ANyone else have a child who suffers from Encopresis or Soiling their underpants. Advice needed please?

[drosophila]

DS has a little problem in this department. He is 6 and every so often will go through a period of soiling his underpants. We used a star chart with a lot of success but it was a slow result and blow me he starts again having been clean for about a year. Anyway went to Doc and we have referral tomorrow but it is with a Gastro Doc. I am convinced the problem is deeply psychological and wondered if anyone knew what type of expert I should ask for a referral to. Is it simply a child psychologist?
Thanks

both my kids have had this - in the case of ds it started in the run-up to school and the GP prescribed lactulose - this did the trick as we sat him on the loo every night at the same time till he did the business. I think it was anxiety over poo-ing in an unfamiliar or school toilet, so he'd hold on too long and bits would leak out during the day. this then led to a sore bottom and more fear of going to the loo... I think the lactulose just regulates the flow and consistency 9sorry if too graphic!) and certainly helped establish a regular pattern. Exactly same thing happened with dd and we did exactly the same thing with her every night and it seemed to work! I think most kids need to "go" once a day and if they have a regular slot to do it they relax and feel much less anxious about accidents. DS was called all sorts of names and found it very distressing - of course the stress then added to the problem! Buy lots of cheap pants that you can treat as disposable and make time for the loo!! By the way we weaned both off the lactulose very quickly too, so it's certainly not addictive! Good luck!

we are struggling with this at the moment. Ds is nearly 6. For whatever reason (he has had lots of strong meds for severe eczema, dont know if there is a link) he had real trouble with goingto the toilet - weeing was fine but he preferred to poo in a nappy which he wore at night. we tried lots of different approaches to get him to sit on the tolet but he was so reluctant and became very constipated. Lactulose was then prescibed. Since then (a few months) he has had encopresis and at the moment his bum is leterally red raw . The lactulose keeps everything liquified (sorry, tmi) and poor ds just cant help but soil himself (3 pairs of pants binned today, I buy the cheapest ones I can). I have now stopped the lactulose as he is costantly leaking runny stuff which is making his skin so so sore. He has showered 4 or 5 times today in a bid to keep everything clean. Last week I returned to the doctor and demanded more help with a referral to the "poo clinic". You might find your local hospital has one of these, my friends dd attended and apparently there is always queue so I suppose toilet problems are really common.

We were referred to a paediatrician first of all but he turned out to be a crock of shit - just give him more lactulose, make sure he eats fruit etc etc, really bloody useful . I am determined to fight my sons corner to get him help he so badly needs.

drosophila, pls keep in touch over this if you can, I could do with soeone to chat to who can sympathise, it is bloody hard going.

drosophilia - my ds suffered with this. you can email me on [email protected]

Thanks guys. Probably won't be able to make apt today as DS is sick. He is asmathic and as luck would have it we all have a cold which as usual with him goes to his chest. WIll see how he is later so may be able to go.

A friend of mine also has a 3yo with this and was prescribed laxatives. We are really reluctant to do this as we don't believe he is constipated. He goes pretty regularily. Thing we are afraid of is accidents happening at school (so far this has not happened) as my friends child has had a few bad accidents. This recent occurance happened I'm sure cos his best friend is no longer his best friend. The last occurance happened when I was pg and there have been a number of deaths in the family which I believe haven't helped.

The star chart did work. We gave him a star every time he did a poo in toilet and two stars when he did it without promting and then the usual prize after so many stars. I would go back to this rather than laxatives I think. I want to see a psychologist as much to help us how to deal with it. I accept we need to rule anything physical out although the GP said a physical problem was unlikely as he was clean for such long periods.
DP has private health insurance with his new job (keep forgetting we have it) so if we can't get a referral maybe we will try that approach.

I'll be in touch when we actually see the specialist (maybe today). Thanks Jampots for the offer.

Buuny I have been thinking about your situation and I can't believe that they prescribed more lactulose even when it clearly was making matters worse. I could undrstand a milder laxative to start with or fybogel. I wonder if food allergies or intolerances may be a problem for you. My DS is severely allergic to a number of foods and I have wondered if there is a connection. Eczema could indicate food intolerances/allergies.

What meds is he on for the eczema?

hmmm, that is interesting, ds has numerous food allergies too - some severe enough to warrant epipens. He has had numerous steroids (was on prednisolone for a year), antihistamines and antibiotics over the years. My friend with the dd who has suffered something similar also has had severe eczema and food allergies and she is convined it was the antihistamines that started off her dds bowel/toilet problems. My gp denies a link but now you say your ds has similar allergies, I do suspect there may be some connection.

I have taken ds off lactulose now, I dont thnk the gp really knows how to treat the problem shich is suprising as it is quite a common thing.

DS had severe eczema for his first year and was on a lot of Meds. Now it's asthma that is the problem. Didn't make today's apt cos of it. I read on another website someone had a child that soiled alot and she stumbled accross actimel and gives child one a day and it was like a miracle.

Prednisolone for a year, wow the eczema must have been bad. DS has had it a few times but never for long periods.

I read somewhere too that encropis can evolve into IBS as they enter adulthood. Haven't found any good websites but if I do I will post here.

he was a walking scab . His skin is not too bad now though. I do give ds probiotic yoghurts, does that achieve the same as actimel? How do you deal with the soiling problem when he is at school? I am thinking of sending ds in with spare pants and Kandoo wipes so he can go off to the toilet and clean himself up if necessary.

