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8yr old boy with encopresis

Question:

Our son was toilet trained for numbers 2s before starting school and all was fine. However, for the last year or so he has had soiling. This was every day but is now about once a week. We tried Lactulose and he was going well. We made him sit on the toilet 20mins after tea and this worked fine. If he is involved with other children or watching TV etc. he will not go to the toilet if he feels the need (sometimes he says he didn't know he needed to go). As I thought things were going well, I assumed his body would tell him when to go to the toilet and we would not have to keep reminding him, but that is not the case. I am going to try Lactulose again but my question is - how long will it be before he goes to the toilet without being prompted by mum or dad? P.S. I believe the encopresis started because he didn't want to do number 2s at school and would hold on, thus becoming blocked up. Any help/suggestions is greatly appreciated!

Answer(s):

Your son may not be aware of the need to open his bowels due to his holding on resulting in his rectum being a bit stretched, and thus not able to feel when there is a bowel motion there.  Also, many children get very engrossed in activities, and do not recognise the need to toilet.  What type of bowel motions is he passing?  Hard, soft, mushy, watery, a mixture.  Lactulose will be helpful in that it keeps the bowel motion soft and stimulates passing bowel motions.  He may need to be on this for quite a few months until rectum has reverted back to its normal size and sensation.

Get your son to sit on the toilet after breakfast and try to pass a bowel motion.  This is the most common time of the day for people to open their bowels, and eating breakfast stimulates the passage of bowel motion through the bowel.  Make sure his feet are supported with a foot stool or similar, and his elbows are resting on his knees.  If he tries to hold the side of the toilet seat, try to stop this as gripping causes the muscles of the pelvic floor to close up and the bowel motion canít come out.

Reward him for trying to sit on the toilet at the right time, rather than if he passes a bowel motion initially.  He has to retrain his bowels and this can take some time also.