Encopresis - Bellevue,WA

Hi,
She's right. You can't make her poop. If I were you, I would tell her that you know you can't make her poop, but that you are worried about her because it's not good for her body to hold the poop in. Ask her if she's scared or if there's anything you can do to make it easier or more comfortable for her. If she thinks you're trying to make her poop than it may have become a power struggle (and she can't let you win!) If she knows (or thinks) that you don't care when or how she poops, but that you're just concerned for her. She may be able to tell you that she's uncomfortable, scared or whatever. Get on her side, try to understand her and she won't have anyone to fight against. The hardest thing to do might be to not say anything judgmental, and wait for her to decide that it sucks to hold her poop in when there's nothing to win (i.e. the power struggle).
Good luck. Kids and bodily movements are tricky to navigate.

There are three things you can't make a child do, eat, sleep, or pee and poop on cue (sigh). But you can modify her diet to make her bowel movements looser and that that would be a good thing in this case. I would include in her diet: raisins, fresh fruit (not apples or bananas) (peaches and pears yes!), rye tack (I don't know if they call it that any more but it really make me go!). Things like that. And lots of water and fruit juice (from canned pears or peaches is good too).

Yes it does sound like part of it is a control issue. I agree to be sure that her diet is rich in fruits, vegetables, and grains which are high in fiber. Also be sure that she has enough liquids. Prune juice and prunes will help. You can mix the prune juice with another juice such as pear to make it more palatable to her. Continue with the Miralax. Mirilax works by drawing fluids into the bowel and thus softening it. Cut out dairy, including ice cream and cheese. They can cause constipation. Live organism yogurt may help.

I would tell her that you are now going to rely on her to poop when she needs to. Explain to her about the health hazards of not pooping. Sympathize with her when she does try to poop and isn't able or it is painful. Tell her that the more she doesn't poop the more painful it'll become. Tell her that you know she can work this out for herself and that you will take her to the toilet after meals because that is when most people poop. But that if she doesn't want to poop that is OK. You'll trust her to poop when she's ready.

It will take awhile for her to trust that you really aren't going to bug her. And it will take awhile for her body to learn how to have frequent softer stools. Have some toys and books next to the toilet, potty chair so that she can go in and sit down to play. Be light hearted with her. Make sitting on the toilet/potty chair a fun thing to do. Pooping is to just be a by product.

This did probably start out because she was constipated and it was painful. Now, after you've understandably paid a lot of attention to her not pooping, it has probably become a power issue. She also senses your anxiety which increases her anxiety, causing her body to tense up. Several different things are going on.

Try to relax.. Let her know that her body will figure it out. Encourage her to relax. Focus on regular trips to the bathroom that are fun without focusing on her having to poop.

It's a two pronged approach. Diet and relaxing, letting her have the control.

Our recently-turned 2 year old daughter is going through this right now.

Our pediatrician recommended the same thing - she was to be on Miralax for 8 weeks, but we're assessing if we need to go longer. She's been riddled with ear infections again this year, too, so the antibiotics have really wreaked havoc on her digestive system. So, we haven't been able to get to normalcy yet.

We do keep lots of fresh fruits and veggies in the house and serve them with every meal. Both of our kids love pears, so we've been loading-up at Costco (fresh) and having them as a snack in the evenings.

We also got Activia yogurt for the kids (we eat the light, they eat the regular) and have that as snacks as well. Because they're only 4 oz, they're a great size for them.

The only other thing we're making a concerted effort to do is to praise her when she does poop. She's still in diapers, but when she does have a BM, we really try to tell her how proud we are of her and ask if she feels better in hopes that the positive reinforcement will impact the psychological aspect of the condition.

Best wishes.

We went thru this w/our oldest daughter and up until last year she was still under the care of a ped gi. Sami was given it all, but the most effective thing at that age was kondromul (available at a pharmacy) - it isn't a RX but it works wonders. She would get that mixed in milk and by the morning, she would have to go potty. We ended up at the e/r so many times b/c of her constipation - it was horrible. I would honestly ask your dr for a referral to a ped gi before it gets way out of hand. Keep your chin up, there is an end in sight.

