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My 12 year old daughter has been dealing with retentive encopresis since age 6. She avoids going to the toilet at all. This results in soiling and the production of an amazing huge toilet-clogging log-like object every week. We have been trying for years to get her to talk about this, but when we do talk about this, the response is ALWAYS "I don't know" despite what her pedi, GI doc and psychologist tried to do or suggested we do to get her to talk about it. We switched psychologists last year after a year of not talking about this, no luck.

We have tried so many treatment plans since diagnosis, specifically tailored to her, such as enemas, scheduled toilet sittings, rewards, consequences, psychologist, etc. she just keeps holding it in. Right before summer, her pedi and the GI doc laid out a clear treatment plan of laxatives, regular bathroom visits, and a rewards program. She did take the Miralax (2 table spoons) but she just kept holding it in and soiling her pants. She avoided going to the toilet. I made her stay at the toilet and told her "if you poop, I will buy you XYZ" (something she REALLY wants)" you can do XYZ only after you poop" and not letting her do things "you can't do XYZ until you poop" and XYZ would be something she LOVES to do. I wouldn't let her leave the toilet until she pooped, so she sat there for hours, no luck. When school started, she refuses to take the Miralax.

Now we laid out a new treatment plan. We TRIED to involve her, the response is again "I don't know." She is supposed to take an enema every morning and sit on the toilet, but she fights daily about taking it. When she does take it, she holds it in and won't sit on the toilet. There is also a diet plan she refuses to follow. She is not supposed to drink dairy, but drinks milk at school. Now the past 2 weeks she refused all treatment which we fight daily about. She refuses to sit on the toilet, no matter what we try. 2 years ago we tried ucanpooptoo, didn't help.

We asked her why she holds it in. Does pooping hurt? Does it scare you to poop? Does it feel good to hold it in? The answer is always "I don't know" and you can question her for hours and hear "I don't know". We explained to her digestion and she knows why she needs to poop. We ruled out any physiological reasons for retention. Luckily her friends don't notice, but one day her friends might smell her soiling, and I talked to her about this, how it would affect, boys , high school, etc. Her response was "I don't know" and she would not talk about this.

Does anybody have suggestions how to get her to start pooping in the toilet regularly?

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    This sounds very much like a psychiatric problem, perhaps perhaps akin to an eating disorder in that the child has self-image issues that conflict with reality and her health. I wouldn't begin to offer advice on something that's likely so difficult, personal, medical, and psychological. Continue to pursue it as the medical issue it is with seriously trained people. – Marc Nov 8 '14 at 16:46
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    Your current psychologist: are they a pediatric psychologist? Do they specialise in encopresis? If not, can you find one that does? – A E Nov 8 '14 at 20:18
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    I suggest looking at some of the other Questions about encropesis that have been asked on here before for advice and ideas, in addition to whatever Answers come here. – Acire Nov 8 '14 at 20:40
  • There is a new book on Amazon - "Stool Withholding: What to Do When Your Child Won't Poo" - it might help, just a thought. My son has this too. Good luck – user11856 Dec 11 '14 at 18:47
  • I had this problem up until I was about 12. The things the answer says not to do, my parents did; that's probably why I had it for so long. I am 16 now. Once I was motivated to stop (from within), after a year, I was totally normal. My parents would ask me why; I didn't know. Back then I thought I was the only one with this problem and never thought to search it until now. I just wish it could have been dealt with properly, much sooner. – user17504 Aug 3 '15 at 3:47
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There are online 'parents of encopresis' support groups. A quick googling came up with several. Interacting with other parents in this situation may help you, and might give you ideas on what to ask your child's doctors.

When encopresis is this entrenched, you need a multidisciplinary specialist approach: if she has never been hospitalized, she should be, in a children's hospital, like Boston Children's or Seattle, Cincinnati, Children's Hospital of Philadelphia etc. where they routinely deal with encopresis. There are Children's hospitals in your state. This is where they will not only evacuate her thoroughly and start a new plan that is tailored to your difficulties, but they will also do any necessary tests that haven't been done, such as a spinal MRI, blood tests, a biopsy of the descending colon (if needed) to rule out a gut wall abnormality of innervation/smooth muscle, a few family therapy sessions to get you all on the same page, etc.

As long as she can hold her stool, she will. It's usually because their sigmoid colon is so distended that she no longer feels the urge to push - and having someone sit on a toilet for an hour will not stimulate her to have an urge to push. If it's not there, it's not there.

You are probably aware that the colon has to remain (relatively) empty for a while for it to get back into a state where she actually has an urge to pass stool. Her intestine and rectum need to be retrained to gain control over bowel movements. This takes time. A frustrating amount of time.

Have diabetes, hypothyroidism, IBD and Hirshprung's been ruled out? I would be extremely surprised if they had not.

