Have you successfully dealt with encopresis?

We are in search of any advice from folks who have successfully dealt with their child's encopresis. anonymous

19-month-old fears painful bowel movements

My 19 month old daughter becomes extremely anxious and panic stricken at the idea of having a bowel movement. This started after she contracted a virus that caused severe and frequent diarrhea. Now she does she all can to avoid pooping. I'm afraid this could lead to bowel obstructions and other problems. Has anyone ever had experience with this? Bummed about her BMs

2-year-old withholding bowel movements

My son is almost two years old, and for the past 7 months or so, he has been withholding his bowel movements. It seems as if we have tried everything possible to remedy this problem: his diet consists of strictly whole grain and/or high fiber foods, his consumption of dairy products is very minimal (I am still breastfeeding). We have tried flaxseed meal and flaxseed oil, he has had to endure several enemas and suppositories. Following a recent three-week period of withholding his bowel movement, our doctor prescribed MiraLax. It really works well, but I just hate the idea of my otherwise healthy child taking daily medication. I heard that frequently children stay on this medication for months or even years. I feel horrible every time I add it to his morning oatmeal. But I simply don't know what else to do. Any suggestions?! Our doctor has assured us that MiraLax is quite safe. Has anyone heard otherwise? desperately seeking advice

The mineral oil worked OK for awhile, but near his 4th birthday (still in diapers), he had another bad bout of constipation. He was so miserable and I couldn't bear to see my son in pain again. We were also anxious to have start potty training which we were unable to do because of the constipation/witholding. I knew he would withold if we took him out of diapers and the whole vicious cycle would start over again, so I agreed to try the MiraLax.

He has been on MiraLax for 4 months and I am glad to report he is now (finally!) potty trained and poops easily/happily everyday. I strongly recommend you try the MiraLax now and don't make the mistake of waiting like we did. I do believe it is safe and it has definitely helped my son. The longer you wait, the harder it is to undo the memories of painful BM's.

One other thing, our insurance Blue Shield HMO, does not have MiraLax on their Formulary so we have paid $90/month ($45 2x/month)for the prescriptions. I believe you can fight this and try to have them cover it, but we have not tried yet. Most Dr's would agree that there is no realistic alternative for MiraLax and would be willing to write a letter or call your insurance company. Just be aware, you may need to shell out a lot of $$ or be prepared to fight your insurance company on this issue.

Good Luck! I would be happy to discuss this further, so feel free to email me if you want. lslez

My advice to you is to give it up. He will live. Let go. He can sense your urgency in trying to control it. Keep giving the laxative. My rule is if he doesn't go for 3 days, then I give it. Usually right about the time I feel it is too long, I give it.

My son is now 3.3 years old. I can communicate with him more about it. But when he was younger..that was more difficult. My niece had the same thing. Go on the internet, this condition actually has a name.

Bottom line is that eventually he will learn that he can poop and be OK. The longst my son held it for was 8 days, and I was a wreck.

Say the serentity prayer to yourself God grant me the serenity to accept the things I cannot change the courage to change the things I can and the wisdom to know the difference

I am not religious but this helped me because I truly could not control his pooping. Let your child feel he contols other things. Give him choices so he feels he is deciding, even with the most mundane of things.

Relax. I was a wreck for so long with this and now that I gave it up he has relaxed about it. I feel my son is coming out of it now. So the whole thing lasted near 6 months.

It started with him when he had a difficult poop with his nanny and she told him it was stuck and she would have to pull it out. email me if you want
yancy

3-y-o screaming while pooping

We are at the end of the rope with my 3 year old daughter. At some point between 1 & 2 years, she started screaming every time she went poop. She only pooped every few days. We took her to the doctor. She went on miralax and then other meds for about a year, but no changes. We went to specialist who told us to continue with miralax at a higher dose and give up on potty training for 6 months (she was trained in pee). Screaming stopped, but poop got mushy and runny and came out all the time. Over the next year, we slowly reduced the amount of miralax to none as it just made it ''leak'' out. Here is the current pattern: She starts to feel like she has to poop. She holds it in and is in some discomfort. The next day, she really tries to hold it in and is in greater discomfort. Several times a day, pellet size poops come out in her butt and she needs them wiped away. The next day (day 3), she is still holding it in, but it's almost impossible so she is in a lot of pain, screaming and crying but refusing to walk to the bathroom or even a potty if put in front of her. She won't ask for help. She won't do anything except scream.

We got a referral to child behavior at Kaiser who told us to tell her ''you are in charge of your poop'' and not to help her at all unless she asks. So we tried it and she just stands in the living room (or anywhere else like at park, play area, class, etc) when the urge comes on, screaming. If you try to carry her to the toilet, she screams more. She can articulate that she is ''in charge'' and how to use the potty and where to go and all that, but when it actually comes time to do it, she just screams. At some point on day 3, 4 or 5, if you carry her to the toilet and force her (hold her down and open her legs) to sit there, the poop comes out. Easily. So we are in a 3-5 day cycle where the only day she isn't screaming the day after her poop comes out, but on every other day, she screams and tries to hold it in.

