encopresis - need help/ ideas

[Greenmama13]

We have been struggling with encopresis with my now 6yods for over a year now.  I feel like I have tried everything. 

He is on Miralax daily, although a small dose.  I think part of our problem is the emotional/ behavioral side of this. 

It is a fight every day to get him to sit on the toilet.  I have tried giving him a game (Leapster) that he can only play while he is there.  I have tried stickers and star charts.  I have tried prizes (from the dollar store).  I have tried monetary rewards.  I have tried going out for ice cream or a treat after a week of cooperation.  I have tried carrying him in there and holding him in place while he sits ont he potty.  We have cheered for him when he has a bowel movement in the toilet.  Most things work for a week or so and then don't work anymore.  I have also tried punishments in the form off no desert, no tv, etc. if you don't cooperate. 

I tell him that he doesn't need to sit there for an hour (although we tried that too - reading books on the toilet).  I tell him just sit there for a minute or 2 and relax and try to have a bm. 

He has all of the typical symptoms - large diameter stools, streaks in the underwear, etc.. and we have been to see our pediatrician probably 4-5 times over the past year. 

I try very hard to not show my frustration, but I know that he knows I am frustrated.  It was difficult to go on vacation this year.  I took enough pairs of underwear for 2 per day and I still had to stop and buy more.  Sometimes I can tell that he has had an accident because of the smell or I will find a piece of stool on the floor.  He will swear up and down that he has not had an accident, when he has.  I have tried making him wipe his own bum.  I have tried wiping his bum for him (he doesn't like to do it). 

He says he can't feel when he has to go - although once in a while he will spontaneously go on his own.  He says he doesn't like the toilet... he doesn't like to wipe his bum. 

Today, when I got home from work he was clearly stinky.  I said, "okay, let's go get cleaned up."  He ran into his room and up on his bed (He has a bunk bed and sleeps on the top) - where I cannot easily reach him.  I threatened no TV for a week to get him down.  He started crying and said he hated me.  Ugh.  I am at my wits end what else to do, and I worry that I am messing up his head.  I am pretty sure that he knows I am disappointed when he has an accident. 

We actually began home schooling him this year - in part b/c of this issue.

Help!

[1stTimeMama4-4-10]

Oh mama,

I'm sorry this is happening to your child and to your family.  My husband went through this when he was a child, and we are fairly certain that it was due to the incredible emotional strain that he was under from his father who emotionally terrorized him. My husband also stuttered as a child. I asked him how it resolved and he said that he eventually grew out of it. He also attended therapy starting around that time though.  I definitely think that encopresis is linked to emotional/psychological stress, and while I am certainly not suggesting that your child is being terrorized as my husband was, I think that the best way to handle it will have to include some type of psychological treatment.

Good luck. 

[Greenmama13]

Thanks 1sttimemama for your reply.  That is what our pediatrician seems to think/feel as well - that he will grow out of it.  But is very frustratin gin the meantime. We will see how it goes.  Right now I am trying to focus on getting him to sit on the toilet twice a day and try to do something - and trying to ignore the accidents. 

[MountainMamaGC]

I had to do milk of magnesia. I started with a tablespoon a day and increased to twice a day when she went longer than 2 days without pooping. We are down to 1 tsp a day now. I dont push the poop issue, and I let her decide when its time to go. She still holds it in but she doesnt try as hard to hold it in as she used to.

When she does finally poop I ask her if it hurt, to which she replies, no it didnt. I ask to to reinforce in her mind that pooping doesnt hurt, because thats how her fear started.

Its going to awhile before she finally lets go of the idea that pooping is a bad thing. They actually lose the ability to feel the urgency to go, especially as the end of the colon gets stretched out. After 2 months of treatment my DDs poops are actually starting to look more narrow.

Its a very frustrating problem mama. Hugs.

[mbravebird]

Have you tried something like pre-sleep suggestion or just-after-sleep suggestion? When my older son had difficult potty training issues, that was a miracle for us. Two days after we started doing it, he had no fear of pooping on the potty anymore.

Your son's fear sounds more ingrained than regular potty-training issues, and there may be physical complications to consider as well, but sleep suggestion is certainly worth a try. What we did was to craft a statement about the positive aspects of pooping on the potty -- I think it was something like "pooping on the potty is relaxing, pleasant, interesting, and easy" or something like that --  and I'd whisper it to him 5 or 6 times after he had just fallen asleep. Then I let go of it and didn't do anything else. For us it resolved pretty quickly, although I'd imagine you'd want to give it a while longer for something more ingrained or more of a charged issue.

Also, have you tried epsom salts baths? That affects both mood(anxiety) and bowel function.

Castor oil packs (not internally, but an external application of a castor-oil-soaked cloth on the abdomen, covered with a heating pad) can facilitate healing of the intestines, helping them get back to their normal shape, and also making bowel movements softer and easier.

Encopresis is such a difficult issue.  Good luck, mama!

[Greenmama13]

mbravebird,

Thanks for your ideas.  I haven't tried any of those ideas.  I especially like the sleep suggestion one - I think I will try it this week.