Things that often don't work with encopresis:

  • Punishing or humiliating a child with encopresis.
  • Expecting a child to "explain" her encopresis (can you explain why your heart beats the way it does?) She actually doesn't know why she can't go more often.
  • Giving her an enema every morning before school (perhaps you should pick a time when she won't drip the rest of the day).
  • Forcing her to sit on a toilet for an hour.
  • Fighting with your child about it.

You say she isn't compliant with her diet. Do you have any food in the house that she shouldn't eat/drink? How is she getting around this?

This isn't just a difficult problem to deal with; it's an enormous problem, and you, as parents, might feel less helpless with some support from a group, or maybe a therapist specializing in this problem. I can only begin to imagine the pain you're going through.

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I would have no idea how to approach this with a 12-year-old, but we recently had a similar situation with a 6-year-old niece who stayed with us for an extended period of time while her mother and father battled out some custody and other issues. It is an extremely difficult situation to approach, and all I can offer is moral support and an explanation of what seemed to work.

Moral Support

You can do it!

What worked for us

The context

This little girl was neglected and abused, and even now has a language and apparent cognitive deficit both from a lack of interaction (left in front of television repeatedly and for extended periods of time, locked in bedroom to the point where she would soil herself several times without receiving attention, punished for soiling herself - as when locked in bedroom, or any other time, yelled at while on toilet to relieve herself, etc. etc.), and we are convinced the behavior is a direct result of some of this mistreatment. This may partially explain how receptive this child was to praise and encouragement, but I don't really know. In any case, this is the general backdrop of our situation.

Behavior and Support

Ignoring the "behavior" side of this. Accidents happen; in this case they happen a lot, and frequently. Provide any assistance needed to make sure proper sanitation is achieved; forget it happened and get on with life. Under no circumstances should any negative attention be drawn to this, or "you should know better/act your age" type of response. Neutral is best, even better if she can do it herself -without feeling the need to do it sneakily to avoid shame/guilt/etc.

Constantly modeling recognition of when to poop. Stating out loud that "I have to go poop" and excusing oneself to go. Exaggerating how much better one feels afterward: "I feeel SOOO much better after letting THAT out..."

Reading books, watching programs, listening to songs, etc., which promote healthy pooping habits, and portray it as a natural, relieving, and healthy process.

Patience, understanding, patience, understanding, coffee break, patience, understanding, beer-after kids are in bed. It can be a very taxing experience if you let it get to you. I started seeing it like a game or personal challenge: "How fast can get this in the laundry and forget about it?"; "I won't roll my eyes until I'm out of sight...", etc.

Teamwork. I don't know how one person could possibly deal with something like this; Parents will really need to lean on each other.

Dietary

Mira-lax, given every morning in a glass of prune juice (and under the supervision of a pediatrician), and served with a movement-friendly diet. We paid very close attention to this, since I don't think this stuff is good for anyone, but in this case is was a necessary evil. We did not usually give a full serving, and we never exceeded the recommended limits. As soon as results were seen, frequency of administration was reduced, and eventually the prune juice, prunes, apricots, and other naturally laxative foods were sufficient.

Flax oil, served twice daily: before breakfast and after dinner.

When things were really bad (to the point of requiring enemas to initiate movements), we put her on a liquid-only diet. One or two days passed before her first (not-in-the-pants) movement happened, and this was great cause for celebration, which really seemed to reinforce "appropriate" pooping.

The Results

When she first arrived, she was wearing diapers. She would not have full movements in them, but would have frequent leakages, and small shart-like poops, after which she would sit on the toilet for a movement (sometimes screaming the entire time. After about a week of this, we started getting proactive with the above steps. She was here for another three months, and by the time she left, she was not accident-free, but she would regularly have accident-free days, she did not wear diapers during the day, would proactively go poop without help (and she had stopped screaming and crying), didn't need the Mira-lax, and continued to show steady improvement.

My strongest advice would be to avoid any kind of judgement or imposed consequences, and would probably avoid rewards (other than praise and recognition) as well. I understand some of what you are going through, and it is tough. With understanding, patience, and a little cooperation from your daughter, slow but steady improvement is very possible, and probably the best thing to strive for.

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Have you tried letting go and not talking to her about this?

To me this sounds like a control issue. This is one thing she can control, so she probably does this to feel in control. Stop focusing on this, stop chaperoning her to the toilet, stop the rewards, treatments, punishments.

She probably doesn't want to talk about it because it's embarrassing. I mean, would you talk about your toilet habits to your friends? No. I think you need to see a psychologist as it will help with your frustration over this.

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    Hi, Maria, and welcome to Parenting. Many parents feel a lot of shame when their child has encopresis. Their friends don't know how to support the family, instead offering suggestions for behaviors that have not been shown to be helpful. But parents should not just wait for it to go away. That has been shown to make the problem worse. – anongoodnurse Nov 9 '14 at 20:18

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