We've tried everything. Bribes, punishment, ignoring her, helping her excessively, reading books about poop, putting her back in diapers, etc. I'll add this cycle is the same even if she is wearing diapers.

The only other thing to note is that she is a twin and her sister has been fully potty trained since 2 1/4. No poop issues.

I'm hoping to god one of you has something that might work because I am about to lose my mind.

I had an epiphany at one point and realized my son's screams were, not b/c the poop hurt, but b/c he was fighting so hard to keep it in!

Encopresis is not always a control issue stemming from diaper training-- it could have resulted from a painful poop and fear of it hurting again. Regardless of its start, it gets physical and can get so severe that the rectum's shape stretches out. The poop balls up and then leaks come around it, hence the smears and little hershey kisses that occur, not to mention the excruciating bowel movements!

My son is a great eater but no amount of fiber was going to fix the problem. Our pediatrician said that the Miralax allowed the rectum to shrink back to it's normal tube shape b/c the movements weren't left to gather and ball up. I found Miralax to work more efficiently and less intrusively by splitting the dosage up to 1/2 in the morning, 1/2 in the evening. He was on it for 10 months with a couple of breaks to see if it resolved. During the breaks, he was back to having trouble with a couple of days! I did not want him on Miralax forever!

Finally, I met a homeopath who felt she could resolve this issue for us. She took our case and we decided to try the remedy during an extended school break (Thanksgiving) so if he had a problem, it wouldn't happen at school (he was in kindergarten by then!).

So, on a Tuesday my son took his last dose of Miralax. On Wednesday, he received a homeopathic remedy. I didn't share with him for a few months that he wasn't taking the medicine anymore but when I did he was thrilled! He is now in the 2nd grade and hasn't had Miralax since that last time two yrs ago. He has had no issues whatsoever! One time the same year, he backed up a bit and the homeopath gave him an emergency remedy which caused him to poop within 20 minutes(!!!). Anyway, a day later, he developed a virus with a high fever and in hindsight, we believed his body was reacting to the oncoming virus and would have resolved on its own; that it wasn't a recurrence of the encopresis!

I will readily admit that I didn't put much faith into the homeopathic remedy but I am a true believer now! Even our pediatrician was amazed, thrilled and entirely supportive! LogicalMama

Give him the highest dosage for about a week or so. Keep him pooping. It doesn't leak, as you described, but it will be a bit of diarreah.It's ok, the trick is to get it all out. Pretty soon he will be pooping without pain, though the excess of it may bother him. It's ok, getting him to poop without pain is the key. Soon you can lessen the dose. We struggled with this issue for almost 3 years. It was all over in about a month. L'il Tummies is a natural herb, Senalina I believe it's called. Perhaps the same thing the homeopath gives, but i wouldn't know! Try it, it'll be alot cheaper and I now know 3 of us that all had the same problem and it was a miracle. Last thing, my little girl still needs a little bit from time to time. She'll still say her poop hurts and i give her a small dose right away. By that night she goes, easily, and she loves her ''chocolate stuff''. Some people struggle with this all their lives, our kids will probably be those people. Better to help them accept that now and give them the power to help themselves. Right in the Walgreens aisle! And seriously, we tried everything else, too! Good luck! excited to share the secret!

Finally we spoke with a pedi GI doc who recommended using Magnesium Citrate - having her drink a couple bottles to clear herself out at first. She was actually excited to drink it as like 'soda' which she doesn't normally get to drink. This worked like a charm.

Then we set a regular dose of Miralax to keep her poops very soft. Spent time on the potty after every meal (at least breakfast and lunch). At first was tricky to even get her near the potty, but stressed that was just time sitting there - no need to actually 'do' anything. We made a sticker chart and each time (after each meal) that she sat on the potty, she got to put a sticker up (poop not necessary). Crazy, but this worked like a charm and she became so confident and proud of herself. She soon lost interest in the stickers and now we are just careful to keep her stool soft (though cutting back on the Miralx slightly). Extremely thankful

3-year old withholding poop

My 3-year old was potty trained for about a month when she started withholding her poops. We initially thought she was constipated but after 2 months of this behavior, I now know she is ''not letting it come out.'' It was really bad when she was using the potty. Now, we're back to pull-ups. She will ask for a pull-up when she has to poop. Then she makes all of the pushing and grunting sounds and sometimes cries that it hurts (after 3 days of not pooping, I'm sure her tummy does hurt), and says she is trying to poop. But I finally figured out that what she is doing is working really hard to hold it in. She started this shortly before her 3rd birthday, around the time she transitioning to a new classroom at school, a change she has been looking forward to for some time. I am trying not to make a big deal out of this. I have no problem with her using a pull-up. I've set the bathroom up so she has privacy but can entertain herself. I've offered her a reward for ''letting the poop come out.'' Nothing seems to work. I know it's a control thing and that I should just ignore it, which I am trying to do. But sometimes it makes me crazy as she will spend all day trying not to poop, will be whiny and irritable, won't want to play with anyone or go anywhere, etc. Any advice or words of wisdon or commiseration will be much appreciated!
To Poop or Not to Poop

