Teen encopresis. It’s a behavioural thing.

[Drybutnotcool]

I posted in SEN chat but I’d appreciate the relational wisdom of this section.

I am losing my fucking mind with encopresis teen
He’s 13. Big strapping healthy lad, he’s at mainstream school with an EHCP for sensory processing and ASD. He’s holding his own academically but socially he’s wonky.

And he stool-withholds. He says he likes how it feels. Then he gets impacted, has overflow diarrhoea and soils himself. But he doesn’t care. He saves/hides the poo pants and says he sniffs them sometimes. I find them stashed, under cupboards and behind drawers.

He saw a cognitive psychologist who recommended essentially sitting with him until he got used to just being able to sit and void on the toilet. He can do that now, but he won’t.

Added to this, apparently he doesn’t do this at my ex husband’s house. My ex has taken delight in explaining how all of this is all my fault, there’s clearly a lot of tension in my house, etc. He is a DisneyDad extraordinaire and lets the kids do what they want, for the 2 nights per month they stay with him.

I have tried everything I can think of - and god knows I’ve read anything I can lay my hands on. We saw the paediatrician who deals with encopresis, privately and he just said “well it’s behavioural. So not my department” hence seeing the psych.

He went to his Dads for 10 days and got back yesterday and I’ve just gone into his room, and been hit by the stench. He was lying in bed watching the telly, in soiled pants on soiled sheets.

I have 2 other children, also SEN, btw and this tonight has sent me over the edge. If anyone has any wisdom please share it now. I feel like I’m losing him and yet I don’t know what to do.

I said I’d take him back to his Dads but his dad won’t have him. And of course it’s all my fault, even though he came home from there already impacted.

please help.

Oh that sounds difficult. Could you ask to speak to a continence nurse - they may have experience with this and/or have some ideas?

Do you get him to clean the mess/do the laundry?

No I haven’t, because usually the pants are beyond saving.

As someone who has been battling with this for 11 years, I can offer you no words of wisdom but solidarity and practical tips of dealing with it. In my experience continence nurses etc are hopeless and will just throw laxatives around and go on about good sitting. This is no use whatsoever when like me you have a 14 year old who will stand on your kitchen floor with liquid poo running down his legs and under his feet rather than use the loo.

Remove the stress and don't tell him off. Mine stopped hiding poo and pants when I stopped getting cross and now he has a routine of cleaning himself up and binning his pants in a black bag that I dispose of. I provide him with stack loads of wipes and Tesco do multi packs of briefs that are cheap enough to be disposable. He knows that's his routine every morning. I don't like it but I accept it and support him in being clean. Like you we've seen endless paediatricians, Neuro specialists and are playing ping pong with CAMHS as he keeps being referred and they keep bouncing him back. No-one is actually doing anything and I've gone from flagging up a three year old who wouldn't sit on a potty to the health visitor to having a 14 year old who soils himself daily and no-one in the entire NHS gives a toss. We have no private services locally so can't even go down that route.

Sorry I can't be more use but you're not on your own x

Omg @TheSnootiestFox That’s it. He has laxatives, he’s been admitted to hospital he was so impacted he was vomiting. But it’s behavioural and he won’t stop.

Does this just go on forever?

Well, I'm preparing for it to be and anything else will be a bonus! Trouble is DS wants to join the army and I can't imagine them putting up with it. I'm just doing the best I can with ensuring that he ensures he's as clean as poss and doesn't leave the evidence around like he used to. The amount of times I've picked up lumps of poo from his bedroom carpet would disgust you!

There doesn't seem to be an answer. DS is holding out for the Drs to do something and they are unwilling as they say it's down to him. So round we go in a viscous circle that's now 11 years old.......

It’s heartbreaking isn’t it? And mind bending too - why can’t he see the consequences? That’s the bit that drives me mad. The stress it causes, the disgust and despair.

Exactly. But it's his normal. DS is now at the point where he's saying he wants to sort it but doesn't know how. I genuinely don't understand why he doesn't see that all he needs to do is sit on the loo like 99.9% of the population. It really does blow my mind!

Oh god same here! He’s cried saying he’s not normal and wants to see a therapist etc. For the life of me I can’t see what approach a therapist could take!
We have tried distraction and replacement therapy but nothing feels as good as lying in his own excrement.

@TheSnootiestFox I’ve just said to my son “there’s a boy who does the same as you and he wants to join the army. What should he do?”

After some attempts at a witty answer he said “well he just needs to not do it.”

