Soiling of pants by 6yo ds with ASD - is there anything I can do?

[TuttiFrutti]

My ds is 6 and has a diagnosis of ASD - quite mild really, most people meeting him for the first time wouldn't know. However, one of his issues is lack of bowel control and about 3 or 4 times a week, he poos in his pants - not the whole poo, just the beginning of it IYSWIM. Sorry, it is disgusting really but there's no other way to say it.

So my question is, is there anything at all I can do about this? I don't think it is deliberate attention-seeking, because he seems quite embarrassed about it and often tries to hide the dirty pants "because I didn't want you to be cross with me". I try really hard NOT to be cross, but I do find it difficult sometimes not to show how horrinble I find it. A couple of times he has smeared poo on his bedroom wall and I find this especially hard not to get cross about.

Would a change of diet help? He is quite a good eater and I think our diet generally is fairly healthy.

It's never happened at school. In fact he says he has never done a poo at school at all. His body clock seems to be to do a poo at about 5-6pm, which is when we usually get dirty pants. Could this be because he is tired at this time of day?

I haven't been to see our GP because I'm not sure there is anything medically wrong, apart from the ASD and lack of muscle control.

Has anyone else been through this?

Could he be constipated?

Sometimes the softer stuff can leak out around the harder stuff and make a mess. Mine both take lactulose to help with this and it made a big difference.

i have had this and its been checked out that its not physical at all its apparently quite common in asd to be very late getting the feelings so as to know you need a toilet untill too late my sons finally out of it now after many years of worry trying to change diet use different underware pull ups different tactics and praise and treats and whatever i tryed nothing worked he finally stopped "marking" his pants as i call it about a year ago (hes just turned 11) it will happen i think when its time he will grow out of it but i completely understand how you feel in the end i just uded to buy 3 packs of underware a week in asda cheap ones rather than struggle washing them as it is disgusting and upsetting i tried medicines as he did get constipated too and then sometimes his stools would be incredibly loose and it would leak everywhere , try anything is all i can suggest as you never know what might work but in the end he will stop eventually so try and take it easy and be forgiving VERY forgiving

forgot to add i had the peadiatric nurse to see him many times too and all they suggested was all the obvious stuff id already tried but even though he doesnt mark anymore he has an exact time of an evening he poos (just before bed) and weve three loos in the house he will only use the blue loo for some reason never when out or at school or any other loo at families houses he always waits till bedtime and does it then HTH

i think all you can do is just keep buying new pants. i have to do this with my DD(7) sometimes its just easier to throw the pants in the bin than try and wash them :(

My 10 year old dd has adhd tendencies and soils. We have tried star charts etc.
She is getting better but still not perfect.
If you know it is going to be the same time each day, could he go and sit on the toilet he likes before and read a book or blow bubbles, we were told this is good ! And hopefully he will manage to do all his poo in the toilet.
Unfortunatly my 3 year old dd is going down the same road as her sister :(

totally janet its horrible trying to wash them so cheap to buy may as well add it into yr weekly shop , it will stop eventually

is he not as tuned into the sensation of needing a poo because he spends all day at school witholding, so as not to go there? (does he have issues with "strange" loos in general, or just at school?

have you tried setting a timer for him to go - eg if his "natural" poo time is 5-6pm, you coudl set a timer for 4.50pm, and ask him to go to the toilet then? hopefully he might be abe to relax, and avoid the urgent rush?

is it definitely the beginning of apoo, rahte rthan not wiping properly?

agree there might be constipation issues, or a lack of being able ot tell the differnence betweena poo he can hold on to (as he may be doign at school) and one he needs to go to the toilet for now

smileandwave - its so much better to throw them than to have to pick them out the wash bin too. its not a nice sight having stained nix on the line either

We have this too. It is gradually getting better -- now we have pebbles (his name) maybe a couple of times a week whereas it used to be full pants every day. Ours was after school too.

All the advice we were given suggested we should eliminate the possibility of constipation first, so he encouraged him to drink a lot and he was on lactulose for quite a while. The problem is with lactulose that if he is not actually constipated you just end up with a mess.

It's a good idea to try and get him to tolerate sitting on the toilet for a while to let it come out (good luck with that -- we had only limited success) and to do things like rocking back and forward, raspberry blowing competitions, blowing bubbles so he begins to learn what the sensation of pushing feels like.
But these things may well not sort the problem out -- they are not a magic solution.

For us the only thing that has worked has been time. As he is getting older he is slowly tuning into the signals from his own body for instance learning to tell, as Silverfrog says, when he can wait and when he has to go now. He is also slowly developing social awareness of toileting issues -- 'disgusting' is a word he has found it very hard to understand.

We try as far as possible to make no comment if he soils (no matter how bad it is I try simply to think of it in the same way as I thought about changing nappies when they were younger). We simply clean up and fetch clean clothes (mostly throwing away the old pants we treat them as disposable.)

But we have done social stories about toileting. It's important to do them at another time when everyone is calm and happy, and to impart information in a very neutral 'here are some facts you might find interesting' kind of way. Be prepared to go through it time after time.

Over time, as I say, DS1's toileting has improved, and so has his willingness and ability to clean up after himself (though I do always check what he's put in the washing basket in case there are any, erm, surprises in there). Hang on in there!