We also gave him mineral oil... and none of this helped. Finally, after 7 long months we got a referral to a gastroenterologist at Children's Hospital. Dr. Haddad is very kind and attentive. He understood the severity of how this was affecting our lives, and explained that our problem was definitely a control issue, and it would be fixed but we had to think in terms of months and years (a slow process). After our first visit, he prescribed a suppository to make him go immediately (we had been avoiding this), and then Miralax every day (a laxative that makes the stool very soft and easy to pass).

Now, my son is down to half a dose every other day and is pooping almost every day. He gets his medicine mixed w/ juice around 5, and poops at 6pm. He will only poop in a diaper, though is potty trained otherwise. It is more important for him to be going, than worry about the diaper. The dr. says ''he won't be wearing diapers to college.'' Also, letting him decide when to start pooping in the potty will give him that sense of control he fights so desperately for. I hope this helps.
in your shoes

My advice? Let your daughter keep the pullups and see what happens. Keep trying gently to get her to poop. But at some point, you may need to get her to go on the potty. For some reason she is 'afraid' of letting go and all you can do is talk her through it. HOpefully it won't be traumatic when she goes the first time (in the potty) and she'll see it feels much better than holding all the time. I have no idea why they choose discomfort rather than release, but some do. Good luck ~ The potty rocks

3-year-old won't poop!

our son is just shy of 3 years old. He was starting to potty train, very successfully, when he came down with the flu, and didn't have a bowel movement that whole week. This started a cycle of holding in his poop, willfully. It has now been going on for 6 weeks. At the beginning he had lots of pain so we took him to the emergency room twice where had an enema. He now goes once every couple of days, but just enough to release a little pressure. We now see that the pain is caused by his holding it in, which he does with all the willpower of a 35 year old man. It's amazing! Under the advice of our pediatrician, we are giving him mineral oil morning and night. We are also feeding him lots of juices, raisins, apricots, flax cereal, etc... We are at a loss as to how to comfort him or how to react when he says ''my tushy hurts'' and then proceeds to do whatever he can to keep himself from going (ie jumping around the room and clenching his fists!) HELP! Has anyone experienced this type of thing? The pediatrician says it's common, but hasn't given us specific tips as to how to react (or not?) to the discomfort that accompanies the holding it in. It has been totally disruptive to our lives - hoping someone has some practical tips. Thanks for listening! Carolyn

Our ped. has advised us to give her Miralax, which we do daily, to keep the poops soft. The key is for the child to go every day, or every other day (and not the every 4-6 days as my daughter tries to get away with). If her usual dose (1/2 an adult dose) isn't working, we give her more: otherwise, the stool builds up and hardens, her rectal vault gets distended, and she will have a terrible time letting herself go. At times, we've had to give her 2 full adult doses per day. It sounds like the mineral oil is supposed to do the same thing as the Miralax. My ped. told me that it's much better to treat the problem from within than from without, like with enemas, suppositories, etc.

You had also asked about the behaviors. We have been having success for the past 3 months by following the routine below::

1. Every night, about an hour after dinner, I announce it's poop time. Sometimes she acquiesces, but most often she protests, cries, whines, etc. I don't give in, and basically make her sit on the potty. (''Do you want to walk to the potty, or should I carry you?'' is my opening gambit, but I've also just carried her in and placed her on the toilet. She hates it at first, but calms down pretty quickly and is always in SUCH a good mood after she goes that it seems to minimize the trauma of going in the first place). [I'm hoping that by following a daily routine, her body will start ''wanting'' to go at that time every day]

2. We sit in the bathroom for awhile. I remind her how good she feels when she goes, how big kids/big people go poop every day, and how she'll get a poop treat once she goes. Sometimes we read a story, but I try not to do too many things that will distract her from the matter at hand. Because I think she's forgotten how to go--or rather, she wouldn't allow herself to let go after having the normal feelings of needing to eliminate--I help her visualize how to go: relax her bottom, let her bottom make an ''O'' shape, and let the poop come out. I make up all sorts of silly stories about the poops themselves: anything to make the experience positive!

3. Sometimes all the positive stuff doesn't work, and then I threaten a Fleet Baby Enema--she's had that twice, and hates it. I know--I hate to use threats, but sometimes it's the only thing that does the trick.

4. Once she goes, I make sure her bottom is clean (using baby wipes or warm wash cloth). If her bottom isn't clean, it's apt to get red and irritated, which means the poop will hurt as it comes out next time (not from any constipation, just from passing the sensitive skin).

