Desperately need help with toileting issues ....

[Anonymous]

Definitely the first step is an abdominal xray. Despite pooping every day it is still entirely possible that your daughter has a big back up of stool in her rectum that is causing the wetting. The daily poop you see just goes right by. Only an X-ray will tell you for sure. Make sure you get a doctor to read the X-ray, not just the radiologist, since they may not be as familiar with this and fail to comment. Good luck!

[Anonymous]

Can a regular pediatrician interpret the x-ray results? Would it be useful to take her to a urologist or gastroenterologist?

[Anonymous]

Anonymous wrote:Can a regular pediatrician interpret the x-ray results? Would it be useful to take her to a urologist or gastroenterologist?

Do not have it interpreted by a regular pediatrician. It should be done by a urologist or gasteroenterologist who is specifically looking for a fecal mass. It's commonly overlooked.

Not the PP above but I agree that just because she poops every day doesn't mean she's not 'constipated'. My 8 yo DS has toileting issues that are related to 'constipation' even though he pooped every day and no fecal mass was detected on physical examination (it was only detected by x-ray later). After posting on this forum about it, several people recommended the book It's No Accident http://itsnoaccident.net/about-the-book/ . What an eye opener. It's written by a urologist who's DC has some similar issues. When he looked into it further, he discovered there'd been research that indicated the vast majority of toileting issues in older kids is a result of 'constipation'. The reason it didn't get much attention is because of how people interpreted 'constipation'. It doesn't mean not pooping on a regular basis, it means have a fecal mass that presses on the bladder as well as pushing poop out the anus.

Prior to getting the book, we'd been giving DS Miralax every day for 2 years and we'd done periodic clean out regimes but he continued to have issues. Turns out, the clean out regimes weren't intensive enough and not clearing the fecal load. In consultation with his gasteroenterologist, we followed one of the suggested clean out regimes in the book and gave him an enema every day for a month (it wasn't as bad as we thought it be). It was amazing how much came out. By day 5, he was no longer soiling himself and no tracks in his underwear.

[Anonymous]

Also highly recommend its no accident. I have a 9 year old who has suffered from chronic constipation for year. Book was a lifesaver.

[Anonymous]

Which gastroenterologist or urologist would you recommend to check for possible fecal impaction? We live in Potomac, MD but willing to travel (we are desperate!)

[Anonymous]

Anonymous wrote:I'd give up (for now) on the sensation thing and just train that every 2-3 hours he needs to go to the bathroom. And it's not acceptable to say he doesn't "need" to go. Sounds like he's in elementary school. You can/should explain that he simply must keep his underpants and clothing dry, he's old enough to do this. And, "Since you don't know when you need to go, we're going to do something new. From now on, at 9am, 12, 3pm, and before leaving a building (to go home, to school, to playground) and when arriving at a building (entering school, house, friend's house) you must go to the bathroom." He will probably urinate most of the time because his bladder is full. And when his underpants are dry all day then he gets a toy that he loves (or a special treat like more time on tv, or whatever really works for him). Eventually, when he's dry more than not, then you can say he gets a chip when he's dry all day, and a certain # of chips get cashed in for special things (5 chips = pizza dinner, 10 chips gets a trip to local playspace, whatever he loves.

This is excellent advice but I would add that he gets a token more often: every time he is dry he gets a token so he can earn up to 3 per day and these can be cashed in on the same day, with smaller rewards for 1 token, medium reward for 2, and big reward (toy) for 3. Keep doing this for at least 3 weeks and see if there is improvement. The book The Kazdin Method has great advice in general on token systems. Also Ron Leaf's A Work in Progress has ideas for toilet training in general and explains reinforcement (rewards) and differential reinforcement (different size rewards) well.

[Anonymous]

Is there any chance that the extreme attention on going poop (I am not judging, just looking for hidden reasons for some of the problems) is causing some of this resistance to peeing and pooping and maybe even sensory confusion about body cues? You son might think that needing to pee is supposed to be feel like needing to poop. Monthly enema sounds really difficult and uncomfortable for a kid and it may be causing him to shut all of toileting out. Magnesium/epsom salt baths are used for constipation so you could try that at times, but overuse could be habit forming I've heard (not sure). Maybe just relaxing on the pooping and not talking about it much might help.

[Anonymous]

Sometimes it's hard not to focus on toileting issues because the accidents happen throughout the day and every where (including public places).

[Anonymous]

Anonymous wrote:Is there any chance that the extreme attention on going poop (I am not judging, just looking for hidden reasons for some of the problems) is causing some of this resistance to peeing and pooping and maybe even sensory confusion about body cues? You son might think that needing to pee is supposed to be feel like needing to poop. Monthly enema sounds really difficult and uncomfortable for a kid and it may be causing him to shut all of toileting out. Magnesium/epsom salt baths are used for constipation so you could try that at times, but overuse could be habit forming I've heard (not sure). Maybe just relaxing on the pooping and not talking about it much might help.

