Encopresis - anyone familar with this

studentdeb · Jun 19, 2004

I am a pediatric nurse and our unit spends a lot of time with children with encopresis. I would recommend that you talk with your pediatrician about your sons soiling. He/She may refer you to an Gastroenterologist. The pediatric Dr. we work with is absolutely wonderful with his patients. Usually he will start out with high fiber diet and mineral oil. There is a prescription medication that works wonders. It is called Miralax. It is a powder that can be mixed in with liquids and had very little taste. The kids do great with it and they are usually very proud of themself when their stools become regular and comfortable to expell. Good luck.

Thanks Beaner, I have an appointment on Tuesday with the doctor. Hopefully we can get this resolved. I feel bad for him because when I ask him if he wants to go on the potty, he tells me he is afraid it will hurt. It's said because I know at this point it will hurt and in the meantime we have the messy pullups.

mitchsmom · Jun 26, 2004

Just curious how the appt went?

I have three sons; both of the older two learned to pee on the potty around 3, with pooping taking quite a bit longer- with periods of going pretty well mixed with not so good weeks until they were slowly completely trained. My little one turned 2 in March and is peeing most of the time on his own on the potty and has gone poop twice completely on his own... shows how they are all different!

Oh yeah, I just remembered... this sounds wacky but I read somewhere that some toddlers are afraid they are losing a part of themselves when they poop in the potty, &/or are weirded out by the mysteriousness of the toilet and where the stuff goes. When my second son was reluctant to poop in the toilet I ended up explaining that it's ok to put the poop in there, that it goes down a pipe to a place where they treat all the poopy water and turn it back into good water again. Might sound ridiculous but my son seemed to like that idea.

How long has your son been trained? Does he still hold it in when he's in diapers? If not, maybe that's your solution until he works it out for himself. Anyway, I hope your son was found healthy at the docs, or you found a solution that is working for him :)

cincygirlpnp · Jun 26, 2004

Milk of Magnesia is GREAT! You can double or even triple the dose. I usually recommend one dose a day for three days (weekend when you aer going to be home is best), then after cleaned out, use Mirilax to get good bowel schedule going. Good luck! Try to stay away from supp and enemas in kinds, the fear factor is great. Milk of Mag is pretty much the gold standard for clean-outs.

studentdeb · Jul 11, 2004

Just curious how the appt went?
I have three sons; both of the older two learned to pee on the potty around 3, with pooping taking quite a bit longer- with periods of going pretty well mixed with not so good weeks until they were slowly completely trained. My little one turned 2 in March and is peeing most of the time on his own on the potty and has gone poop twice completely on his own... shows how they are all different!
Oh yeah, I just remembered... this sounds wacky but I read somewhere that some toddlers are afraid they are losing a part of themselves when they poop in the potty, &/or are weirded out by the mysteriousness of the toilet and where the stuff goes. When my second son was reluctant to poop in the toilet I ended up explaining that it's ok to put the poop in there, that it goes down a pipe to a place where they treat all the poopy water and turn it back into good water again. Might sound ridiculous but my son seemed to like that idea.
How long has your son been trained? Does he still hold it in when he's in diapers? If not, maybe that's your solution until he works it out for himself. Anyway, I hope your son was found healthy at the docs, or you found a solution that is working for him :)

Mitchesmom-

My son has been potty trained for pee without accidents for about 8 months now. The poop issue has been ongoing. He does still hold it when he has a pull up on (which I put on him when we the soiling starts) He tells me "it will hurt" when he needs to poop, but will poop quicker in a pullup so I have told him to go ahead and poop in the pullup and I won't be mad at him, and to just let me know and I will clean him up. But he is still not pooping well.

We did see the doctor a few weeks ago, but I am not happy about the visit. I told him what was going on and for how long. He talked about his diet which I had already modified and a reward system. I have been trying to use a chart and when he goes he can pick a sticker and after so many stickers I will give him a surprise, but it is not working. I still need to get him on the potty a few times a day everyday to try to see if this helps.

We have had to use an enema twice over the last few weeks to clean him out, but then the days go by without him pooping and we begin all over. He pooped a few times (small poops) in his underwear and I had thought that maybe we might be getting somewhere, but today we are back at square one. He is soiling again and cannot control it. He tells me "the poop slipped out".

This situation breaks my heart and he looks so sad sometimes and if he doesn't poop on the potty, he asks me if I still love him and I tell him yes and it makes me want to cry. I try to hold it together for him, but honestly today I went into the living room and just cried.

The doctor said he wants to see him back in a few months if things don't improve, but I don't know how long I can hold out. I am taking one day at a time.

