Soiling

How old is your son and is “three good months in a row” the longest he has ever gone with good bowel control? This makes a difference in the possibilities to consider. It certainly can be just stress or a transient condition. On the other hand if he is elementary school aged and has never had good bowel control it is worth a full workup by a pediatric gastroenterologist. I used to work with a spina bifida clinic and we ended up seeing a couple kids with the least obvious form of spinal cord defect who were not diagnosed until ages older than 6. They had bowel control problems that were basically ignored by the family doctor something they would “outgrow”. In fact they weren’t going to outgrow it because they had a “tethered spinal cord” and needed surgery and specific bowel management training. At least one of these kids also had lower limb problems which should have been a tip off to investigate the spinal cord by MRI. Its always a hard decision how much to pursue specialty medical care. Good luck.

Our son is 7 (8 in September). Doctors have been little help suggesting only that it be managed with sticker chart incentive programs.

He had three months without an accident. I explained to him he had a form of encopresis which would require diligence in “sitting” after breakfast & dinner. These three months have made me think that it is not a physical problem. I’ve been reading about sensory integration and have been wondering if he is somehow unsensitive. I just don’t know.

I will certainly take your advice and take him to a pediatric gastroenterologist for a full work up. Thank you.

I have had students with this problem in the past (both boys, now that I think of it….) One major concern is that there are no rewards for soiling, including one-on-one time wiht mom or some other significant adult who helps with clean up…or even worse, mom taking you home from school!

It will take more effort for your son than for an average child to control these incidents. Social Stories, which are often use for children with autism, helped with at least one of my students while there were some temporary family issues.

You can find out about Social Stories at http://www.udel.edu/bkirby/asperger/socialcarolgray.html
The story we created certainly did not cure the problem, but did provide more constant reinforcement for the need to spend time “sitting.”
Karyn

You don’t say how old your son is but certainly stress can be a powerful thing. If it is the stress of the move, it isn’t likely any sticker reward system is going to do much. If there’s anyway to relieve this child’s stress, that would probably help more. As you must move, maybe you would consider having a conversation with him about the things he’s surely worried about like making/losing friends, new school, new bedroom,….

Moving is hard on everybody. Psychologists say they see people under the greatest stress when they lose their jobs, get a divorce, experience a death, or when they move.

Good luck to you and your son with this move.

Karyn,
Thank you for your response. I looked at Dr. Gray’s website and get the gist of the social story but could you give me an example of how a story would go? She mentions specific guidelines? Maybe this isn’t something we should try on our own.

BTW, we do not provide any positive reinforcement for soiling. He changes and cleans up by himeself and rinses his own underwear. Although I am in the room for part of this operation, I’m all business. I do however sometimes keep him company while he is “sitting.” We’ve tried so hard to keep this from being a big deal in his life (though I have lost my temper a few times in the 3 or 4 years since potty training).

Thanks,
Jess

My son is almost 9 and we have tried almost everything. We have never been so diligent about anything. We have done the whole gastroenterology route, MRI, motility testing etc. We are going through sensory integration now because he is undersensitive from the SIPT test, he has a high pain tolerance.
The GI feels that he needs more help with body awareness, we are going to do a type of maritial arts for this after the OT is done.

Since we have tried everything, and still cannot figure out why he relapses we are hoping he will outgrow it. I am in the medical field and find it very very frustrating.

Thank you all for your input. I’m learning more about “social stories” from: http://members.tripod.com/RSaffran/social.html
I think my son will benefit in several areas from these stories. We are also scheduling private O.T. evaluation.

Your support is encouraging. Thank you.

Just once I heard of this problem being associated with attentional issues. The child did not attend to the signs of the need to release. Medication for attentional issues, not something every parent is comfortable with, did the trick for that child.

Good luck.

What is a SIPT test? We’ve been battling this for the last few years, with very little improvement and occasional bad setbacks. We’ve ruled out the spinal cord problem. Like you, I suspect there’s more here than simple encopresis. It seems as if there are sensory issues. He has apraxia, with a whole host of assiciated sensory issues. My son is scheduled for a test next week that we hope will rule out Hirschsprung’s disease where a part of the intestine lacks feeling. He tells me he has no urge, even when he has been given massive doses of of pretty intense laxatives (under a doctor’s direction and supervision). I don’t think it’s Hirschsprung’s, but think it has more to do with his apraxia. Would the SIPT test give us a clue?

Thanks for any info you can give me.

You didn’t mention what your boy’s particular condition is, but for many autistic people with this problem it is not so much a question of attending, it is one of sensation.

I know several adults with autism who have related to me that they do not feel the need to void a movement like you and I do. They can be moments away from the act before they can sense the pressure and need to go, which can often lead to a footrace to the john.

If your child has strong sensory issues, this may be the case with him as well. One thing you can try is to get him into a routine of trying to go at specified times to head this off. This can help if he can overcome the lack of sensation and try to void.

If your child has strong sensory issues, there are two things you can investigate to ease them. One, try removing all dairy (including milk solids in processed foods) for a period of about 6 weeks. Casein peptides are known contributors to sensory integration problems.

The second thing is to test for the presence of elevated lead leavels in the blood. Toxic metals are all around us, and many LD children have elevated levels and do not get checked for it. Lead can give many of the same symptoms as autism/ADD/PDD. Your pediatrician can order the test for this and it can be done at nearly any hospital lab.

Good luck to you!

Hi. Thanks for your insight. I thought the same thing about lead but when I called and asked for a test a few months back I was told by the physician assistant that if he hadn’t shown high levels at three y.o. he would not show them now at seven. It must be time for me to get pushy.

My son’s learning problems are difficult to pinpoint but a recent neuropsyche examiner wanted to sum it up as ADD. I think he definitely has some sensory issues which are being addressed at home and at school with OT and we are going to have a further OT evaluation done soon. He is also being checked out for CAPD.

Since my first cry for help on Monday, I have eliminated whole wheat bread from his diet and asked him to please be patient when he goes to “sit” after dinner (he’d been making his visits shorter and shorter). I don’t know if its the wheat gluten or if we were just in a bad place for a month but he seems to be doing better now and we have been three days without an accident. He also seems to be more “present” again. We’re keeping our fingers crossed!