Need some help--4 yo and soiling.

[ehunter27]

Where to begin?

Our son has been peeing in the potty since a bit before 3.5

Very hard on himself; very difficult time to do the pee on potty; but once he could do it, rarely ever ever an accident.  Almost never.

He has not yet pooped on the potty.  Ever.  We tried, but he woudln't.  So he spent until a couple months ago in undies--but he would use a pull-up for pooping.  I'd help him change, and wipe him/he'd help wipe.   About two months befoer he was 4, I felt we just had to get rid of the pull-ups.  So, for a month or two, we encouraged sittig on the potty, etc.  He still pooped in his diapers, usually once a day.  he was a very regular child. 

Now, he has started to hold it.  He usually poops every other day, and the poop comes all of a sudden.  I don't think he can even get anywhere.  He often wets himself while this happens.  It is so sad for me to see.  I am saddened, not frustrated.  I feel for him, as his sister 2, is now peeing/pooping on the potty.  She has a few accidents a week, but if I put her there consistantly, we are diaper free.

I look back and can see how this cycle began.  I want to help it end.  I want for my son to feel success.  He has no idea how to make the poop come out anymore (I don't think).  so...

Here is what we have been doing--but it is not working:

providing fiber rich foods

sit on potty after breakfast lunch and dinner (this has become a struggle)

Here are my options:

1.  Put pull-ups in the bathroom.  Tell him when he needs to poop, get a pull-up and let it out.  Encourage letting the poop out as the positive activity.  Try to slowly transition to sitting on the potty in diapers, etc. 

2.  Keep doing what we are doing.  I refuse to have what we are donig continue for more than a week--I can see that m;y son is starting to withhold poop more and more--I don't want to go down this road.  Look into an enema and sitting on potty option to teach him the feeling of pooping on the potty.

My son is bright, fun, happy for the most part!  I know if he can just do this once or twice, he'll be able to do it all the time.  He is not intentionally pooping his pants, I am sure of that.  Though, he does often hide when he poops in undies--will go stand behind a chair, etc.

Oh, I should mention, I have tried the watching him like a hawk thing numerous times...but by the time I can get him on a potty--it comes so fast--he has let it out.  So it doesn't seem to work, as by the time he goes, he is in the no control over bowels stage, I think.

I would appreciate sound advice from someone who has travelled down this path...

Thanks!!!

[ehunter27]

Sorry--typo in there--when we tried to get rid of the pull-ups for pooping, DS continued to soil undies.  He wears only undies now but soils them with his bowel movements.  Which have become bigger, I've noticed.  Due to withholding.

[ehunter27]

Anyone???? :)

[DariusMom]

Sounds a lot like my DS when he was four. We had to potty train him (pee and poop) faster than he was ready for, because school where we live begins at 4 (we don't live in the US). He was pretty ok with peeing, but pooping was a massive drama. Nothing seemed to work.

We finally took him to our family doctor, who diagnosed him with encopresis. He was given a mild laxative and was pretty much fine after that.

You may want to google it and see if it sounds like your DS.

Hang in there. I know how upsetting and stressful it is.

[Llyra]

I would encourage you to read up on encopresis and soiling issues. There are a number of different approaches you can take with this. The first thing I would do, honestly, is to take him to a medical professional for advice, and to rule out physical problems. A health care professional can also help by being the "voice of authority"-- I know my DD1 listened intently to what our ped told her, about the dangers of "holding it" too long.

I went through this with my DD1. Actually, we're still dealing with it-- she's six now, and still needs dependent on a soluble fiber supplement and a regimented "toilet sitting" routine. Without all that, she goes back to withholding, and gets blocked up, and then stool starts leaking uncontrollably around the blockage, and she gets stressed out about it, and we're back to square one.

Our approach:
1. Manipulate the diet-- increase fiber, sure, but also increase natural dietary fats. Increase liquid intake. Give a good probiotic supplement, and lots of live-culture foods to maintain intestinal health.
2. Use a reward system, with concrete rewards and a chart she can understand herself, to reinforce two things: 1. sitting on the toilet, regardless of the result, and 2. actually pooping in the toilet.
3. a consistent routine for when she has to sit-- for ten minutes following each meal, about a half hour after the meal. This meant arranging with the school nurse and her teacher, for this to happen at school, too.
4. When she is "holding it," and I can tell she is (she leaks small amounts in her underpants, for instance, or she's turning red with the effort, she goes to "poop camp." That's our in-family way of describing that she's restricted to the bathroom and her own bedroom, until she poops in the toilet.

I think the idea of allowing him to poop in a pull-up, on his own initiative, is a TERRIFIC idea. That gives him back the control over the process, and encourages keeping the poop moving, which is WAY more important, health-wise, than actually getting it into the toilet. Then go with that for awhile-- a few weeks or a month-- before trying to move him to the "next step." The more you get involved with struggles over elimination, the higher the anxiety levels get, and anxiety can make it really hard for a child to move his bowels.

[ehunter27]

Thanks for replying.  I've spent the last two weeks reading about encopresis, which I know he is developing/developed.  I'm trying to find a way out of it early.  He has no health issues--I'm pretty sure.  he was always very regular when in diapers.  I can tell he holds it until he looses control.  We have been sitting on the potty.  he doesn't know how to poop.  He can't seem to activate those muscles...I'm not sure why.  I know as soon as he can activate them, he will probably poop on the potty.  I feel so stressed and lousy.  I have devoted myself to a healthy diet for the kids, etc.  I also just learned my 2 year old, who is basically potty trained, has caries.  She is such a healthy eater.  It is bottle mouth, from nursing.  She is still a huge day nurser.  This is obviously for another post.  I'm obviously feeling awful about both situations. 

I just want his body to get back to normal.  I constantly wish for this.  I knwo how it all started (daycare, holding it all day...don't think he ever pooped at daycare in the year he was there...)

Beth

[Llyra]

Would you ever consider using something like Miralax, for awhile-- it'll soften the stools enough that it's impossible for him to hold them. For some kids, it helps-- they get over their reluctance to poop, and get some experience actually pooping successfully, so that they start to figure out how to make those muscles work correctly. It's the course of action that was recommended to us, when DD1 was 4 1/2-5. I'll be honest-- it didn't turn out to be the right solution for us. We had better luck with Metamucil, which is what DD still uses. But I know the Miralax has helped a lot of kids.

Hang in there. I remember the year when DD was having her poop issues-- it's the same year DD2 started having migraines, too. I remember feeling so totally overwhelmed. But I can say with assurance that one of the things that really helps with soiling issues is time and patience. Sometimes doing nothing, and just handling the currently situation patiently, is enough. It reduces the general level of anxiety in the house, and that alone helps so much.

Even if you are sure it's not a physical problem-- I'd still totally recommend talking to a good understanding pediatrician or family doc. These problems are so common, and often doctors who see a lot of kids have so much experience in dealing with them. It really helped us, to have somebody else involved in helping me decide what to do.

[redpajama]

I agree that if you son is able/willing to poop in a pull-up--especially if it's like you said, having a stash of pull-ups in the bathroom that he can access at will, put on himself, and poop in--is an EXCELLENT idea.  My almost-6-year-old has been dealing with encopresis for almost 3 years, and if you can prevent this from going that way you'll save yourself so much grief.  My son was a little different--he was pooping on the potty for more than a year before he began withholding, but at this point he's having to re-learn to respond to his body's cues (which, for him, currently trigger a withholding response instead of prompting him to use the bathroom).  So if your son is willing and able to respond to those sensations and poop in a pull-up, I would definitely begin doing that immediately while you figure out a way to gently transition him to using the toilet.