Hi all, I took my DC to the author of "It's No Accident", pediatric urologist Steve Hodges at Wake Forest. It's only a 5-6 hour drive But I was so impressed with his book, and I figured, why the heck not. We made it a little vacation to NC.

In addition to looking for fecal masses, Dr. Hodges also looks at the size of the rectum. If your child has megacolon, the sensations are dullened for pee and poop, and that's on top of any hypotonia or sensory hypoawareness your kid may have.

I wouldn't have thought of focusing on constipation for wetting until I read "It's No Accident." Dr. Hodges also has a webpage: bedwettingandaccidents.com, and he has a book for kids too.

I don't mean to sound like an ad for Dr. Hodges -- on the con side, our visit was really short, and he didn't have many ideas beyond clearing up the constipation.

It seems like some PP's imply that a regular radiologist might have trouble identifying a problem. Is that not a concern?

Thank you for the help!

Your regular ped can order the x-ray, pp, and it can be read by the regular radiologist. If there is a big old clump of poo in the guts, they can see it. If there is a load of poo you do the clean out (read Its No Accident for the clean out process) and follow steps. All this can be prescribed by a good regular ped. If that doesn't resolve the problem then you need a gastro. We didn't like gastro at Children's, but did like gastro practice at U of Maryland in Balto.

I'm reviving this topic because I desperately need a recommendation for a doctor to see for my 5 year old's poop accidents. Can someone please recommend a good pediatric gastroenterologist at children's or anywhere in NOVA?

I'd love to start with getting an x-ray, but I have no idea where to go...

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.

It sounds like if you think this is an underlying issue related to muscle control and sensory cues, then he can't fully control his bladder yet and he is not ready to be out of pullups, especially if kids are making fun of wet clothes and teachers are annoyed. Pullups feel a little different so they might help cue his awareness to that part of his body. Wearing pullups doesn't mean you stop doing all the behavioral methods like timed voiding or changing if wet, it just keeps the clothes dry and reduces embarrassment while he learns cues and control. It also gives something to work toward. That once he has dry pullups all day every day he will get back to thinner underwear. As far as developing muscle awareness and control, some PTs work on those issues with women (for things like postpartum incontinence) with these types of exercise, like stopping the stream of urine and kegels: http://www.nafc.org/index.php?page=pelvic-muscle-exercises Not sure if this is for kids though. I've heard of people pressing on their abdomen over the bladder to help them know if they need to go (also knew someone who did that on their stomach to know if they were hungry or not).