Luckily it's never happened at school. This is what DP and I dread. That's why DP is so dead against the laxative route. I think the probiotic yoghurt is the same as actimel. Has your DS had many accidents at school? COme to think of it we had several wee accidents at school but so much easier to sort - Teacher just sent him to toilet.

AM I right in thinking your DS went from being constipated but not soiling to having constant runny stools (courtsey of lactulose) and soiling. And is he still soiling now even though you have stopped the laxative. If I'm right is it possible that it is not a behavioural thing but perhaps more a bowel thing that the treatment has made worse. You know something like IBS.

god I wish I knew. Gp wrote it off as a very typical cycle: consipation = pain = fear = holding in = constipation worsens etc. Hence lactulose being given. Ds didnt soil himself till he had the lactulose. His soiling has got so bad that I took him to the hospital several weeks back as he was literally screaming in pain.

I dont know if it is psychological, physical, both or whatever. Ibs hasnt been looked into but there are many food allergies and intolerances on both sies of the family (my cousins daughter has coeliac, as does dh's brothers son, dh is wheat intolerant, my brother has severe IBS. There is certainly enough familial history to warrant a further look into this possibility but how do we start?

MY DS (4) does this too. Yes the paediatricians seem to just think its constipation so we stopped the lactulose or senokot after a few weeks.

I don't know how to deal with it psycologically. We don't get cross but DS just doesn't seem to care at all am I really think he needs to understand that this is not really accepatable. So we've started getting a little bit cross but he gets really upset and then sits in his poo for ages! Stars don't seem to help as he then claims he doesn't want the star or the present anyway!

Freddiecat, we have begged, pleased, shouted, I have cried ... nothing has worked. I try to keep emotion out of it now, I am very kind nad gentle with ds and dont make an issue out if it. God, I m fed up with it though

pleaded not pleased!

My 4 1/2 year old son has had encopresis for 8 months now. I'm going nuts as it will usually be 1-2 weeks in between occurances. He has also thrown up at night 4 different times now and does not have the flu. Does anyone else have this? I assume it is the same off and on again problem. The gastroenterologist does not think the problems are related. Help!!!!

There's some really interesting narrative therapy theory on working with children who are going through this, dros. It involves recruiting children's "inner superheroes" to battle against the sneaky poo trying to trap them. Probably sounds a bit bizarre but I've heard it can work really well with many kids. To access that type of thing you might need to be referred to a psychologist or family therapist.

I think Marina has posted before about her little boy going through this at a very difficult time for their family so perhaps she might have some advice.

SOunds interesting Scrummy. Will have a look at ERIC too. I wasn't going to post this but what the heck....DS was clean for a couple of months and last weekend Dad walked into the room smelt poo and assumed he had done one in his pants. He had. Sent him up to the loo but the smell didn't go. He had only put his had down his pants sccoped out the poo and smeared on the wall which was hidden by bookcase. How do you deal with that. He has hidden pants before but this was unbelievable.

This is the kind of thing I need help with. How do you explain to a child that Poo is dirty and shouldn't be smeared on walls (health hazard) but at the same time not make a big deal ablut it.

My 6yo is on Movicol and has been for the last 18+ months. Her problem was a blockage higher up in her bowel from constipation at some time. Apparantly it distorts the bowel so that it doesn't behave how it should. The treatment was high doses of Movicol to move the blockage and a maintenance dose thereafter until her bowel rights itself and normal service is resumed - however long that may take. She is much better now and mostly doesn't soil but does have occasional setbacks.

My 5 year old is the same as your dc juuule.

She has had the getting it all out stage and we are now establishing a 'maintenance' dose of Movical. It is the first time ever that she has pooed in the toilet.

We got referred by GP to see the paediatrician, who was lovely.

so glad to hear others have gone through this and finally reached some success. I will look at the ERIC site right now. We did see a paed but he was useless - saw him twice in 6 months and his advice didnt change - sit on toilet after meals, have movical/lactulose, eat lots of fruit! Didnt need a paed to tell me all that! I am waiting for a referral to a special clinic now.

Off to ERIC

so glad to hear others have gone through this and finally reached some success. I will look at the ERIC site right now. We did see a paed but he was useless - saw him twice in 6 months and his advice didnt change - sit on toilet after meals, have movical/lactulose, eat lots of fruit! Didnt need a paed to tell me all that! I am waiting for a referral to a special clinic now.

Off to ERIC

also I looked at a site callled
something like www.childhoodconstipation.co.uk

Bunny3 - sorry to hear that the Movicol hasn't done the trick for your dc. I don't have anything to suggest but hope you find something that works soon.
Cece - hope your dc is happier now. It was a relief in a way for us to find out what was wrong and that our dd couldn't help it. We had gone through the options of - was she just being naughty? did she need more attention? was it psychological? We just didn't know what to do for the best and the soiling and changing up to 6 or more times a day was depressing. She was upset and we were upset. So although things aren't right yet, they are sooooo much better. She tends to need the dose upping if for example the weather has been hot and she hasn't had enough to drink. Or like just recently, she had chickenpox and wouldn't drink the movicol as it made her feel sick, so we've had a few 'accidents' again while we settle the dose. But the 'accidents' are nothing on the scale of pre-movicol.
Hope things settle quickly for you.

CAT64 i find your post very reassuring. You start to think your child has started a dirty protest or something.