That’s as far as we get. I’ve just said to him that when he chooses this then he chooses the consequences which are me being upset and a mountain of laundry.

I genuinely have no clue where to go now - sorry I'm hopeless 😂but it's grim. My whole house smells to the point I won't allow people round, which impacts my younger DS too. I literally have no clue what else to do.....

If you do look for a therapist, try to find someone who can work from the Object Relations/Kleinian model of development. Faeces is conceptualised as hostile weaponry tied to feelings of rage and hate/suppressed love, and what the child/teen does with their own faeces is based on unconscious symbolic meaning, eg. they withold it, control it, use it for purposes of controlling their environment and reactions/behaviour of others, etc. Basically, they have a relationship with it that serves some objective buried in their early lives. The toilet can symbolise things like being devoured/falling into a void, and toilet training can evoke unresolved issues around authority and power struggles. It's all tied to some grave, early disturbance in their inner world; even how they handled or made sense of their parents' relationship/separation/divorce can be a significant factor that, as long as it's buried and unresolved, continues to influence their behaviour. The key insight is that it's about their relationship to/sense of ownership of their own 'productions' and is an emotional problem first and foremost, although the nature of the emotions changes over time in response to other developmental and circumstantial influences which entrench the behaviour. A book called The Presenting Past by Michael Jacobs has a great section on the 'anal stage' and its emotional and symbolic relevance to the young child. How that then develops into encopresis in some children is something that would be therapeutically addressed by a Kleinian/Object Relations psychotherapist.

I'm sorry @Drybutnotcool and @TheSnootiestFox , this must be incredibly difficult, upsetting and demoralising to deal with, for you and your boys.

By the way, it would be counter productive to try to share that bit of theory with your boys! The therapy would be very diluted by a premature attempt to 'see behind it' before it has a chance to 'take'.

You're a star! Finally something that makes sense - thank you x

Wow that’s heavy duty stuff isn’t it?

I’ll give ANYTHING a try. My thoughts are though that he’s very sensory driven and this is just a nice thing (his words) and he also gets lots of negative attention when he does it. And he’s desensitised.

Any ideas on how to find a therapist please, @baroqueandblue ? I've just had a quick google but it's not as easy as I'd hoped!

Have you had a look at ACE surgery?

@TheSnootiestFox you can try BACP and Counselling Directory websites for listings by postcode/nearness to you. The online site for Psychology Today magazine also has a directory for local therapists that is free to access. Key words in a broader Google search might include adolescent or child psychotherapist, object relations psychotherapy (Melanie) Klein or Kleinian school. The BACP site might have a separate directory for child/adolescent practitioners. Also take a look at this on the UKCP website:

www.psychotherapy.org.uk/seeking-therapy/therapy-for-children-and-young-people/

Yep and he’s not a candidate as it is absolutely behavioural. He’s a big strong lad who eats normally. He just won’t poo. WONT.

Thank you x I shall get on the case now!

@Drybutnotcool all stuff that a decent object relations child psychotherapist/psychoanalyst would want to unravel with him.

As above. Just will not poo on a loo!

Thankyou I’ll look there. My ex husband seems to think the NHS will sort it all, overnight and refuses to consider private treatment even though he has insurance. Tbh I don’t think they’d cover him but it’s his way of making sure I pay for the treatment.

I feel so much for those of you dealing with this, it must be extremely difficult to cope with both practically and emotionally.

Have you been in touch with ERIC (the children's bowel and bladder charity)? This sort of thing is right up their street:

www.eric.org.uk/blog/what-is-encopresis

Unfortunately toileting issues seem to be one of those things that it's a real struggle to get help with unless you happen to come across a HCP with a particular interest in it (I don't believe the average GP would have any specialist training in or education around encopresis, for example) and so the gap is filled by the third sector - which often does it brilliantly (they'll have all of the experience and specialist knowledge) albeit you do have to navigate and figure out how to access provision independently.

I understand they currently have a high volume of enquiries so there is a wait list of a month or so but you can contact them via their online form or email or telephone to get on their radar and they will get back to you as soon as they can. I would also really recommend having a look around their website which has loads of stuff on it, case studies etc.

Best of luck.

Thank you anyway but this was several years ago for us. Again, take Movicol, sit with your feet on a stool, eat plenty of veg yada yada.

No mention what to do if your child won't actually use a loo to begin with!

I have no idea if this is up her street, but you could try and contact Charmaine Champ. She's on Facebook and Google her and her website pops up. She respond really quickly on Facebook.