Encopresis

[~clover~]

He's at the point that he can't feel he needs to go again. Regular toilet trips. We've been trying for about an hour between today.
Need to clear the blockage to shrink the bowel back so he has sensation again.

I'm taking dd1 to the gp on Wednesday to see what he suggests. 10 days would be enough if it clears most of it. We can continue one or 2 a day, but hard to do more with school.

[Abigail]

We've been dealing with this for well over four years. Some things we have learnt;

- medication, we've been through a lot before finally being moved to osmolax which is similar to movicol and works the same way. Essentially these two draw water into the bowel, they don't cause a dependency and they don't make the bowel lazy. For this reason they can be used long term with little side effects, up to three years.
Although not ideal if you need to use fizzy drink to get the medication in or whatever the favourite drink is. Osmolax won't change the taste of the drink though will curdle cold milk.

- water is your friend, not enough water means that these medications do not work efficiently or effectively.

- this is a long term problem which requires a long term solution.

- routine, routine, routine. Especially where toilet refusal is involved. So sitting on the toilet after every meal ( the most likely time to need to go) sitting for a minimum of five minutes and rewarding just for sitting. Sensation can take months, even years to return if at all. My own child doesn't have normal sensation, we toilet each night before bed as part of the routine, this is just when he goes and how he determines his toileting for the day. He doesn't feel the need to go unless he is in severe pain, we go as a matter of course.

- severe back log, you may need to consider a suppository or enema to stimulate the bowel and clear the back log or if severe enough seek assistance from your hospital.

- position matters, we keep a stool by our toilet and it is used for the purpose of doing a poo. Feet are placed flat on it and the correct pooing position is then assumed. Google it. It helps. Don't fight the body work with it.

- Bristol stool chart, keep a chart in accordance with the Bristol scale, it will let you know what is happening and where you are at. It can be invaluable guide, record when he goes, how much difficulty and what scale it fell. This can also help you later if things continue to escalate and if you need to see a medical practitioner.

- weaning, if you think your ready to wean then you probably aren't. Wean too early and you can wind back at step one. No where. Weaning should be done gradually so that you can see if you are going backwards and you can go back a step. We've been trying to wean for years, we are getting close. You shouldn't wean until you have a pooing routine in place and follow it religiously with success. Another reason these medications are recommended for children being that they are easily manipulated and you can tell how you are going each step of the way. It can take years for sensation to return and for the bowel to shrink. Again this is not a short term problem, it will take time. One day we will get there until then I'm happy for him to be medicated if it means he has a normal life where our every moment doesn't involve pain and poo. We have our routine and unless you were to come to an appointment with us you wouldn't know he has had this issue for years.

- inguinal hernias, enough strain can cause this to form. Be alert not alarmed.

- doctors will only get you so far, gps are just that general practitioners. Our best ally has been our paediatrician, if you think it is not behavioural then ask to see a gut and bowel specialist, otherwise a behaviouralist specialising in constipation. We have gotten further with our pead than any doctor before her. Our gps actually prolonged our problem and made it so much worse than it needed to be. If you can also seek out a continence nurse they may be able to offer you more advice. I understand you will likely have to travel to a major city centre for these. They are worth it.

- you are not alone xo hang in there.