Why Children Soil Their Pants and What you Can
Do About it.
By Dr. Noel Swanson, MD
NORMAL TOILET TRAINING
Most children learn control of their bowels at about age 2 or 3. If
they have NEVER learnt control by the time they are four year old this
is known as "primary encopresis" (as opposed to enuresis which refers to
wetting). If your children are in this position you should seek help from
a pediatrician.
Much more common, however, are children who have learnt bowel control,
and then seem to lose it again. Not surprisingly this is known as "secondary
encopresis".
There are, of course, a number of reasons why this might occur. In older
children it may be a sign of severe emotional disturbance (eg from abuse)
and may be accompanied by smearing the faeces on walls, or depositing them
in strange places. Again, this probably requires expert help from local
child mental health and/or protection services.
The most common problem, particularly in younger children (anything
from 2 to, say, 7 or 8) is related to constipation.
Here is what typically happens:
Food is eaten, digested, and passed along the intestines.
Eventually they arrive in the large intestines (colon) whose job it
is to dry the stool from liquid to a soft putty texture. When this
is done, the stool is passed on to the rectum.
The rectum is normally empty. It has nerve cells in it that detect
when it is full, and it is this that give you the urge to go to the toilet.
Toilet training is about recognising those urges and responding to them
appropriately.
But suppose, for some reason, that you don't go to the toilet.
For example, sometimes children get constipated.
When you are constipated, the stool stays in the colon longer, which
means it dries out more, which makes the stool more solid.
Such solid stools can be difficult, and even painful to pass.
They may even cause a slight tear in the anus, which is very painful.
This might put a child off the idea of going to the toilet next time,
since every time he goes, it is painful.
So, what does he do? Instead of responding to the rectums signals,
he "witholds" his stool, and just tries to avoid the whole issue.
The problem of course, is that more stool continues to come down the
pipe. Pretty soon you get the whole colon backed up with stool waiting
to be passed. And, of course, the longer it hangs around the drier
and hard it gets and the harder (and more painful) it is to pass.
A true vicious cycle.
But it gets worse.
First, as I said, new stool is coming down the intestines. At this point,
it is still very liquid. This liquid stools comes up against a colon full
of solid bricks. But, since it is liquid, it is able to leak past the solid
lumps - all the way to the rectum, and out the anus. The result is frequent
uncontrollably soiling with small amounts of liquid.
Second, since the rectum is habitually in a state of being full, it
gradually stretches, just like a balloon being blown up. As it does
so, it loses its strength (just like a balloon, which gets easier to inflate
the bigger it gets). It also loses its sensation.
The end result of this is that the child can no longer sense that the
rectum is full and that they need to go to the toilet.
And even if they do try to go, the bowel has lost all its strength,
making it difficult to pass the stool.
The net result of this?
1. Child does not know that he needs to "go".
2. Frequent soiling of pants with liquid.
3. Occasional passing of more formed stools (when the loading
becomes too full) - often without warning, since the child has lost sensation.
Then, in response to all of this, the child may become embarrassed,
and try to hide the evidence by hiding dirty pants etc.
This then becomes a chronic condition that can, literally, last for
years and years, even forever, if it is not properly dealt with. The longer
it goes on, the weaker the bowel becomes, and the harder to correct.
TREATMENT
So what do you do?
The big problem is the flabby, insensitive bowel. So the goal is first
to empty it, and then to retrain it back to normal functioning.
To empty the bowel will require positive assistance, ranging from simple
suppositories, to laxatives, to enemas, to manual clearance in hospital.
So your first step is to go to a doctor - and don't let them brush you
off!
Once the bowel has been emptied, it then needs to STAY empty. But since
the child has no sensation telling him when to go to the toilet AND a weak
bowel even when he does, this stage will also need positive assistance.