5. Give her her poop treat, which can be anything your child really wants. In our case, it's some candy.

6. Reiterate how proud I am of her, how she's such a big girl for going poop, how it didn't hurt, etc.

I have learned the hard way that I have to be REALLY vigilant. If we let it go for a few days, all the old withholding behaviors come back full force.

We have good weeks and bad ones. Sometimes she goes into the bathroom all by herself and, lo and behold, makes a poop without any prompting. Other times, she withholds, and then carries on as if I'm trying to torture her when I insist she try and go. This can be a very, very long process, which is discouraging (to say the least). I'm hopeful that by following a routine, we'll eventually get to the point where her body learns to go on its own, and she allows her body to function normally.

Best of luck to you guys! Christine

It dawned on me that she was eating a banana and a PB&J almost every day. Those foods can cause constipation/some tummy pain. In addition to limiting those 2 foods, I also stopped buying Pull-ups and explained to her that 'this is the last one and after that you will have to go poo-poo in the potty.' It somehow clicked for her and she started pooping in the potty. Good luck angela

He held his poop so long that it would slip out when he slept at nap time. Since he was in preschool all day, we were not aware of the problem until he started soiling his pants. His doctor also had us give him mineral oil, which actually caused him to have even more accidents! However, I think that ultimately, that was the way to go. Unfortunately, because we hadn't acted sooner, his body lost its ability to feel when he had to go, which was causing the frequent accidents.

I agree with the folks who say deal with it now and in a positive way - especially as it can lead to a problem that will persist for many years. But I would also look into why it is happening in the first place. In my son's case, I found that he had been teased a bit in the potty room at preschool, which was what led him to not want to spend much time in there.

Good luck! fm

It was not an easy process- we actually ended up having to use enemas (he would not poop for up to a week). Honestly I think some kids go through this. We tried mineral oil, we tried mild laxatives, we tried getting him to drink more liquids, we tried coaxing, we tried threats, everything under the sun. He pretty much resisted everything. After the 3rd enema, he figured out that pooping on his own was a lot easier a lot more pleasant an experience. Another thing that helped was trying to encourage him for being such a big boy, talking a LOT about how everyone poops, etc. We even resorted to bribery- if he pooped X number of times on the potty he could get Annie and Clarabel (Thomas the Tank Engine coaches).

Also now when he poops on the potty, he likes to hold a train or helicopter because he says that they ''help'' him poop. We also made a big deal when he did poop- lots of cheers, hugs, high fives, the works.

I know it is hard, but just try to staty patient and viligent, he will get it worked out. Hope it happens soon! Lisa

3-year-old Holding on to Poop, Withdrawing

Hi everyone, My 3 and a half year-old daughter has been asking for diapers when she needs to go ''poupou,'' and having accidents in her pants when she is not with me. I don't mind these two behaviors. It will take the time it has to take for her to be ready. Now, here is the problem. At her school she has accidents, and sometimes she will deny it with the teachers. Then she withdraw from the other kids (she stays alone); she told me once it's because she does not want the other kids to smell her. At home, she put a piece of schotch tape on the bottom of her favorite stuffed animal; so ''the poupou can't come out,'' she says. Also sometimes even with me, she will not go pipi on the potty, and will refuse a diaper. She just hold herself until she can't hold it no more (the same with ''poupou'' if I am not with her). What disturbs me is that she is holding so much (up to 4 days for ''poupou'' during Christmas time - we were away to my parents, and I guess, she reacted to the new environment) and must feel so uncomfortable; and, now I worry about this withdrawing behavior at school. In the past, she saw all the videos and books about potty training; I promised her the best toys if she does ''poupou'' in the potty. We use a calendar that we put stickers in for pipi in potty (or poupou, if ever,...) I do not act negatively if she has accidents; rather, I try to show that I have confidence in her (''I know that, when you'll be ready to use the potty, you'll get there on time). Any suggestions? thank you

3.5-year-old still holds poop - we've tried everything

Help! My 3 1/2 yr old daughter has been holding in her poop for about 1 year now. We have tried everything from changing her diet, to drinking prune juice, to giving her mineral oil. All has helped, but she still will not let it go naturally. We have read books about going ''poopy'' and I explain to her that it is a normal bodily function, but she just refuses to let her poop come out when she has to go. She will hold it for as long as she can, no matter what. I will let her fight it for a day or two, but then I can't stand to see her suffer so I place her on the toilet (usually kicking and screaming) until she fianlly goes. She is terrified when she see it come out of her. When she finally does go, she cheers and brags about going and asks for a treat for going, but then the next time she has to go she refuses again. Its just a constant cycle. We go through this about every 2-3 days. She just fights it as long as possible to hold it. Does anyone have any advise on how to let her know that she doesn't have to suffer every time she has the urge and that it doesn't have to hurt when you go? I appreciate any advise.

