Special Needs

Matthew made me cry today

He woke up with a bug poo in his pullup.  As I was cleaning him up I asked him if he even realized that he was going and he said no.  Then he told me he was a bad boy for going poo in his pants.  Crying

I just don't understand?  I hugged him and told him he wasn't a bad boy but we needed to figure out what he was doing.  We go back to the developmental ped in February.  It can't come soon enough!

Re: Matthew made me cry today

  • poor guy. im sorry :(
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  • Have you ruled out any medical causes for this?  Just wondering...

    Heather

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  • Hi -

    I mostly lurk on this board because both my kids are speech-delayed, but my 4-year-old also won't poop on the potty (he never did - I think I read that Matthew did and then stopped).

     We've seen both a GI and a behavorist for this problem.

    We think it started when his little sister was born - control thing, got constipated, something.  So, he started holding it in - and then it would hurt to come out.  Long story short, he's diagnosed with chronic constipation and takes Miralax and Benefiber daily.  But, still claims it hurts to much to go in the potty.

     Behaviorist - control on his part, wanting to be like the baby, pain wrapped up in it, etc.  This is what she told us to do, if you don't want to wait for your appointment.  Start off my him having to ask for a pullup (no going in underpants).  Reward.  This was easy for us - he did this the first day after the appointment.  The next step is having to go in a pullup in the bathroom.  We're still working on this -he'll go in another room for privacy,but not always in the bathroom.  After the holidays, I'm going to start a sticker chart for this step.  The next step is in a pullup ON the toilet, then she said that if we felt like we needed it, we could cut a hole in the pullup so it goes in the toilet, and then no pullup.

     She said this is actually a fairly common problem - people just don't talk about it.  Good luck!

    ETA:  Oh - and no pressure.  It shouldn't be talked about a lot, he shouldn't think that he's bad, etc.  Some of our issues is that this is a power struggle with daddy.  Upsets daddy a lot that he's not pooping in the potty, so daddy is the main enforcer of the poop rules and he fights that.  So, it takes some daddy behavior mod as well...

  • Gin and Tonic, we know each other from the old TTC board :)

    DH and I discussed it being a possible medical issue this morning and we both are in agreement that it sounds more medical than behavior, to a degree.  He has excema and it usually is bad on his butt.  He was afraid and he would hold it.  Now it seems to ooze out, like he is unaware he does it.  I told him that I wasn't upset with him just that it wasn't a great situation for both him and I.  He must be so uncomfortable laying in poo but he's doing it at night and unaware he does it.  But the behavior aspect comes in where he's holding it as well and has constipation issues.  We're going to the peds today because I think he has an EI so I can ask then.

  • I thought I knew you :)

     How the GI described it to me is that an analogy like boulders in a stream - they get hard "rocks" stuck in there and what oozes out is softer stuff flowing past the rocks.  Eeew.  DS still does this - he stains his underpants without even knowing.

    The first treatment we did, over a year ago, was a course of three enemas (not so much fun) to clear him out.  Then we started the miralax.  He still claims it hurts and pushes really hard - even when it's soft as it could possibly be. His general pattern seems to be to barely go for a few days and then he gets the rocks out and the dam opens.  Usually on a weekend.  Because he does NOT go at school (which is part of the problem).

     The GI ran some bloodwork initially - to rule out things like IBS and Crohns and even Celiac (which mostly presents as diarrhea, not constipation, but can be constipation).  I also took him to an allergist (more for seasonal allergies) and had him tested for milk, wheat, soy - just to make sure none of that was an issue either.  I have a feeling he might have some dairy sensitivity/intolerance (his sister does), but haven't really tested that by removing milk.

     We didn't get as far as xrays or an mri to test for blockages because by that time I think we decided that there's way more of a behavioral component involved.

    I feel like I've been through the ringer on this, so if you have any more questions, PM me.  I don't always check them, I'm not here that much, but I will eventually...

  • DS is on the younger side of this..... our OT suggested that exact behavioral approach. It hasn't worked. He doesn't know he's going until it's done (and I think this is more an age thing for him, 3.5).

    BUT if you think it will help, another thing you could try instead of stickers is coins in a baby food jar = treasure box. DS likes that the coins make noise and we make a HUGE deal when he gets rewards. He exchanged 10 rewards for a treasure and I mix up what's in the bos. All highly rewarding things. However, we've switched to making these rewards for other behavioral things.... not for pee or poop. He has seperate rewards for that which cannot be acheived any. other. way. 