Thanks for asking and hopefully soon I will have something more positive to post.

studentdeb · Jul 11, 2004

Milk of Magnesia is GREAT! You can double or even triple the dose. I usually recommend one dose a day for three days (weekend when you aer going to be home is best), then after cleaned out, use Mirilax to get good bowel schedule going. Good luck! Try to stay away from supp and enemas in kinds, the fear factor is great. Milk of Mag is pretty much the gold standard for clean-outs.

I didn't know you could use milk of mag, he is afraid of the enemas. I feel so bad using them.

What about this Mirilax? Is this a prescription?

Have you heard about Senakot for children? It's a liquid, but tastes bad.

kids · Jul 11, 2004

I would avoid Senna (childrens or not), it is a stimulant laxative and could cause laxative dependancy (stimulants also cause cramping). Miralax is a prescription and as I recall it is a granulated sorbitol or lactulose, in my experience it is very expensive, insurance won't cover it unless there is a documented failure of 2-3 other laxitives.

My choice would be Milk of Mag, it is cheap, is an effective first line laxative and is NOT a stimulant which is healthier in the long run (and also doesn't cause the cramping that stimulant laxitives do).

I've lost track, is the stool he is passing soft or hard?

Is the stool he holds soft or hard when finally passed?

studentdeb · Jul 12, 2004

I would avoid Senna (childrens or not), it is a stimulant laxative and could cause laxative dependancy (stimulants also cause cramping). Miralax is a prescription and as I recall it is a granulated sorbitol or lactulose, in my experience it is very expensive, insurance won't cover it unless there is a documented failure of 2-3 other laxitives.
My choice would be Milk of Mag, it is cheap, is an effective first line laxative and is NOT a stimulant which is healthier in the long run (and also doesn't cause the cramping that stimulant laxitives do).
I've lost track, is the stool he is passing soft or hard?
Is the stool he holds soft or hard when finally passed?

I didn't think it was good to use milk of mag often? Wouldn't that cause dependency also?

My son pooped twice today on the toilet, but in between each one, we had alot of soiling, but I praised him so much each time and he got to pick his stickers and put them on his sticker chart. I have decided to try really hard at getting him on the potty a few times a day and I have what we call "poop bubbles" in the bathroom for him when he is trying to go. He was so cute today when he told his older sister that the bubbles were for when she needed to poop.

As for the consistency of his poop, I can't really tell. He just says it hurts. But this evening when he pooped again, I asked him if it hurt and he said no. I am hoping that if I can get him to go more often, he will be more comfortable and continue to go.

Do you think his muscles are messed up and he can't feel them when trying to go?

jaimealmostRN · Jul 12, 2004

i think all this attention on his bathroom habits will make every thing worse in the long run, esp the whole enema thing. i'm not sure i agree with the freud stages, but if they are correct you are just asking for some very 'anal' adults. let your kids be, the more you stress this, the more stressed he will be....he'll follow your lead. if you act like a trip to the bathroom is a nonevent, your son will too.

kids · Jul 12, 2004

Ya know, it just dawned on me that his complaints of pain could be fissures from passing large diameter stools (caused by holding them), if it is fissures they usually heal on their own.

MoM is the least harsh of the true laxitives (less habit forming). Unless he is constipated (no stool for 3+ days with abdominal discomfort/disention) I would not use any laxatives.

I would push whole grain breads, fruits & vegies & fluids. If he is eating a high fiber diet and still complaining of uncomfortable stools (except after holding them) you might try a stool softener (docusate sodium) or a fiber additive (Metamucil comes in a cookie).

I do agree with jaimealmostRN, focusing on toiliting issues can definately make them worse.

A story comes to mind: We had a 3 yo come into the practice with abdominal pain/disention & no stool for "a week". Xray showed a huge amount of stool in the large bowel. I gave the little guy an enema and asked mom if he could poop on the toilet, she said yes. We put him on the toilet and he became absolutely hysterical, begging for a diaper and was franticly trying not to go. Mom insisted on the toilet, Dad interveined and put him in a diaper and he immediately went a bucketful.

I gave the doc a heads up on what I had witnessed. Later I looked at her notes...apparently Mom was refusing to put the kiddo in a diaper, insisting he use the toilet. Parents were given a LOT of teaching specificlly that his GI tract was not the place to have a power struggle.

studentdeb · Jul 12, 2004

i think all this attention on his bathroom habits will make every thing worse in the long run, esp the whole enema thing. i'm not sure i agree with the freud stages, but if they are correct you are just asking for some very 'anal' adults. let your kids be, the more you stress this, the more stressed he will be....he'll follow your lead. if you act like a trip to the bathroom is a nonevent, your son will too.