Oooh, we went through this EXACT same thing! It was awful for a while. Our ped also put us on Miralax, but regular doses just weren't working. So we ended up taking a weekend and having a poopfest (gross huh?). But it worked and she hasn't had a bowel movement since. I'd recommend doing it under the guidance of your ped (I don't know the particulars AND I'm not a doctor) but we gave her Miralax four to five times a day for two or three days to the point where she physically could NOT hold it in. It meant that poop was everywhere for a little while. But after that weekend she has pooped in the potty ever since. Again, please check with your doctor. My daughter was 3 when we did this so she was a bit older. And it totally was a control thing. :)

-M.

I went through the same thing with my daughter for years! I wasn't getting any help from the doctors, then she started bleeding. I went to a gastro specialist and Miralax is the way to go, but you have to double up on the dose to clean her out. She won't be able to hold it in any more and she may leak a little. but then you can cut back to the normal dose. My daughter went through it for so long that her intestines actually became stretched out and she no longer felt the urge, so it took her a while to get back to normal. She is 12 now and doing fine. The sooner you start the better. My son started going through the same thing and I started him on Miralax right away and now he is a great pooper.

I second the Magnesium supplements, we have our son on CALM for kids, as suggested by the last post, it is a powder that you mix with a small amount of water, it tastes like orange. Then we mix it with his juice, and you can't even tell. Definitely a more natural solution than Miralax. Works like a charm, although he is not on it for constipation problems. My husband and I have tried the adult version for other benefits as well, and we can attest-it is effective! Good luck and hopefully its just a phase.

It can be so frustrating when our children won't do what we know will help them! And, it's painful for us to watch our little ones hurting. I know a mom who went through this, here's her story of how she worked through it:
http://superprotectivefactor.wordpress.com/category/emoti...

It's important for you to have support as you work through your feelings about what's happening, the frustration, the powerlessness, the fear etc. Th more you can be supported, the more relaxed and supportive you'll be of your daughter. Your little girl is lucky to have a mom taking such good care of her and getting her all the help you can!

We have a product called probiotic boost for kids and probiotic restore that will make her regular. This complex of Bifidobacteria and Lactobacilli includes seven strains naturally found in the human small intestine and colon and is formulated with prebiotic fructooligosaccharides to restore and maintain healthy flora for enhanced digestion.

Make sure you are not dosing with any extra Iron (supplements, in foods)which will cause constipation problems.
Magnesium supplements can help loosen bowels. It usually takes about 6 hours for magnesium citrate to start those bowels moving. Kidcalm is dosed for children.
Magnesium oil is a substance you can put on her skin and she can get a bit of magensium, that way also. Vit c is another that can get the bowels moving with a high enough dose.
By all means, reduce grains (especially processed- breads, cereals, cookies, crackers, etc)which contribute to this problem in many ways. Her diet should be meats, fruits, veggies, some milk, and LOW LOW grains. Cut out white breads completely.

I will add my two cents to all the answers you had... We have been dealing with constipations since my son was 2 months old. Instead of Miralax, try to use Glutalax (this is the perscription version of Miralax), it works better with less amount. And it might be cheaper with the insurance coverage. I'm not sure about the name but I can find it for you. But before that I would try to solve the problem with probiotics. The ones you get in the yogurts are not enough. My son was on Glutalax for 5 years before we did find out that the probiotics can do the job. We still use the medication from time to time when the things get bad. Enough that it looks like you need to deal with some contorl issue. I would let her have some control over the situation. Let her deside when, where and how to do it. Just give her choices. If she thinks that she controls the situation your life will get easier... Good luck!

My daughter has had the same problem off and on for the last year. In our experience, when she would get very defiant and withhold for days on end, it was a control issue. So, as hard as it may seem, don't talk to her about it for a while. She's trying to exert control over her body and the more you try to control when she poops or where, she will keep trying to hold it back. Continue with the Miralax per your pediatrician. It will work in time and she won't be able to hold it back. Once she is "cleaned out", you can adjust the amount of Miralax you give her so that she's passing a soft poop daily and it stops being scary. Once that happens, you can start talking to her again about how she's a brave girl and how she can make the poop come out everyday. In the meantime, be prepared for some messy pants and try not to be upset by it. To get to a point where all the backed up poop comes out, you have to give her a large enough dose that she won't be able to completely control it. Good luck!

Hey girls, How about dried plums (prunes). Kids love them and they will definitely cause them to poop. Just 3 or 4. You can get them at Costco in a bag. It makes me feel terrible that children have to be on some kind of a drug to take care of some of the simple (please know that I don't consider this a small problem) every day body functions. I really don't have any idea if it will unclog her system but, I guarantee that it will keep her regular if she eats 3-4 a day. Red grapes are also great. Watch out because, there is a chance it could turn into a loose bowel too. My best to you H..