You do this by:
a) Developing a clear routing of going to the toilet EVERY day. Since
the child will be nervous about this - because of previous negative experiences
with toileting - you will have to encourage this by means of various rewards
and incentives. My book can help you with this: http://www.good-child-guide.com/index1.html
It is VERY important that you avoid punitive responses. That will only
make the child even more fearful of the whole toileting issue.
I suggest that you have a set time each day for toileting, and that
this be after a meal. Why? Because the body has what is called the "post-prandial
reflex". Basically this means that when you put things into your stomach,
your body automatically shunts things along the system, and out the other
end. So let's make use of this reflex by training the child to pass a motion
at the same time.
This avoids the problem of the child waiting for the "need" to go to
the toilet, which won't happen because sensation has been lost.
2. Because the bowel is overstretched, flabby and weak (like a
deflated balloon), it needs help in moving stuff along. The best
solution for this is to use a mineral oil type of laxative. This is usually
available as a pleasant flavoured liquid (mint flavoured liquid paraffin
- available in UK), or even as a raspberry flavoured jelly (Lansoyl - not
available in UK).
This works literally as a lubricant. It makes the stool so slippery
that it CAN'T stay inside, and so gets passed.
Now, the trick is to use this correctly - and very few physicians will
tell you this:
Your goal is to achieve a successful bowel motion EVERY day. So you
adjust the amount of laxative to achieve this.
If you increase the dose, then there will be more, and easier, bowel
motions. It will also leak slightly into the pants. If you decrease it,
then there is a risk of no bowel motion. My suggestion is that you give
enough laxative that it DOES leak slightly. It is vitally important to
get that regular bowel motion even at the expense of some dirty pants.
You MUST do this every day.
If there is a single day that passes without a bowel motion, this requires
emergency action. You CANNOT afford to allow the bowel to get backed up
again, otherwise you will rapidly return to the same problem and will have
undone all the good work up to that point. I cannot stress this enough!
So, if a day passes without a bowel motion, go to the pharmacy, buy
some glycerin suppositories, and insert one.
That normally produces action in an hour or two. Then increase the
daily dose of laxative slightly.
If ever more days than two pass without action, then it is time to go
back to the doctor for more intensive help.
Gradually, provided the bowels stay empty, they should return to their
normal strength and sensation. Be warned however, that this normally takes
AT LEAST a year, and often two years or more, depending on how chronic
the condition was to start with.
Where most people go wrong is to assume, after a few months of success,
that the problem is resolved. They then stop monitoring it and, before
they know it, their child has missed one, then two, then five bowel actions,
and it's all back to square one.
Yes, you can gradually reduce the dose of laxative as you achieve success
over the months. But you must still monitor it. Only when you have
had a good few months, without laxatives and with no further problems can
you begin to relax!
Dr. Noel Swanson, MD is specialist child psychiatrist who has treated
many children with encopresis. His free newsletter is available from http://www.good-child-guide.com
Copyright
2005. This article may be freely reproduced provided this resource box
is included.
Happenings Around GrandsPlace
Grands Week 2006 will be held the week of July 4th in Georgia.
It is a week long get together of grandfamilies and other kinship caregivers.
Mark your calendars..
GrandsPlace Chat Room
Want to "talk" live in real time with grandparents and other kinship caregivers
that are living the same life as you? Join us in the GrandsPlace Chat Room!
Some of us are just starting this new adventure of parenting again and
others are old hands at it. This is the place to come laugh and cry, to
find answers to your questions, get sympathy and advice when you are down
and celebrate your successes with people that understand. Chatting is free
and easy. Hope to see you there!
Chats are held nightly at 9 pm easter standard time. Join us by logging
on to http://grandsplace.org/gp2/chat.html
or http://grandsplace.org/gp2/chat.html.
Both sites will take you to the same chat room. For people like me that
are time zone challenged it's:
9pm Eastern time
8pm Central time
7pm Mountain time
6pm Pacific time
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Spanish-Style Chicken
Source: Better Homes and Gardens
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