I noticed when I became more controlling over him he held it longer. Like when he turned 3 yrs I sort of tightened my discipline of him. That was when he went w/out for a week. His pediatrician prescribed Miralax, a gre! at laxitive that you can hide in any drink. But this makes it as loose as can be. After I actually 'gave it up'--stopped trying to control his poop. He has been pooping every other day now for over a week. He still fights it and he is proud afterwards. I say very little now about it. I sometimes tell him ppop likes to comeout an that it was nice that he let it go. I told him it was up to him if he wanted to poop. I try to make him feel like he controls things in his life.

Incidentally, this happened about 3 weeks prior to our move away from his dad. He may have picked up on the stress in the relationship.

My niece did this with here poop for a year or more. It is actually labeled encopresis. You can go on the internet to read about it. Type in encopresis + without holding All advice I was given is that potty training during this time is futile. This is very common. 3% of all visits to ped. involves poop issues.

Seriously, you have to let go of trying to control it. Its a big lesson for us parents. Also, I remind myself that he will poop normally someday and that, at least with my now 11 year old niece, there are no lasting effects. She doesn't even remember. good luck

3.5-year-old with encopresis

Ever since we've been giving him a prescription medicine called Propulsid which apparently inspires the intestinal nerves to send the proper signals, and the results have been good. He still experiences some constipation, but not nearly so bad as it used to be. We're hopeful that after a period of time, we'll be able to abandon the propulsid.

I should probably also add that our son has some diabilities which, for lack of a consistant pattern and diagnosis, are generally classified as developmental delay. Not sure how that might tie in with the intestinal nerve thing, but I thought I'd mention it.

I would say we have been working on this for six months. Though he still resists a couple times a week and he rarely poops anywhere but our house, he has come to be able to poop almost everyday. Another suggestion is reading books about toilet training and poop in general - we found our son was squeamish about poop and this helped to ease his unease.

I know it is different since your son is still in diapers, but maybe he is beginning to become ready to use the toilet and is worried about making mistakes. The most important thing is to reassure him and not become overly tense and obsessed about his poops. I know this is difficult, but he can be affected by your anxiety. Good luck!

A while back, someone wrote asking for advice about their child withholding poops. The American Academy of Pediatrics has good information on 'functional constipation' that I thought might be useful to the parent who was looking for insights. http://www.naspgn.org/constipation.pdf Ann

My 4-year-old has been diagnosed with encopresis

My soon to be 4 year old son has been diagnosed with encopresis (withholding of his bowel movements.) I've read the postings on the website and found them helpful and would like to hear from parents who have successfully treated their child for this problem. We have consulted with our pediatrician and a pediatric nurse about the condition. Currently we are giving our son as much fiber and fluids as he will eat (he's a somewhat fussy eater, but likes some fruits, veggies, oatmeal etc.) In addition, we spike his nightly bottle of milk and water with a little Milk of Magnesia. We have our good days and bad days, but it's hard to see a general curve of improvement. Our pediatrician doesn't want us to pursue toilet training and our son is also resistant to the notion. I'm getting a little anxious about getting him potty trained since I think the delay might cause some social problems with his peers, but we don't make an issue out of it. I should add that this situation has been going on for more than a year. I would appreciate hearing from other parents the answers to the following questions: How long did it take to fix the problem? What did you do? How old was child at the time? How did potty training go? Thanks in advance.

He wouldn't eat fruit, so we gave him apricot juice. We also had to give him mineral oil (two tablespoons mixed with frozen concentrated Hawaiian juices). The oil helps to make the bowel movements less painful.

Now he's a lot better. But if I forget to push those apples on him, he's clogged again.

5-year-old witholding bowel movements

Help! My son had a bout of diarrhea and it seems to have freaked him out. For the last 3 wks he has been back to normal physically, but he is terrified to have a bowel movment. He starts to cry when he knows he needs to go, telling us "it will hurt, it will hurt". He works himself up to quite a state, and refuses to go alone to the bathroom. Often we sit with him for an hour while he tries to go, with him crying and worrying the whole time. While the diarrhea started this, I think, it is clearly just psychological now. His poop is normal, and we have tried everything dietwise to make it soft and easy to go. When he does finally go, he says it didn't hurt, but that doesn't seem to make the next time any easier. Now it seems he is starting to withold because of his fear...when he does go, he goes quite a lot. But he is still going every day or so. We are at our wits end, and trying very hard to be patient, but sitting in the bathroom for an hour is no fun! Also, this is a kid who has never had any problems with this kind of thing before...usually he's great about toiletting and its no big deal. Any suggestions much appreciated...we are running out of reassurances to give him and ideas. Ann

