Encoparesis and Smearing

[LittleCoffeePot]

Posting for any kind of help or advice. My DS is 4, diagnosed ASD, no communication, very little understanding and has recently started withholding poo and smearing and I have no idea how to deal with it.

We've been making limited progress with potty training lately and his last full poo was 6 days ago in the potty and was absolutely huge. He passed this with no problem or upset but since then it's all gone wrong. Clearly resisting the urge, body posturing like he's holding it and he permanently has a smudge in his nappy which has made him sore. Constant nappy changes and wiping don't help either. Pretty much as soon as he's changed there's more in there again.

Today has been a low point. I'm not sure if it's because he's sore but now as soon as his nappy's off he grabs at the area, ends up with poo on his hands, gets upset and then suddenly it's everywhere. He's very big and strong and it's impossible to stop it as it happens so quickly.

Today he's smeared even when I'm not changing him, just got his hands inside his nappy from the side while wearing shorts and it was everywhere. Even after trying to wipe him he smells of poo and needs to be showered which he hates and leads to a meltdown. Showering him is dangerous because he jumps and screams and fights and it's awful. The bath is the same. I think now he's starting to associate pooing with showering which I'm worried is going to make the withholding worse.

I've ordered some M&S special needs undertops to arrive tomorrow and am going to put him only in trousers from now on but I don't know how else to address this. Paediatrician advised he is too young to be referred to the continence service. I've read some helpful information on ERIC but I feel like we're now in a cycle I don't know how to break.

I don't know if it's a one-step-forwards-two-steps-back situation but it seems it's coincided with the school holidays and his transition to school which is even more worrying if this continues into September. He's also started refusing some previously safe foods and eats too much bread which I know definitely isn't helping.

Apologies for the long post, just venting after a long day and desperately looking for some advice and light at the end of the tunnel.

Hi, I have an 8 year old with ASD who was chronically constipated until end of year 2, smearing and everything exactly like you've described. He was on laxatives for years, had laxative courses multiple times from doctors. They just made it worse it was runny and horrible made school a nightmare as he was in nappys until end of year 2. He now has the Peppa pig pro tummy probiotic gummies. Been having them probably about a year and he is fine now . They are age 3-7. Probably worth reading up on and maybe asking GP about if you're unsure. I just order them online. In my experience laxatives soften stools whereas these help digestive system. Theyve been a lifesaver.

I'm not sure if your boy is constipated or not but it could be the case especially if he's holding it in. I started having mine sit on toilet until he had done one, everyday 20 minutes after dinner I would put him on the toilet with my phone to play on or book or whatever would help him stay on for a good 5-10 minutes at least.

I feel your pain! Nursery used to accuse me of neglect because he was always dirty, it was under his fingernails and everything but he wouldn't let me wipe him and also hated baths at the time, It was horrendous but things are fine now hopefully things will get better for you!

Hi OP, I have a 5 year old with ASD who has had various poo issues including constipation, soiling and faecal impaction. My advice would be keep pushing for professional help with this - we were told (because DS has ASD) that the issues were behavioural when in fact he was was impacted and needed medicating.

Stool softeners from the GP might be a good thing to try. Double check the advice you were given about the continence service - in my area the children's continence service takes referral from age 4 but the awaiting list is very long so best to get on it asap. We were referred via the Health Visitor. Have you had any HV involvement at all? They can be quite useful with all things toileting.

Thanks for these helpful replies. I posted this on a very bad day but thankfully things have gotten better from there. After this post I took him to his favourite park which helped to get him all excited and finally get things moving to sort of 'reset' the cycle. He managed 3 poos in the hour we were there!

I've actually queried with the paediatrician if he's got some sort of allergy or intolerance because before now his stools have always been very loose and mushy, but suddenly they're much more solid and whole now that he's withholding so it doesn't seem like genuine constipation. They're not hard or dry, just huge in volume, and he passes them easily when he's not fighting the urge, does that count as constipation? I haven't spoken to the HV yet but ours is a bit useless.

The M&S undertops have stopped most of the smearing which has been a big step forwards even though the 'smudging' is still happening regularly but he now can't get to it. I've also stopped pressuring him to sit on the potty unless he's posturing like he's withholding and now roughly 75% of the time he will produce a huge poo on the potty so I'm hoping this is just a bit of a bump in the road to being potty trained.