This has always been a problem for my DS2, ever since potty training. In the early days I did it all wrong, he wasn't DX and I couldn't understand it. Roll on 9 years and he still 'starts' and only goes to the toilet at set times. I'm completely calm, never tell him off, he gets his own clean pants, now. He's not constipated, it's not overflow, he just doesn't have the feeling that he needs to go as he's hypo-sensitive. Any sort of rewards etc, haven't worked and I've really tried. He can't help it, so he could never gain the reward. The best solution has been having a warm drink, 20 mins after tea, then sitting him on the toilet with a book or Ipod. Got through lots of pants!

It's much better now, he manages it by himself, but it's far from perfect.

Thanks for all your replies. I don't think he is constipated, because when he does do a poo there is no straining and it all seems a bit on the loose side. I might try giving him lots of fibre one day as an experiment, but will have to wait till I am feeling very strong!

It's reassuring to know it will probably get better with time. He has got better actually, we used to have poo in pants every day and now it's more like every other day, but still that's bad enough isn't it?

It's a good idea niminypiminy about the social stories. I might try writing one about poo in pants. Before I had children, I never would have thought I'd have to write that sentence!

smileandwave, sounds like you have been through exactly the same - thanks for your reassurance that it will get better eventually.

*silverfrog", I think it is the beginning of a poo usually rather than not wiping properly, because usually it's when he rushes to the toilet that we find the dirty pants. It looks like he is just getting the feeling too late. He doesn't have a thing about strange loos generally, will do a wee in public loos no problem, so I don't think that's the problem, although possibly school is different - very hard to tell without being there though!

Sorry silverfrog you were meant to be in bold not in inverted commas!

If he is constipated and blocked up, TuttiFrutti (great name!) then what is coming out would be more runny, overflow, that is escaping around the blockage. I'd get it checked out at the GP as it's the easiest thing to sort out first. That would explain the lack of control, also. It's really common.

tutti, as ej says, you have the wrong idea about 'constipation'. google 'encopresis' and faecal impaction.

it's very common for the type of soiling you desribe to be caused by (undetected) impaction. really really common. definitely the first thing to check.

treatment is usually lactulose or similar and the introduction of a rigid toileting regime. ds1 sits on the toilet ten minutes after breakfast, and ten minutes after dinner. for long standing impaction it can take a long time for the soiling to stop.

OK, I didn't realise that. Can you buy lactulose over the counter?

you can, i think, but tbh you can get it on prescription and it's worth the gp checking tummy etc anyway. ds1 had x-ray to dx impaction, but he's a bit more complex i think...

i'd discuss it with the gp as an issue apart from the asd tbh - so difficult, isn't it? you don't know which is linked, and which is just a regular childhood/ medical issue... it's def worth ruling it out anyway.

you can but be best to take him to gp or even better have it checked out by the paediatrician ,lactulose helped with my dc at times but only if not used too regularly as he got used to it and in the end we had at time to resort to stronger methods and now the size he is it doesnt work as you would have to have far too many spoonfulls of it, but still it was due to non sensation causing the impaction but even when he wasnt impacted he wouldnt go no2s anywhere other than at home at a certain time (he would use any loo for a wee) so as i did its best in the first instance to check there is not a medical reason it is hopefully the sensation thing causing it which is just a case of delayed maturity

TuttiFrutti Try adapting this into a shorter social story:
www.narrativetherapylibrary.com/img/ps/spoo2.pdf

Wassup beat me to it for that link. I posted much the same several months ago. The social story (adapted slightly) really helped ds2 - especially as it helped him to understand why this was happening to him. He is a 7yo who knows pooey pants is not cool, but it seemed he could do nothing to stop it.

We went back on Lactulose and regular toileting (each evening), which before the story, he was reluctant to do, refusing to sit. The story helped his understanding as to why he should sit. It also helps ds2 to drink hot water (or tea which he likes) while he's on the throne. It seems to speed things up) He insists he needs a straw!! (It's amazing what lengths one will go to, but if it works........hey!)

It seems endless, but if the soiling stops, it really is worth the effort of keeping up the regime. It is likely to need to continue for a long time. If we forget for a few days, then the build up just starts again - he won't feel the need to 'go' for well over a week and then the soiling would start again.

The situation is definitely better than it was and 'sneaky poo' was a great way of explaining things. Ds2 takes a book, or his ds into the loo with him and when he's finished, he spells out 'D O N E'. He's not yet ready to sort himself out, so I still help him with that, but one day, that will come too, but for the moment, I'm just happy that the soiling has improved dramatically and there's no more sorting out (or chucking) minging pants!!

The stress levels are greatly reduced!

Yes we used the sneaky poo story as well and if nothing else it gives you a code to use in public though I think the best thing about it is that it makes the soiling the poo's fault not the child's.

yes nim - that had huge mental impact and it totally made sense to ds2 in his very logical mind relieving him of any blame. He had been getting upset with himself, but not understanding why he couldn't help it iyswm.

Thank you wasuup, I love the Sneaky Poo link! Have printed it out and will go through it with ds.

You have all been such a big help - I love Mumsnet!

:)

Thanks for the link ( sneakypoo) this will really appeal to ds who likes a challange! Excuse butting in!