5-year-old terrified to have a bowel movement

Help! My son had a bout of diarrhea and it seems to have freaked him out. For the last 3 wks he has been back to normal physically, but he is terrified to have a bowel movment. He starts to cry when he knows he needs to go, telling us "it will hurt, it will hurt". He works himself up to quite a state, and refuses to go alone to the bathroom. Often we sit with him for an hour while he tries to go, with him crying and worrying the whole time. While the diarrhea started this, I think, it is clearly just psychological now. His poop is normal, and we have tried everything dietwise to make it soft and easy to go. When he does finally go, he says it didn't hurt, but that doesn't seem to make the next time any easier. Now it seems he is starting to withold because of his fear...when he does go, he goes quite a lot. But he is still going every day or so. We are at our wits end, and trying very hard to be patient, but sitting in the bathroom for an hour is no fun! Also, this is a kid who has never had any problems with this kind of thing before...usually he's great about toiletting and its no big deal. Any suggestions much appreciated...we are running out of reassurances to give him and ideas. Ann

5-year-old with encopresis

My son, who is 5 and 1/2 years old has been having problems going to the bathroom when he needs to have a bowel movement. His doctor told me that he has a mild case of encopresis, and that it should be treated right away or it could become very serious later. She ruled out the possibility of being physiological, she thinks he needs to see a psychologist for that. What happens to him is that, when he is out of home, or playing with a friend, he doesn't stop to go to the bathroom, if he needs to poop, he tries to hold and most times gets his underwear dirty. When he is at home by himself he usually goes to the bathroom normally. This used to happen from time to time before, but in the last six months it is happening almost every day. I would like to know if anyone have had a similar experience and what they did. Also, if anyone could recommend a good children's psychiatrist that preferably would take Health Net. Thanks a lot.

I originally posed the constipation problem to the digest over a year ago - and, as usual, you guys came up with great advice! Since the issue has come up again, I thought I'd share what worked for us. At the time, my son was 5 and had been having problems pooping for over 2 years. For the past year, we have made real progress - though it's still a big part of our daily routine. Here's what we did...

An x-ray showed a big bag of poop. His muscles were stretched all out of shape, even after months of mineral oil and Lactulose (prescription). Our doctor recommended clean out either with daily enemas for 4-5 days or surgical removal. Why she hadn't recommended that 18 months earlier, I don't know - but I digress. We opted for the lesser trauma of the enemas. Our little guy was a real trooper.

Now we're on a daily dose of mineral oil and Milk of Magnesia. Yes, both. Some hints...

1. Mineral oil hides really well in milk shakes.

2. The emulsified mineral oil, Kondremul, is best served cold. Mix in a little chocolate syrup or strawberry syrup for flavoring. You don't need much to get results.

3. Walgreen's sells a *concentrated* Milk of Magnesia that's strawberry creme flavored. You only need to give half as much as the regular - a real plus when you're having to coax the stuff in. We serve ours cold mixed with regular milk.

Since our little guy was a pre-schooler, we were able to reason with him and explain the consequences. "If you don't drink your milk and oil, your poop will get clogged and you'll need a squirt (enema)." Well, no arguments there. In fact, he reminds us if he doesn't get his milk and oil for the day!

Finally, the absolute best thing we did was a consultation with Meg Zweibec. Our pediatrician had been helpful, but, by this point, I felt we really needed a coach. Our little guy was in quite a bit of discomfort, and it was impacting other parts of his life (i.e., socially, potty-training, self-esteem, etc.). Meg was great - she gave us the confidence that we could solve this one and we walked away with an action plan on how to do it. Meg's hourly rate isn't cheap - but she's worth every penny. Her number is in the Oakland white pages.

Bottom line - don't let the problem go unsolved. Exercise, increased fluid intake (good luck with that one!) and improved diet (well... you can try..) might solve the occasional bout, but if this is a persistent problem, you need extra help. Avoid prune juice - it can cause cramps (per Meg, our pediatrician and the surgeon we consulted). So does Senekot (over-the-counter). Try everything and anything til you find what works. But, whatever you do, get it resolved as soon as the symptoms develop. Good luck!

Strategy one. Figure out when your daughter is having her bowel movement. BEfore or after midnight? And then narrow it down. Don't wake her up, just see if you can do some detective work (nose). She probably does it at about the same time each night. If you can, then try to catch her in the act and talk softly to her (good job, feel your body pushing it out...)..still don't really wake her up, you don't want her to do her automatic response of shutting things down. Eventually, wake her up a little, not much, so she can start to feel what her body is doing. (I'm assuming that you have explained the strategy to her already...see it as a training period to get reaquainted with her body). Eventually when she can poop in her bed while awake (half asleep is good), then it's time to move a potty chair into her room, and see if she can, half-asleep, sit there (even still with her pull-ups on) and poop. etc.. eventually, you'll have a sleepy girl going to bathroom, pooping in the toilet, in the middle of the night. From there, it can be translated to recognizing the feelings during the day. This approach takes a lot of night time work though, and who can afford to lose more sleep?