I thought so also at one point, so I told my son he could poop in his pullup and when he was finished come and tell me and I would clean him. That seemed to make him relax about it. But it really hasn't made him go. He still holds it. I quit asking if he had to go and I waited for him to come to me the way he does when he pees. It hasn't helped, but from everything I've read and with talking with the doctor, putting him on the potty after he eats even if he doesn't go is a way to develop good habits.

I can't just let him be, and I try to stress as little as possible, but when he is soiling his underwear/pullup several times during the day, we cannot do too many activities or go many places which is not fair to him or his older sister. He enjoys swimming and things like that, but constantly having poop leak out is very uncomfortable for him and makes him feel worse. I can see it in his eyes, not to mention his poor skin on his butt getting red and sore.

I just keep trying different things and I think as long as I don't get mad at him and remain loving and positive with him, things will get better.

studentdeb · Jul 12, 2004

Ya know, it just dawned on me that his complaints of pain could be fissures from passing large diameter stools (caused by holding them), if it is fissures they usually heal on their own.
MoM is the least harsh of the true laxitives (less habit forming). Unless he is constipated (no stool for 3+ days with abdominal discomfort/disention) I would not use any laxatives.
I would push whole grain breads, fruits & vegies & fluids. If he is eating a high fiber diet and still complaining of uncomfortable stools (except after holding them) you might try a stool softener (docusate sodium) or a fiber additive (Metamucil comes in a cookie).
I do agree with jaimealmostRN, focusing on toiliting issues can definately make them worse.
A story comes to mind: We had a 3 yo come into the practice with abdominal pain/disention & no stool for "a week". Xray showed a huge amount of stool in the large bowel. I gave the little guy an enema and asked mom if he could poop on the toilet, she said yes. We put him on the toilet and he became absolutely hysterical, begging for a diaper and was franticly trying not to go. Mom insisted on the toilet, Dad interveined and put him in a diaper and he immediately went a bucketful.
I gave the doc a heads up on what I had witnessed. Later I looked at her notes...apparently Mom was refusing to put the kiddo in a diaper, insisting he use the toilet. Parents were given a LOT of teaching specificlly that his GI tract was not the place to have a power struggle.

How can a fissure heal if he doesn't start going everyday? Also, can't it get worse?

I have changed his diet, cut down on his milk intake, increased his water so I am hoping once he starts going more, it will get easier for him.

And also as i stated in my last post, I did lighten up on him going on the toilet, gave him back his pullups, it seemed to relax him, but he still holds it. I can see when he needs to go, (this happened yesterday) he stands still, and holds his buttcheeks closed and you can see his stomach going in and out. That is when I put him on the potty yesterday and although he didn't want to be on the potty, I got him laughing, we played with bubbles and it seemed to relax him enough that when the urge came back, he was able to let it out. I am hoping when he realizes it won't hurt everything, he will relax more.

Thanks for all of your information, I will look into the stool softeners.

andre · Jul 12, 2004

Deb,

My son has encopresis. He is 8. I have never been uptight about him using the potty--he was between 3 and a half and 4 when he completely potty trained, I just never pushed it, figuring he's ready when he's ready. Just trying to point out, it isn't necessarily anything you've done, unconsciously or directly-- although I agree with you that relaxing a bit does help.

It was a long process for me to figure out that what was going on with him was not a hygiene problem--i.e. not wiping properly--but in fact, intentionally witholding stool. When I finally got him to talk about it, he recalls that it hurt him to poop ONCE a few years ago, and ever since then he tried as best he could to hold it in, because he didn't ever want to feel that again.

Before I took him to the doctor, I had already cut pretty much all dairy out of his diet (he gets calcium from lots of leafy greens, which thankfully he likes), adding bran to pancakes and such, and I was already a whole-wheat-only kind of gal. Lots of water and fruit juice, and fresh fruits and veggies. We tried this and a stool softener for a couple of weeks, with somewhat mixed results. His doctor put him on Miralax (after an abd xray and a negative thyroid panel), and suggested that, with dosage modifications, I can expect him to be on it for about two years--because we need to completely break that mental association he has that pooping hurts.

This makes complete sense to me! Especially since, even though I have always talked to my kids about everything in as straightforward a manner as possible, still he couldn't tell me what was going on. He was embarassed. Even without pressure from me to stop soiling his underwear, HE still felt bad about it. I will mention that he is also very very hard on HIMSELF, and I think this played into his issues as well.

Anyway, my advice would be, if things don't improve with what you've tried so far, to talk more with the doc at your f/u visit about what to try next. If your doc is "hands off" about it, ask to be referred to a pediatric GI specialist. Yes, he's young and not all kids are potty trained at your son's age....but ignoring a potential problem means he may end up like my son, dealing with it at age 8, when it's a much more ingrained habit. I wish I had put two and two together sooner.

Hang in there. Believe me, I know how you are feeling!

Andrea