ERIC
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New - son with bowel problems

Hi - I have an 8 year old son that continuously wets the bed and also soils himself. I have been doing research and had no idea that constipation could cause the bed wetting. We have tried everything from diet to drinking to reward charts to encouraging him to go at regular times to stop the soiling but he honestly does not know it's happening. It is having a negative impact on his self esteem and school life and it is so hard to live with as a family - just because I'm so sad for him. He definitely suffers from some anxiety and may have attention issues but we are not sure if it's ADHD or just anxiety which has built up from being afraid to poo - holding it, constipation and now fear of soiling. We are waiting for a separate referral re the anxiety/attention issues but does anyone know of a specialist we could be referred to re the soiling? I know we have to go via a Dr but I want to ask to be referred to the right person not wait 6mths then have an appt, wait another few months - if I have to pay to get help I will. I feel so guilty it has been so long but we kept thinking we could solve it with encouragement, love and support (never cross, no punishment, no attention etc). I am so so sad for my son as you'd never know - he is the most fun, sweet, outgoing boy and he never complains but I know he has deep shame around this and I want to help him so much but don't know how. Has anyone seen an expert that's really helped them? Thanks, Liz

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How hard for you both! If you read posts on here you’ll see you’re not alone!

Has the gp prescribed any laxatives? My son was a bit younger than yours but had the same toiletting problems. We’re still working on night time but it sorted him out during the day! Good luck! X

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Hi there, so sorry you’re having such a tough time. We’ve had constipation and associated wetting problems. I would definitely get to the GP and ask for some laxatives-movicol or a dulcolax and it might be worth asking to be referred for a scan. You both need some help (I know we did) and these things can make a big difference.

There is lots of info on the ERIC website. Hope you get some support!

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For us the advice from gp was good but it was the continence clinic that cracked it. They are the specialists and so might be worth asking for referrals to them while trying medication from gp. Best wishes to you and your son. X

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Bless you both,really feel for you but things can get better. Have you watched the pooh nurses video , that is really helpful. You need to get medication to do a disimpaction and then continue with a maintenance dose. This has to be taken for ages until his bowel is no longer stretched. Reassure him that he is not alone and that it happens to many many young people. Good luck x

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Sorry to hear this! You are definitely not alone but it's really tough. We got a referal to the continence team through the GP and although it's early days they have been fantastic, as opposed to the GP who seemed at a bit of a loss. Good luck x

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Hiya - I'd echo what the others say above. For some really fast help you could call the ERIC helpline, the people on those phones are amazing and will help you get a plan of action together. We got a referral to the local children's continence team from our GP who have been terrific for us but they can have long waiting lists. There are specialists bowel and bladder consultants that you might be able to get a private referral to if you want to pay or have cover.

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Hi - thanks everyone! So helpful and supportive - I'll try all the ideas you suggest!! It's nice knowing you are not alone!! Thank you!

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Hi Liz. After a year and a half of trying to fix my son's soiling, I came to this conclusion. If the child is still constipated, first step is to do a disimpaction. There are different medications on the market, Movicol that will take a week or Pico Prep which takes 2 days (I am in NZ but the medication may be the same).

After disimpaction, it is very important to keep the rectum empty so do whatever needed to get the poo out every morning! Trust me there is poo every day.

In our case that means our son, who is now 5 and a half, takes 2 sachets of stool softener Movicol (to keep the poo soft), a laxative, which is senokot, 1 pill every night, which keeps the poo moving along in the colon, and every morning after a big breakfast, my son sits on the potty for 10-15 minutes and if the poo is not out by then, I administer an enema or a suppository - that clears the rectum. In this way, he does not soil during the day anymore.

Our paediatrician told us to do whatever it takes to keep the food moving and remove the poo every day. Not in the evening, that's too late, by then the child has had lots of accidents.

