Toilet trouble! Is it possible that he just doesn't know?

[GraciousWhatDidIDo]

DS is now 11 and will go days without having a poo. He has surpassed himself this time in that last night was the first time since before the 23rd. In that time he has had a Christmas dinner on Christmas eve, another on Christmas day, another on the 27th and curry on the 28th. He eats all veg including loads of sprouts which he loves (odd child!). He obviously has had other meals, snacks and plenty to drink including orange and apple juice. He has gone that long in the past I just can't work out how he managed it with all that intake!

When he does leave it for a long time he blocks the toilet and is embarrassed to have to call for help. I have spoken to him and explained that he needs to go more regularly. I have asked if he holds it in and whether it is painful when he does go. I explained that if he was more regular then it doesn't hurt so he wouldn't need to hold it in. He says that he doesn't feel the need to go and that it doesn't hurt. He does however complain of feeling sick, gets reflux and heartburn.

As chief toilet unblocker I can confirm that it is fairly normal looking (apart from the fact there is loads), not dry, hard pellets.

When he was younger he would have accidents until the age of around 6/7 and claim that he had no idea that it was about to happen. He was diagnosed with IBS (which basically means the dr has no idea why he gets the symptoms he does) and was given medication for the reflux which we have since stopped as we had a better response by controlling his diet. There are no food groups completely cut out of his diet but some groups are limited, e.g. he doesn't have milk but has small quantities of yogurt and cheese. These changes helped enormously.

The thing I really want to know is if it is possible that he doesn't have feeling in the lower part of his digestive system and is only aware that he needs to poo once it starts to affect him further up iyswim.

TIA

I don't know Gracious, but I have a 9 year old DS (nearly 10) who still has toilet accidents (of both kinds) and claims he has no idea he even needed the loo. Like you I wonder if it's possible he genuinely doesn't have feeling. What is your DS like as a person? Mine has no official diagnosis but I strongly suspect ADD as he finds it very difficult to concentrate but can get utterly engrossed in other things. He hasn't had any issues with holding on instead of going to the loo, though. He is pretty regular, it's just he can't always tell when it's coming... Another thing, DS has a noticeably high pain threshold. Accidents and injuries that would reduce other children to howling wrecks, he barely flinches at. I do wonder if it's all somehow connected.

That's interesting Biscuits. Mine is a very anxious child (has been to cahms and has an IEP because of it) and also has a visual processing disorder. I don't think he has a particularly high pain threshold unlike your DS.

My DS (6) claims to have no idea that he needs poo and has regular accidents (all the time at the moment) and like your child Biscuits he seems to have a weirdly high pain threshold, which is fortunate as he is pretty accident prone.

OP, do you think your DS would cooperate with regular sitting on the toilet for 10mins or so with a book/magazine etc (e.g. every morning after breakfast) as it might eventually help a better bowel habit? Also I think it is a bit harder for boys as they generally stand up to wee, so possibly less opportunity to pass a motion, iyswim?

re: Biscuitsneeded

I came across this post by accident and I noticed your comments on you suspect ADD - just wondered have you also heard of Asperger's (or as some are now calling it High Functioning Autism). Asperger's can share some similarities to ADD (and some people with Asperger's can also have ADD - I have Asperger's and ADD - when I was younger I used to have Asperger's and ADHD however most of the time now I've grow out of the Hyperactive side - although if I have too much coke it can sometimes still come through).

The reason I mentioned about Asperger's was when you said about the high pain threshold - this is also very common with Asperger's. Asperger's affects many of the senses - some senses can be overloaded and some not receive enough attention, and actually some people with Asperger's find if they close their eyes and actually listen they can hear better because they've shut down one of their senses and in some cases what is actually happening is the "vision" sense is actually going through the hearing sense because there is just too much for it to cope with.

The same is the case with the pain sense - in some people with Asperger's the pain threshold can be really high, and even a hug can send them into a lot of pain, where as in other people they could cut off their ear and not even notice how painful it is (it is thought actually that Leonardo Da Vinci possible had Asperger's and that is why he was actually able to cut off his own ear!) and this can also differ some people with Asperger's might not feel any pain if they have a massive gash in their leg, but someone goes to hug them to make it better and they might feel intense pain just from the hug.

Also with Asperger's (and many other ASDs) there can sometimes be various toiletry issues - this is also down to the sensory issues with the Aspergers. I have urinary incontinence myself because I just can't tell until the last minute when I need to go (I assume it's some part of the sensory issue with the Aspergers) - my incontinence nurse classes it as urge incontinence, I use incontinence pads in the day and drynites at night as drynites seem to absorb more than the incontinence pads. I have helped once with some severely autistic people and some of them had sensory issues which had double incontinence and in some cases you had to watch them because they would actually do faecal smearing which was apparently part of their sensory issues.

Autistic spectrum disorders can affect the senses in many different ways, people with ASDs can be over sensitive to certain senses, and then under sensitive to other senses and it can be different in each person.

One thing though is that if it is an ASD it can be quite a struggle to get it diagnosed - many people aren't diagnosed with it until they're in their early 20's by which time the person with the ASD has already developed many "coping strategies" which can cause them to struggle, but the sooner diagnosis happens the better it is. I went to school, college and university before being diagnosed and ended up failing a degree due to the struggles I had and not being diagnosed in time (at school I was told I had ADHD and that I'd grow out of it - which actually is very old information - the hyperactive side disappears over time but the ADD still remains) - it wasn't till I got to 21 that I was diagnosed by a friend in the scouts and then it took me till I was 24 to be officially diagnosed - thankfully at that point the friend in the scouts had got me onto the Gold Duke of Edinburgh's Award which taught me a number of important skills that I'd actually missed out on like working in a group, communication, etc.

I hope this information helps.

Thank you The KLF for your long and thoughtful post. I have heard of Aspergers and indeed taught several children with an Aspergers diagnosis. DS doesn't really seem to be like them, though. I understand that it will manifest differently in each individual but he is a very sociable and demonstrative child who makes friends easily. I recently spoke on the phone to the GP about the toilet issues and other problems relating to extreme distractibility and he is writing to DS's school (again) for more info. We had previously seen a paediatrician a couple of years ago who said that if anything we would be looking at ADD, but DS had been very calm and focused in the session with her so it was difficult for her to see anything much to comment on. And I suppose a 7 year old having occasional toilet accidents is reasonably normal, but a nearly 10 year old really isn't. He also still puts T shirts on back-to-front or inside out, shoes on the wrong feet, can write with either hand, walked very late etc - all of which led me to consider dyspraxia, but actually he is now a very strong and robust child who climbs about like a monkey so I don't think he can really be that either. He's a mystery! The high pain threshold thing is interesting though, and it's true that DS always says he can't get on with any work at school because of the 29 other children in the room making noise - although he's perfectly happy with noisy music, live theatre etc so I don't think he has a true sensory overload issue. Thank you for your post - I will mention Aspergers again even if it's just something to rule out.