to act as motivation but increase the pressure. For example, if I asked my ds to run 100m in less than 10 seconds it wouldn't make any difference how big a reward I offered him, he still couldn't do it no matter how hard he tried ... Am I making sense here?

Can you ask your paed if there's a specialist clinic in your area?

Thanks Mimsmum. I think I've confused you re what we are doing with the charts - we are not giving stars for performing on the loo, we are giving them for literally just attempting to sit there after a meal. He doesn't have to do anything once he is on. The Dr is still recommending them, but like you I think it is cruel to reward for a behaviour they have no control over.

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Apologies for bump. Reallllly need to know I am not alone in this.

Not sure if this will comfort you at all. It is meant to . DS#1 is 10 and until about 18m ago he was still doing this regularly in phases and nothing but nothing we said or did made a difference. DH thought he was just lazy and I was all for taking him to see the GP in case there was some underlying problem. It was horrible - I worried that some of his friends would smell it and tease him but that didn't seem to happen. When he was younger we tried star charts and the whole business but it didn't help. He has got over it on his own and almost without us realising, he is now 100% clean (well perhaps 99.9%).

As to "DS is bright and sensitive, and generally a sunny little chap but with quite a thin skin". But thankfully his skin is thickening a little - at least he doesn't get upset by things quite so much now.

no you're not alone - my 5 yr -ds1 does this to an extent, but for entirely different reasons - he has aspergers syndrome and it's all anxiety based - he won't go any where but his own toilet and because he has loose bowels this often leads to soiling when we're out - on the way home last week because he'd held it in all day at school, he wees everywhere but the toilet and he broke the porta potty that was meant to be for his younger siblings!
i agree with getting rid of reward charts but i do do big big praise for small improvements about fear of the loo - we got ovet a refusal to sit on our loo by doing small steps - pooing in nappy whilst standing near then sitting on loo with lid down and i'm all for offering chocolate buttons in return for sitting on it.
i think the others on here sound more helpful with your ds's issue, but re the paed i find constant phone calls saying you can't cope and the school can't either means the paed will look for more experts/ advise for the problem.

We are also having the same problem - ds is 7 and like OrmIran's ds, nothing seems to make any difference. He doesn't seem to be constipated or anything - when he does go, it is "normal". The problem seems to be that he gets too involved in waht he is doing and ignores the "cues". Really frustrating.

The probelm actually started when he was 5 and at school (he had toilet trained at 3) - and then spread home and although we seemed to have got on top of it at school (who were great), the problem seems, if anything to have got worse at home.

The other problem is that he has the wrold's stinkiest poos, so if he does have a "mistake", we know immediately - even though he will swear blind that he hasn't and we have amjor screaming match to get him to the loo!

Not really much help - but at least it lets you know you are not alone!

In terms of temperament ds is "is bright and sensitive, and generally a sunny little chap but with quite a thin skin". He fortunately also appears to be quite a polular wee boy, so he hasn't had too much teasing (apart from a short incidence of bullying a few months ago, which was stamped on my the school once we brought it to their attention)

My DS suffered really bad constipation from age 2. She had to have several changes of pants a day because she was in continuous overflow. It was so bad we seriously considered delaying school entry. I never thought I'd be able to say this (and I'm touching wood as I do) but she is now 8 and is fine. I do appreciate how awful it is for you. DS was hospitalised 3x 'cos of blockage and the encropesis clinic wouldn't take her because she was so bad. Two things really helped. First weekly visits to a homeopath. All the prescribed laxatives from doctors had no effect. Altho I'm not convinced the homeopathic remedies had either it felt we were doing something. It is difficult to overestimate the stress to the whole family when a child soils; picking them up from school or a party is a real worry in case they have soiled.This stress is likely to make the problem worse. The homeopath helped with that stress.
Secondly, the hospital consultant in desperation suggested she have her tonsils out. This was strange as DS had never suffered with them. However she'd never eaten very much and her appetite was suppressed by her constipation. She was 5.9 when she had her tonsils out and she began eating for Britain. That was the beginning of recovery. A stretched bowel takes 12 months plus to return to normal size but by 7 she was fine. Your DS will be fine eventually too because you are seeking ways to deal with his problem. I felt at the end I knew more about encropesis than the docs. Sorry this post is long but I really wanted to say you will get there.

My DD went through this till she was about 6.
She also was never dry at night till this year (after attending clinic). The root of her problems has been - quite simply - not drinking enough.

The other thing that helped greatly with the soiling was that by 6 she was old enough and I was finally wise enough to realise it was her problem and up to her to take charge of. I don't mean washing her owb knickers - I mean me stopping getting uptight and control freaky about it (which I hated but bet loads of you know what I mean). It is both a physical and emotional problem and the latter not always just the child's.

Anyhow, we are now a success story - hang in there.

I sympathise with you. My ds was potty trained sucessfuily at 2.5, then when he started reception last year he started wetting, then soiling. WE had about 5 months of him not pooing in the toilet ever. He would ignore the signs, he would pretend he hadn't pooed when it was ovbious he had. His poos seemed normal, no constipation, no nothing. The GP was not overly concerned, but it drove me to distraction. We tried everything, getting cross, reward charts, ignoring it, making him clean up etc etc.

And somehow, a few months later it has solved itself

I don't know what happenned, but suddennly, he now goes to the loo. So although I don't know what we did right, just wanted to say there is light at teh end of the tunnel.

And yes, my ds is happy, sunny, very confident and very thick skinned.

hoping - this is something we tried. I don't know if you think your DS is too young or doesn't yet get pocket money, but we did find a way to get him to take responsibility for this in the end. It wasn't a punishment just an acceptance of reality. The soiled pants couldn't go straight in the machine and DH and I got sick of scrubbing sh*tty pants day in day out. So we told him that whenever it happened the pants would go straight in the bin and when he ran out of clean ones, he would have to pay for more with his pocket money. Sounds harsh but he just didn't seem to care about it and this made him do so.

BTW thinking about when it all started. He'd been trained successfully for about a year - he'd been clean before he was dry. Then he had a tummy bug and had loads of accidents - and it started from there.

OrmIrian - thank you. Good to hear a success story. Not sure I am up to the 'charging' for pants though because as he has been constipated then he really can't help it, plus the stress of that may make him worse.

DrNortherner - great news

EmsMum - I know what you mean. It's hard not to get control-freaky about it when he messes about rather than wanting to go on the loo after breakfast, when I know that failure to do so will almost certainly result in an accident at school. We have started giving him more freedom about how long he stays on though (DS's idea) which I think will help him feel in control. If only I could do them for him!! I don't even mind him having accidents at school anymore - so long as he doesn't end up being teased, friendless or bullied.

JBabe - good point about the fluid intake. He's not too bad on the eating and drinking front, but I will definitely try and encourage him to drink a bit more.

Prettybird - yes it does help to know I am not alone! It's an isolating problem to have. Good luck to you too!

Luckylady74 - thanks - I will start to get a bit tougher with the paed I think. I think back with anger to all the times the HV said 'oh he will grow out of it'

this resource is very good www.eric.org.uk/ and might be helpful