On the subject of enemas, when my son first got constipated and we became aware of it, I manage to give him an enema twice. After that it became impossible as he was screaming and fighting it so I stopped. He was 4. The problem is that the top-down medication(Movicol and Senokot) doesn't always work. A year and a half later, I decided to try the enemas again. I offered my son $10 to let me do an enema. He said no and I asked him again the following day. On the 3rd day he came to me and said ok, do it. I was very gentle and not rushed, it did not hurt him and the poo was out a few minutes later. After that he noticed he does not have accidents anymore and he is now 3 weeks soil free, he is fine with enemas, there is no argument, it takes 10 seconds. By the 2nd week I was only giving him $5 and kept decreasing the reward. Just an idea to consider. Your son is older he may be easier to convince to try enemas. It was important to get over the first one. I just got a prescription from the paediatrician for the enemas as they were quite costly.

I read somewhere and the paediatrician said it's true that 40% of kids have results with the top - down approach but the others will need enemas/ suppositories to keep things moving.

Keep in mind that small sized poo, ribbon poo, some diarrhoea, sticky poo, dark and smelly are indicators of constipation. It took me over a year to become aware of this. You are looking for big poo, light coloured, soft but with some shape. For this reason my son still uses the potty, otherwise the poo goes down the toilet bowl and I can't tell size, shape, colour. When you deal with this problem, you really need to know what the poo looks like. The poo should wash off easily not stick like glue.

Sorry for my English, it's not my first language. It is also past midnight, I am very tired but wanted to reply and hope something I wrote will help.

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This is really helpful some great ideas for us about the enema and using the potty. It's really annoying not knowing how often or what his poo is like!

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The other think I find hard is knowing if he is constipated. However I have noted over the years that his poo smells unlike normal poo. So reading your post I think he is regularly constipated.

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Sorry one more quick question on enema's if I was bold enough to try without a doc prescribing. Is the solution important? Or is warm water ok?

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Buy it and then consider home made enemas. I researched it but in the end the paediatrician gave me a prescription and now we get them for free.

'Homemade enema treatments should always start with a base mixture of 1.5 tsp ordinary table salt, thoroughly dissolved into 1000 ml of tap water. These proportions make the solution similarly neutral to that of the inside of the colon. This will have a very gentle, least irritating action on the colon to wash out stool.

DO NOT use strictly plain water without salt added, as the chemical structure would draw out the enema water from the colon into the surrounding body fluids and could be potentially deadly. This base saline solution may be capped and stored at room temperature, for later use at room temperature or warmed close to body temperature (100 degrees Fahrenheit).'

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We use 5ml enema tubes.

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Thank you Nanoiu this is really useful advice. Feel confident about giving it a go now. He's happy to try it based on your experience which is good. At the moment going through a good patch which is nice so maybe never even need it. Really appreciate the posts. x

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Read about the gastrocolic reflex, which senses food in the stomach and sends the rectum the message that it is time to function. As such, sitting on the toilet 10- 20 minutes following a meal, even without the urge to have a bowel movement, can encourage the bowels to move. That's why you will read on this forum about kids having a sit after each meal.

Familiarise yourself with how the digestive system works.

Kids who soil often have a mega colon and a distended colon. They withhold poo because at some point it hurt to push it out. So you got to make the poo soft and keep it like that for a very, very long time until the child forgets it once hurt to push the poo out.

If your son has been dealing with this condition a long time without success he may have lost hope that the problem can be fixed and be reluctant to try new treatments. You need to show him quick results, then he will do what it takes to remain soil free - Here i am referring to enemas. Enemas will empty the rectum and if done every morning he will stop soiling in a matter of days, I believe. The oral medication takes such a long time to show improvement and getting the right dosage right is a nightmare.

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A distended colon and rectum, I meant to write

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Hi Liz thanks for posting. I just wrote a long note and somehow it got erased before I posted!! So please excuse this brevity now. In essence we have a very similar problem. Can never seem to be sure whether or not it's constipation now or from the past. Using senokot which he feels helps. Soiling continues, hes 8. Not keen on the complex medical approach, but like the posts about enemas, which we've never tried. However he's keen to have a go. So any further advice on how to administer enemas safely and comfortably to willing children would be greatly appreciated.

Keep up the good work parents, we're all amazing!

Best wishes

Alex.

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I recently read the first chapter from encopresis.com, it is available for free on the website. Very informative. You will find lots of info on enemas use for treating soiling.

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Also read the page on Treatment of Chronic Constipation on med.virginia.edu

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