Encopresis: how can we encourage our child to clean himself or ask for help immediately instead of ignoring the dirty underwear?

Question

Our son (now nearly 6.5 years old) has problems with potty training for years now. (The long history is described here: How can we potty-train our pre-schooler outside the home? ).

Remarks:

We are in regular contact with a doctor specialized in such problems and her diagnosis is "encopresis with obstipation".

We still have those problems, at least every second day on average he is soiling between 1 and 7 underpants. That's ok for us, but the main problem is that when it happens, he does not try to clean himself immediately or tell the kindergarten teachers or us to help him, but very often he just ignores it and continues playing/"working"/whatever he does and often even does not admit it if he's directly asked if he has dirty underwear.

We think that this makes things even worse, as it smells for sure and other people notice it and the other kids are making fun of him for that reason.

But although he is very clever and comprehensible in other matters, it happens very often, that he tries to hide it and continue as if nothing had happened.

That makes it very frustrating for his parents and we are not sure how to handle it, as every attempt to "motivate" him acting on it immediately has failed - positive motivation as well as negative one (negative consequences).

We know that this is a very sensitive and difficult topic - more than ever as because we had a lot of arguments and hot discussions with him in the past. But it feels wrong to just let him do what he wants (and at worst run around the whole day with his smelling pants) - also as cleaning him(self) is much easier and faster as long as it is "fresh" ...

Any hints are appreciated.

In autumn, he'll go to school, which might make things even more complicated as there will be nobody any more who feels responsible for helping him clean himself...

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Additional remarks:

I am not sure, why he so often refuses to tell us directly, when he soiled his pants. Some ideas (maybe it is often a mixture of several reasons or even something else...):

• He does not want to interrupt his play/activity
• He does not want that other people notice it
  (however we do everything to help him and to avoid that others notice it, if he tells us)
• He sometimes might be so concentrated on his activity, that he really does not notice it directly
• Maybe he did not tell it us for some of the above mentioned reasons and then is ashamed that he did not tell it directly and tries to ignore or hide it
• Maybe he's trying to ignore it
• Defiance - some days ago he said, the more often we remind him to "tell us as soon as it has happend", the less he would do so... I decided and promised to him to not mention it again for some weeks. The months/years before, we (parents) had reminded him several times a day to tell us - especially before "critical" situations, where it would be especially difficult to clean him or where the "damage" might be significant

I asked him, if there are situations, where he feels, that he must go to the toilet but would rather keep playing/crafting/doing what he currently does. He said something like "not many", but maybe he just says what he knows is best for him ... I'm not sure.

There are, however, also times when he tells us... we had one such "accident" in public transportation, where he directly told us that there was poo on his seat (shock), it was so much that it had even "jumped" out of his pants. Thanks to his quick reaction, we could clean it and search a place where to clean him.

Answer 1

My son had this same problem. In fact, just tonight, he had a "skid mark" in his undies because he held his poo and it leaked out. It was his last day of school, so, like your son, he was too busy to hear nature calling. Btw- my boy is going to be ten in the fall! Way too old for this, IMO, but, it is leaps and bounds better than it was when he was 4-6 years old.

As a parent who has suffered through years of stench, ruined social events, embarrassment, frustration, and so on, I am willing to endure more unpleasantness if it will help you and your boy overcome this. Here's what we did, under the guidance of a psychologist.

First, she told us that ultimately, for US as parents, it was a mere laundry problem that could be solved with bleach. This was important advice because really, we were wound pretty tight by this issue and that wasn't helping. Our first mission was to get everyone in the house to relax. How did we do that? We completely ignored it. We stopped asking him. We would do the usual "last chance for potty before we go out" and then we would go. (Prepared for external clean ups, but nothing more.) No more bring held hostage by a child. If he pooped, we continued on with our day. The pediatrician assured us that he would seek help before any serious harm was done, and reminded us of the environment inside a diaper that the boy survived. I realize you have tried this, but it really is about attitude. You can't ignore it, and yet be a basket case. Go deep inside yourself and really really let it go.

Meanwhile, we publicized our bathroom habits. My husband and I would announce "I'm going to go poop now, and when I'm done, I will get back to ___." We enlisted relatives to do this as well. You'd be surprised how hard this is for some people. It becomes clearer why the kid is having issues once you start seeing adults struggling with it.

Now, here's the part that I think will get everyone in an uproar. We made a pin for him to wear only at home when he had accidents, or, whatever they are. It was about 2 inches by 2 inches, and it had "I pooped my pants" written on it. Whenever he pooped at school, and got off the bus reeking of poo, we would say nothing, but the badge would go on. If he pooped while watching tv at home. I'd put the badge on. You catch my drift? The first time I put it on, he was very insulted. Why do I have to wear that? I would ask him "why do you think you have to wear it?" This made him talk about it-be the first to bring it up. As soon as he said "because I pooped in my pants" I took it off. The deal was he had to wear it until 1) he cleaned himself up, or 2) admitted he pooped and asked for help. A few times, he wore it for quite some time before he took action. We told him he could wear it as long as he wanted, but obviously it couldn't leave the house. He went back to playing until a friend came by and he didn't want his friend to see it so he hurried up and cleaned up. That incident I must admit was the turning point for him. He finally got it. It's embarrassing to poop my pants. It's not embarrassing to go to the bathroom or ask for help. Aha! I get to play if I have fresh britches!

Now, look. I've already been reamed out by my friends and family. He only ever had to wear it at home.. We carefully guarded him from outside eyes. Not one person who didn't share direct DNA with him ever saw him wear it. We very seriously considered the impact such a method could have, but, to us the benefit outweighed the risk. He, like your son, had had issues with friends at school and in the neighborhood teasing him. We knew that the social consequences of his actions would be long lasting and severe. I can still remember the name of the kid in my kindergarten class that pooped his pants regularly. I can't name one other child. I refused to have that happen to my son. So, it was worth a try.
The reason I asked if you knew his motivation was because I am sure that this method is not broadly applicable. In fact, you might think I'm out of my mind for doing something so drastic. My boy seemed to think that no one noticed or that no one cared about his bad habit. He thought he had everyone, including Mother Nature fooled. He assumed that since he didn't mind the smell, no one else did. Like your boy, the more we harassed him, the more defiant, sneaky, and determined he got to NOT use the toilet. He needed a strong message. Here's how I think it works: The combination of removing the "shame" from using the toilet (by us announcing our bm's and talking about it openly) and making him feel shame where he should (when he poops his pants) we broke the cycle. He didn't like wearing the badge, sort of like we didn't like he smell. He soon associated the smell and feeling of poopie pants with being unhappy. Kids that young aren't capable of true empathy or being objective, so it has to be about them and their feelings.

I just want to be clear: This is not potty training. Making a young, untrained child feel ashamed of having an accident while learning is a big BIG mistake. However, my older child, who btw was successfully potty trained for almost two years before this started happening, was not having accidents. He was making a choice to hold his stool so that it would eek out uncontrollably. (Actually, he admitted that sometimes he would "let a little out" to buy himself some time!! Evidence that this was a decision he's making, not some physiological or medical issue. We knew it wasn't anyway, after a year spent testing, evaluating, laxative experimenting-all under a doctor's and several specialists' supervision..). So, there you have it. Perhaps the most unconventional answer on all of stack exchange. I truly feel for you and your son. It's a really tough time. But look, you will get through it. My son's incident today is the first one in over a year. He's not perfect, but vastly improved. I'm sure you can agree that any improvement is welcome. I hope you see some soon!