Strategy two. Again in the atmosphere of a "training" program (like athletes have), your daughter will start a training program to retrain her body and her mind to recognize her body's signals. It can be a special project. Nothing to worry about or get overly focused on trying to poop right away. Her body's signals are still there, but may not be very loud any more and your daughter has tuned them out. SO, if she tends to have her bowel movement early at night, try an after dinner session, otherwise, maybe go for the mornings...but that's complicated by school. What this involves is stimulants to encourage the bowels to move even when she is awake. So what do you do after dinner? Exercise is a natural stimulant...start jogging with her a few blocks. DOn't expect miracles right away. But plan on a regular schedule after dinner, and then see how it goes. CHocolate, coke (caffeine) can also be used to stimulate the bowels...though different people have different sensitivites to them. SOunds like you'd rather avoid the caffeine route--so do what you're comfortable with. I'd suggest having your daughter wear pull-ups while running etc. you want her to focus on the feelings (or not focus, just start to recognize them) and not have to worry about finding the nearest bathroom. She may hate wearing them, but hopefully you can convince her that they are simply a tool to help her get in touch with certain feelings again.

ANother idea, you may want to revisit the bathtub scene--and just talk about how her sister was going through a stage where she thought pooping was disgusting. ONe's body knows when it's time to poop, and it just so happened that it happened in the bathtub. It shouldn't be any big deal. Your body is amazing-- poop is really quite a good thing. Sure, it carries germs etc., so it needs to be cleaned up, but ....you get the idea.

Good luck. I spent some years constipated as a teenager (only vague memories of it now) so your message got me thinking. There are books too about special exercises one can do to motivate the bowels (I remember laying on my back with my legs stuck up high in the air). YOur daughter might enjoy reading the potty- training or poop oriented books for toddlers (the stage my daughter is now going through). Remind her she has no problem recognizing her urination urge, so it's just a matter of time before she and her body can communicate about the bowel movement urge. Sorry for the length of this message!

6-year-old daughter has encopresis

We just asked our pediatrician about the fact that our 6 year old daughter has occasionally been pooping (a small amount, not a full bowel movement) in her underpants without realizing that she's doing so. (She also has a lot of stomach aches.) He asked some questions about her habits (one big, large-diameter poop each day), and determined that she has ''encopresis'' -- chronic constipation, with poop leaking around whatever's stuck in her intestines. He advised that we give her strong laxatives for three days to ''clean her out,'' and then a course of mild laxatives for 6 months. This all seems counterintuitive in light of what seems to be her easy regularity, but the internet completely backs him up, both on diagnosis and on treatment.

My question is: Has anyone else experienced this problem and been given similar advice, and yet achieved good results WITHOUT doing the three-day ''clean out''? It sounds so horrible, and one would think that a full six months of mild laxatives, resulting in more frequent bowel movements, would do the trick! Of course we will take our final orders from our doctor, after asking him more questions, but I'm just curious what other people's experience with this condition has been (including, for that matter, whether the three-day ''clean out'' really WAS that unpleasant, if you did it).

Thanks! Anonymous

6-year-old son encopresis - clean out?

Hi everyone- I have a 6 yr old son who was diagnosed with encopresis and still isn't potty trined with the bm's. He will only sit on the toilet, with a fight, in Pull-ups only. That took a year to do. We are seeing a Pediatric Gastro here in Sacramento and she took an xray and said he was backed up. We are going to do Magnesium Citrate over the weekend 3X, which he gags on and I haven't been successful. After that he does his Mirilax and ex-lax.

My question is- Has anoyone had their child end up going to the hospital and getting cleaned out with the NG tube? I'm so scared and she said if this weekend doesn't work we'll have to do it.

He has a deathly fear of the potty and I cried my way into his Ped's office and said he HAS to get over the fear before wwe can do this! I dont want to clean him out and then we're back at square one. She said our ins. won't cover a psychologist but I don't know what to do. Aren't they expensive?

I'm so scared for him becuae I think this is hurting him emotionally too. We have 4 other children and it's hard to devote 100% of this to him. Any advice or suggestions of doc's would be great. We have an HMO but I've fought to get referred somewhere with our other son. Thank you so much, Marisa

7-year-old holding bowels at school

Today, while cleaning out my children's closet I came across 5 (!) lightly to moderately soiled old undies stuffed in the back of the closet. This is not the first time I have found undies hidden like this, just not so many at one time.

I knew they belonged to my 7 year old son. I talked to him about it, letting him know that it is okay to tell me he's soiled his underwear and that I would not get mad at him. Everyone has accidents. I let him know that when he hides his soiled undies (they could have been there for weeks) it might make his room smell, I might not be able to get all the poo out of them, I have to throw some of them away(the ones beyond hope), undies cost money etc. so please allow me to wash them right away. He said he understood and ran off to play.