    Pee it has helped!!!!!!!

    Poop it has not. But, just moving forward in any capacity makes me feel better.

    Sorry this was not entirely relevant, but I think at some point, we might be more in this conversation and I wanted to read what you were talking about.

    Hope you find a solution..... could the pedi get you in any quicker w/a referral?  

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  • Hi - just wondering, if you guys looked into the reason behind the constipation...IMO it must be double-hard for him to try to re-learn toilet-training if he's having difficulty physically.

    Have you had any GI tests done? Food allergies? Yeast? ....tried pro-biotics? We had problems with rash and our doc told us it was related to yeast in the stomach, we did a test, and sure enough....yeast. I had no idea and there were no other symptoms for us....after we treated the yeast, problem was solved and rash disappeared. 

  • My dd has encopresis, which is witholding of bowel movements and passing them somewhere besides the toilet.  She too is on Miralax and also a high fiber diet. My dd had been completely toilet trained and then stopped pooping on the toilet. She would not go in her pants or pullup willingly either. She only goes when she cannot hold it anymore and it just sort of comest out. 

    The stuff that is oozing out of your son is leakage that is coming around a harder piece of poop that is still in there. That is common in encopresis. 

    My daughter also went through a stage in which she didn't even know that she was going.  Think of it as this:  When you listen to the refrigerator humming, eventually you tune it out.  Well, when they constantly feel the urge to go poop but don't, their body learns to ignore that urge. They also lose sensation from being so "stretched out" with having such a large amount of fecal material in there.  In time the sensation and recognition of the need to go come back.

    My daughter's issues started as a reaction to an anal fissure so she was afraid to go. It has since turned into a control issue. You have to remember with control issues is that they can't just stop as some people like to think.  It is so deeply engrained. Its like telling someone with anorexia "just eat". If it were that easy they would!!

    We have followed a behavioral system with success.  It involves practice sits after meal times, plenty of other opportunities for control. a reward system. When she starts a new phase of the behavioral plan she is given an immediate reward for the targeted behavior. As she gets more comfy with it we move to a sticker chart in which it takes several to earn a reward.  

    I have found that often times medical drs just go the laxative route for this. My daughter was given laxatives by her pedi plus he pointed us in the right direction for behavior piece, but the GI dr just wanted her on huge amounts of laxatives, which actually made things worse because you were ripping control away from a child so desperately trying to hold onto it and she had such loose stools that she couldn't make it to the bathroom if she tried!!

    My daughter has been dealing with this for over 1.5 years and in treatment with psych for a year and we have seen HUGE results.

    I also agree with not talking about it a lot in front of him, don't make a big deal about it, just clean him up very matter of factly and don't mention it again.  

    If you have any ?s page me I'd be glad to give you more details....

    Good luck

    Kirsten DD 4-7-06
  • imagehopanka:

    Hi - just wondering, if you guys looked into the reason behind the constipation...IMO it must be double-hard for him to try to re-learn toilet-training if he's having difficulty physically.

    Have you had any GI tests done? Food allergies? Yeast? ....tried pro-biotics? We had problems with rash and our doc told us it was related to yeast in the stomach, we did a test, and sure enough....yeast. I had no idea and there were no other symptoms for us....after we treated the yeast, problem was solved and rash disappeared. 

    I assumed his constipation was because he held it in when his excema got worse.  It was painful to wipe even with soft tp.  I called and spoke to his developmental ped and the social worker wasn't very helpful and told us to use a behavior mod technique to help.

  • Kirbear, this sounds like what is going on, IMO.  I usually give him a lot of juice because he loves it (and I figured it would help him go poo).  I made sure to buy stuff with extra calcium.  He eats a lot of fruit.  I'll have to find more ways to add other things to help.
  • Auntie, I want to try this so bad. I have the WORST anxiety about him cleaning up POOP though. He has had to dump it, but then he thinks the dumping is him pooping in the potty. I guess I wont fully understand until I just do it.

    A couple days ago, it was in the floor, carpet, and I found him JUMPING OVER IT like a game. ew. ew. ew. It was everywhere..... and yes, I was where? IN THE SHOWER.   Now after he's done going in his undies, I'll walk close to him and he says 'GET BACK, DONT COME HERE'. So, I KNOW he's putting pieces together. I just can't figure out which ones.

    And getting him dressed is a whole other issue. It might take me 2 hours to have him clean it AND get clothes and get those clothes on.

    I feel like a big whiney for not trying it. Wish I already knew if it'd work.

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