My daughter is now 4. We have been struggling with constipation since she was 20 months. At that time she broke her leg and was in a spika cast for 2 months. She wanted to be potty trained at about 2 1/2 but constipation became an issue. We just put her back in diapers and told her that her body wasn't ready yet. At 2 yr 10 mos she decided that she was definitely not going to wear diapers anymore. She got constipated and cried and cried while trying to poop on the potty. It became a fear thing. At that time I took video of her on the potty to the doctor and we started her on adult doses of miralax. She was never a big drinker and it was hard for us to push fluids and make sure she got it all (without it becoming a power struggle). We were successful with mixing it in pear sauce (Trader Joes has it). We let her use a diaper for poops. She did have to be in the bathroom when she went poop. She got to the point where she would get her own pull-up, put it on, use it and then we would help her clean up. This lasted for about 6 months. It got really old for us but we were careful not to make a big deal of it. I knew she could feel when she had to go and was not afraid. I finally told her that we were almost out of pull-ups and offered the potty or maybe to poop on a newspaper on the floor in the bathroom (gotta give choices- thankfully she chose the potty, phew). She then transitioned to the potty. We tried weaning the miralax down and did get it to about a teaspoon everyother day but then got in to trouble again. She now takes it every day which seems to be good for her although she does not go every day. She calls it her "poo-poo medicine".
I have friends who have daughters who still poop their pants in kindergarten. This is because their bowels get too stretched out and they can't feel it. Also the softer poop will go around the clogging poop. Both of these friends have had some success/support with the encoparesis clinic- I think in Edmonds or Everett.
I would suggest- upping the miralax to where she has soft poops. Doing all of the nutritional stuff everybody has suggested. And most importantly, not talking about it with her at all. If she is in diapers - just tell her that her body is not ready yet. Make it a total non-issue. I wouldn't even tell her that you are concerned. I would completely drop the subject and try to remove the issue from her radar. Treat it all as normal. I wouldn't even praise the poops -although you could comment "wow, this is a big one" but not "good job for going." Read "Everybody Poops" or any other of the potty books to her if she is interested. Just have it around but don't force it on her.
I totally understand your anxiety around it. Everytime my daughter starts gettiing in to trouble I get very anxious. I start thinking of her being incontinent in kindergarten or at a playdate. It is very stressful. You can't let your daughter know that you are worried though. I don't know how well I hide my anxiety around it from her but I try. It's hard.
We are going to go get an abdominal X-ray this week just to make sure we are on the right track. I suspect that there aren't any "rocks" in there but need to double check. We are a year and a half away from kindergarten.
Remember that your daughter has the best parents for her. She will be OK. Who knows, pretty soon you will be responding to this question on mamapedia with what worked for you.

There is actually a clinic in Edmonds Wa. for encopresis. It was founded by a nurse from Seattle after the Children's Hospital shut down it's clinic. We took our soon to be 3 year old there for the same issue and have been following her advice. It is not a control issue. After children get constipated for a long time for whatever reason their rectal muscles loose the ability to tell when they are full or empty. The only thing you can do is completely clean her out...lots of miralax (we're on two capfulls daily) and a week of Fletcher's laxative (one teaspoon) and two teaspoons mineral oil. Once they are completely cleaned out (our son had 3 months of poop inside him) it takes 6-12 months to regain muscle tone so you need to keep up the miralax for up to a year or more. We have had 3 x-rays and have been devastated to see that even when our son was going completely liquid poop every day it doesn't mean they are empty, it is just the leakage around the big ball of poop still in his rectum so don't get excited and stop early. They not only don't want to poop because they have memories of pain but if they were constipated for a while they probably still are really backed up inside and it still hurts every time (poor kids!) Bribes won't work because it is a medical issue and we were amazed how little most doctors know about it. Good luck! Thanksfully we were told that with them so young we can turn things around quickly but don't push potty training at all before they are feeling better and know that you want to get it fixed before they start school. That is when it can lead to really big problems.

I don't know how to help you and I'm so, so sorry, but I just wanted to let you know that you're not alone. My 22 month old is headed down this same path. I will be following this post to look for help, too. Thanks for posting... I'm sending you strength! :)