I'm sorry but you don't know what the fuck you're talking about. I don't know why you felt the need to post. I suspect you wandered here from GP? Most people on this forum know to treat constipation with Miralax (not habit forming and can be used for years with no ill effects) and not magnesium/epsom salts.

[Anonymous]

I truly did not mean to offend and you are right that I don't know this issue personally. I have been given similar advice on other issues (e.g. related to feeding) and I was mainly thinking about the enemas being uncomfortable and intrusive. They may be necessary but that doesn't mean they don't have an effect on a child's psychological experience around voiding that might lead to avoidance or shutting down. When my kid was toilet training in fact I was advised by several people to back off when it wasn't progressing and not give it too much attention. In any case, point taken PP, and apologies OP.

FWIW, I wonder OP whether, until your son has more success with the strategies you are trying, using pull-ups or some version of depends for kids (?) would help your child stay dry in his clothes and not get discouraged or ashamed. Perhaps you already do this. This would eliminate a lot of stress over the urgency for a solution for you as well and you cold discontinue when he's successful down the road.

[Anonymous]

I used these training underwear for toilet training (like pullups they are absorbent for accidents but not disposable). They make junior sizes up to 55 lbs. https://www.imsevimse.us/p-97-organic-cotton-training-pants.aspx

[Anonymous]

I agree that if you are having toileting problems at age 2 or even 3, it's probably a good idea to just back off for a while and let the child develop more. Regular accidents at age 5, 6, 7, 8 are totally different, and the "don't stress about it" is just not realistic, as I guarantee that all the other children are making fun of the child. Nor is it helpful because, at that point, there is a problem that is not merely developmental, and ignoring it is only going to make it worse.
We did use pull-ups for a while, because the school required it, but I think that is detrimental to overall progress, and the professionals all agreed with me on that. It does not work on resolving the underlying physiological/neurological issues, which are often related to the fecal load, and undermines the establishment of a timed voiding system, which really is the best way to go if your child is able to do that.
I'd love to hear folks suggestions on a good gastroenterologist or urologist to deal with these issues. I'd like a follow-up xray read by someone who knows what they are doing.

[Anonymous]

Anonymous wrote:I agree that if you are having toileting problems at age 2 or even 3, it's probably a good idea to just back off for a while and let the child develop more. Regular accidents at age 5, 6, 7, 8 are totally different, and the "don't stress about it" is just not realistic, as I guarantee that all the other children are making fun of the child. Nor is it helpful because, at that point, there is a problem that is not merely developmental, and ignoring it is only going to make it worse.
We did use pull-ups for a while, because the school required it, but I think that is detrimental to overall progress, and the professionals all agreed with me on that. It does not work on resolving the underlying physiological/neurological issues, which are often related to the fecal load, and undermines the establishment of a timed voiding system, which really is the best way to go if your child is able to do that.
I'd love to hear folks suggestions on a good gastroenterologist or urologist to deal with these issues. I'd like a follow-up xray read by someone who knows what they are doing.

We've seen a gastro but you don't need an expert to read the x-ray. It's very very common in kids and even the x-ray tech at Children's has always been able to tell whether my kid has fecalomas... or maybe it's b/c my kid had a lot. Anyway, our pediatrician has always been happy to write the script to get an abdominal and then if there's a blockage, we do the Miralax cleanout.

[Anonymous]

Anonymous wrote:I truly did not mean to offend and you are right that I don't know this issue personally. I have been given similar advice on other issues (e.g. related to feeding) and I was mainly thinking about the enemas being uncomfortable and intrusive. They may be necessary but that doesn't mean they don't have an effect on a child's psychological experience around voiding that might lead to avoidance or shutting down. When my kid was toilet training in fact I was advised by several people to back off when it wasn't progressing and not give it too much attention. In any case, point taken PP, and apologies OP.

FWIW, I wonder OP whether, until your son has more success with the strategies you are trying, using pull-ups or some version of depends for kids (?) would help your child stay dry in his clothes and not get discouraged or ashamed. Perhaps you already do this. This would eliminate a lot of stress over the urgency for a solution for you as well and you cold discontinue when he's successful down the road.

I understand you don't mean to offend but I, too, wonder why you feel the need to post when you clearly have no experience with the issues we're discussing. Do you even know what fecal impaction and encopresis are? The problems discussed on thread go light years beyond the garden variety challenges GP parents encounter with toilet training. If your child hasn't experience fecal impaction or encopresis, you have no business opining on the use of enemas or 'sensory confusion'. You obviously have never witnessed the psychological and phsyiological impact of those medical conditions.

[Anonymous]

The OP didn't mention any of these medical terms and opened this thread with concern about sensory issues and didn't state the age of the child. OP also expressed desperation so I figured OP is looking for any and all suggestions to take or leave, and having a kid with sensory issues I thought I'd throw in my two cents. I did get the idea that there was a constipation issue as well from later posts but didn't hear from OP that this is an exclusive clinical discussion. Now that I see it has become more focused and specific, I won't say more, except to wish the OP all the best with this.