Then it occurred to me what the real reason is behind the hidden underwear! I remembered that for 3 years of pre-school my son NEVER, EVER would have a bowel movement during school. He always waited to come home. I always thought that he would out grow this obsession(of not pooping at school). I think he's having accidents holding in his poo at school and soiling his undies in the process.

The thought of this is breaking my heart! He needs to, but won't poo at school, has icky undies and is self conscious about the smell, uncomfortable etc. then hides the undies when he gets home. My son is a VERY well liked, and popular child at school. He gets along well with everybody, and is an excellant student.

I gently told my son that it is perfectly fine to go poo at school, and that it is not good for his body to hold it for so long.

I wonder if this had anything to do with his perfectionist personality? Is it a control issue? We are pretty layed back parents (except when it comes to social graces and table manners), and our son is a really good, well mannered, intelligent boy.

Has anyone encountered this problem before? What did you do to solve it with your child? How can I encourage and help my child understand that it's natural to go poo (even at school)? Worried mom

My son just turned eight and is having problems with encopresis. He has had this problem in the past, we saw a counselor and things seemed to have gotten better. However, the problem has started back up again.

I am at a loss as to what to do. I have looked online and the resources I've found have stated that this problem is often a result of constipation, that I need to give him laxitives and get him back on a regular bowel-movement schedule, yet, I just don't know where to start.

Because he is so ashamed of the situation he often tries to hide the situation which makes things worse. He very often has accidents in his pants which I can smell it, and sometimes falls from his underwear onto our floors. It really is unsanitary, and quite awful. Though I don't let him know this, I am disgusted at the uncleanliness that he lets happen, and his resistance to clean himself up after these accidents. Again, I just don't know where to start, or what to do. Any help or advice would be so appreciated.

When he starts having the problem again we point it out to him (he doesn't want to talk about it!) We try to get him to drink more water, eat applesauce and other natural methods of reducing his constipation, and when desperate we use mineral oil (he does tend toward constipation also). We also make an effort to get him to use the toilet before school, when he gets home, and before bed. The bathrooms at school are not nice and clean like at home, so he holds his bm's in at school... this leads to a bad habit of holding it. Also, he really hates stopping playing to use the toilet, that's why we've tried to get him to sit at regular times. Although it actually hasn't become a habit.

It's less frequent now... I don't know if it's because he's older and more in control of himself or not. he's definitely not a good "wiper", and I often wash his soiled under separately in bleach after soaking it. I make sure that we have flushable moist wipes in the bathroom to help him clean himself better. The doctor we saw when he was 5 suggested getting him to blow up balloons while trying to make a bm: this uses the same muscles as pooping and was fun besides.

Best of luck. It's gross and you'd think he'd be too old for it, but that's the way it is. Lynn

Each requires a different strategy, and I don't think that the parents can figure it out for themselves, because of all the issues you mention. My daughter is still rather peeved at Dr. Durant but he is my hero. Good luck!

9-year-old's encopresis & bedwetting

My 9-year-old daughter continues to struggle with encopresis and night-time bedwetting (actually, she is still in pull-ups at night and always has been). She has taken Miralax for years for encopresis, and has done the ''sitting'' thing and all the other recommended stuff, yet the problem persists. Has anyone had success with alternative medicine (e.g., homeopathy, accupuncture, whatnot?) Any suggestions would be welcome! Discouraged mom

I also did heavy incentives for her to poop daily. She loved Barbie, so I gave a Barbie outfit for each poop, anywhere. Excessive maybe, but stickers did not motivate, and no time to gamble her health to find the min. that would incent her to poop. After 6 months, I lowered the dose. She had every Barbie outfit made, and we went to check-marks on the calendar. She was relieved that it got easy to poop in the right place, and to hold it until she was at the right place. Then I gradually backed the laxative down to zero. Now, at 8.5, she knows she must poop every day, part of her bed-time routine (so she can put it off as long as possible). I do not let her to skip more than 1 night without giving a dose of laxative. She now only has occasional "skid marks" in her undies. BTW, I got resistance from all - daughter, husband, pediatrician, friends - about my program, but felt it was my duty to do *something* beyond the nothing that they proposed. It worked, thankfully.

On Good-Nights (pull-ups): my daughter wears and needs one every night (actually she needs but eschews them daytime too). I say G-d bless Kimberly-Clark! Imagine this problem without their fantastic product!! With these, she can sleep-over and camp-out. No success story on this problem, nor advice, other than: you are not alone.

These have not helped much: acupressure, Jin Shin, homeopathy, chiro, UCSF pediatric incontinence clinic, NAET, chiropractic neurology and nutriceuticals (still working on this), DNA analysis, shame, blame, wet beds, will-power. My latest effort is a ''broth urine culture'' to discover/rule-out interstitial cystitis. Next, I'll check for Lyme disease (borellia infection), and/or hypnosis. All of these therapies have done wonders for a lot of other issues, like sluggish learning and over-sensitivity to *everything.* I'd love to talk more, if you like. Meg