Encopresis (Refusal to have BM's in the Toilet)

Question

            I love working with kids and I know you work with a lot of kids so I thought I'd pass this post on to you. If you can offer insight, I’d appreciate it!

             Had a call from a mother who is looking to help her four year old with constipation.  I am working on getting a doctor’s referral.  According to this mother, the doctor gave the child a prescription for benefiber and it is not working.  He goes to the potty once every 2 days; has had accidents in school where the teacher had to change him.  He was, at one time, potty-trained and was doing fine, but now is not.  She says he goes potty in his pants THEN sits on the toilet to please her. 

             I read up on encopresis (not going #2 in the toilet past the age of potty training) and stool retention and found that it can sometimes come from having a painful bowel movement that causes the child to become afraid to potty.  Other than this, I don't know what it's all about.  Have you worked with this before successfully?  If so any pointers? 

Answer

             When I child has done okay with potty-training and then, suddenly, is no longer doing well, I start wondering what’s been going on in the family. Did a new child come into the family?  Is there fighting? Is the child afraid the parents might divorce? Was there a death of a relative or pet? Of course, a painful BM is certainly a possible initiating event, especially with a very young child who can’t imagine beyond the moment.  

Here are just a few of the possibilities for assisting such a child:

            1.  Find out the child’s favorite hero/heroine or TV character who they admire.  Ask if they think that person soils themselves or gets the potty on time? Then make up a story where the child goes on an adventure with that character through a day-long period, where they stop now and then to go to the bathroom, in order to continue their adventures.  You could even have the child in the adventure have to “go” but hold on until getting to the proper place because of not wanting to be embarrassed in front of their “hero.”  Always include how easy it is and how much better they feel afterwards.

            2. In my GREAT ESCAPES, Volume IV are some bed-wetting scripts which might be adapted. Also there are methods of “dumping problems” - stories and scripts which could be helpful if, indeed, the child is concerned about something, including the habit.

            3.  There are certain animals, such as a cat, who are extremely clean about their habits.  The child could think of themselves as a “cat” or other animal, who would never think of dirtying any place with their feces. 

            4.  If the child is overtly fond of a parent, you can ask the child if their mother or father (whichever is favored) dirty their pants? Do they use a toilet in time? Then ask if they want to grow up to be a big boy like father or mother?