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4 year old with encopresis (new here)
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<blockquote data-quote="rlsnights" data-source="post: 314949" data-attributes="member: 7948"><p>Hi Lakehart - welcome to the board. Got a long reply for you because my son has been through a lot of medical investigation related to his constipation and encopresis.</p><p></p><p>I will tell you a bunch of stuff that probably none of her doctors have told you to do or avoid - mostly because even though they see kids with constipation all the time they are pretty ignorant about what works when it comes to really stubborn constipation. Much of the information I offer came from the head of pediatric gastroenterology at UCLA. They have a special clinic there that is devoted to the treatment of constipation in children.</p><p></p><p>I have a different perspective than some of the others. We too dealt with what appeared to be encopresis for over 6 months before it became clear that something more was wrong with difficult child 2. It turned out that he had an autoimmune disorder called Crohn's which affects the intestines.</p><p></p><p>It is highly unlikely that your child has this but it is possible. It is also possible that she has an undiagnosed motility problem like Hirshsprungs or an allergy related condition like Celiac disease.</p><p></p><p>That's why I second a consult with a PEDIATRIC gastroenterologist. Not an adult GI. And if the pediatrician GI doesn't do anything to investigate your child's symptoms beyond listening, doing a brief exam and then telling you to use Miralax you might want to get a 2nd opinion, preferably at a large university hospital with a pediatric gastroenterology program.</p><p></p><p>in my humble opinion the pediatrician GI should do a KUB (an xray of her abdomen) to confirm the extent of the constipation and to do a very rough screening for obvious abnormalities of the intestines, do a screening for blood in the stool and do a rectal exam - at the minimum. While you are attempting to treat the constipation, if it is long-standing then it is my feeling that more serious potential causes of severe constipation should be ruled out. I would not go more than 6 months with unsuccessful treatment. At that point in my humble opinion the pediatrician GI should be taking a second look at the causes for her symptoms and do further investigation up to and including doing colonoscopy.</p><p></p><p>I would stop doing the enemas personally. As you have already figured out this is highly traumatic to your child and if there's any other way to deal with the problem I would do it. This is not a long term solution and is likely to make your child more angry and uncooperative. Above all you want to work with your child cooperatively to solve this problem. Even though she's only 4 she is probably acutely aware of the social implications of soiling and feels ashamed. So if you need someone's permission to stop - you have it.</p><p></p><p>My son's main symptom of Crohn's was severe constipation to the point of obstipation. Obstipation is when the intestines just shut down because they are full. For a long time his pediatrician gi at the time insisted that the constipation could not possibly be a symptom of his Crohn's and put difficult child 2 through many invasive tests intended to identify a motility disorder.</p><p></p><p>They even proposed surgery to place an ostomy into my son's cecum (the part of the intestine where the small and large intestine join) so he could flush his colon daily they were so convinced it was a motility problem. difficult child 2 was on 5 doses a day of laxatives and a high fiber diet at the time he became obstipated and had to be hospitalized for 6 days to clean him out. So for 2 years we went through the ringer and tried every possible treatment around except the surgery.</p><p></p><p>Here are my suggestions:</p><p></p><p>1. Use a combination of Miralax and Benefiber or something similar to Benefiber. What happens with Miralax is that it makes the poop slippery as you may have noticed. That's why she's having accidents on the Miralax - the poop just slides right out. When you also give her Benefiber it thickens the poop without getting rid of the slipperiness. So it reduces the chances of leakage and makes it easy for her to poop at the same time.</p><p></p><p>2. Give her the Miralax with a minimum of 8 oz's of fluids like water or juice. Same with the Benefiber but you don't need to give them together in our experience. She needs to drink the Miralax within 20 minutes to get good effect from it. No dragging it out over the course of the morning. If she gets a snack and hasn't gone following her breakfast, I would give her the Miralax with her snack and put her on the pot afterwards.</p><p></p><p>3. If you are not already doing so, have her sit on the toilet immediately after meals and snacks for a minimum of 10 minutes. Eating triggers the intestines to contract and move food through the system. So within 20 minutes of eating she is the most likely to need to go poop whether she feels like it or not. This should help eliminate the constipation which is your true enemy. </p><p></p><p>You can offer her a small treat as a reward for sitting the full time. I suggest using a kitchen timer that you set and put in the bathroom with her so she knows when her time is up. She also needs something entertaining like books or a special toy that she only gets to play with when she's on the pot.</p><p></p><p>4. As someone else said, once you have long standing constipation the bowel has been stretched out and the normal sensations that tell you to go poop are just not there. The bowel has to be "shrunk" through prevention of constipation and then retrained so the child feels and recognizes the sensations that go with needing to poop. Once the constipation is stopped it can easily take a year or more to retrain the bowel to give normal sensation signals. That's why the enemas are a really bad idea in my opinion. They do not help retrain the bowel and that is what is going to fix the problem.</p><p></p><p>5. Make the following dietary changes if possible:</p><p></p><p>Avoid constipating foods like applesauce (yes it's constipating), bananas, carrots, dried fruits or any other foods that you notice seem to add to the problem. Some people have problems with milk so you could try using an alternative like rice or soy milk. You could also try lactose free milk. </p><p></p><p>Add food to her diet that promotes good bowel health. Give her this every single day:</p><p></p><p>6 - 8 oz a day of apple, apricot, pear or plum (aka prune) juice or nectar</p><p></p><p>At least one serving a day of the following fruits. They can be served raw, cooked, canned or stewed:</p><p></p><p>apricots, pears (with the skin on), cherries or prunes</p><p></p><p>6. If you see blood in or on her stool then back to pediatrician gi you go with a demand that further investigation be done NOW. If she has fissures (tears in the skin around the opening) and if she has little pouches of skin called skin tags do not let the gi tell you it is just from constipation. Fissures may be but skin tags are usually signs of inflammation. And persistent fissures that do not heal are also potentially signs of a more serious bowel condition.</p><p></p><p>7. You can massage her belly to help encourage proper motility of her bowel. The large intestine (colon) goes up the right side of the belly (the ascending colon) across the top of the belly right below the ribs (the transverse colon) and then down the left side of the belly (the descending colon). If you do some gentle but fairly deep massage you want to follow the natural formation of the bowel. so you would start on the lower right side, move up that side across the top and then down the left side. You can also do a circular sort of massage that goes in the clockwise direction.</p><p></p><p>8. Since she is only 4 I would be using pull-ups myself. But you should have her check them frequently and have her change as soon as possible after she soils. And I would have her do as much of the clean up as she can do. Buy the flushable wipes and put a handheld shower head within her reach so she can take a shower on her own to a certain extent. You want her to take ownership of this problem - it is her body and you are trying to help her get in touch with it. This is a lesson that will serve her well all her life and it is not too soon to start teaching it.</p><p></p><p>If you continue to have problems and get to the point that you feel the pediatrician GI should be checking for motility problems, post to the board and I will be happy to tell you about that. Or you can probably get good info on the encopresis board someone else mentioned.</p><p></p><p>Good luck.</p></blockquote><p></p>
[QUOTE="rlsnights, post: 314949, member: 7948"] Hi Lakehart - welcome to the board. Got a long reply for you because my son has been through a lot of medical investigation related to his constipation and encopresis. I will tell you a bunch of stuff that probably none of her doctors have told you to do or avoid - mostly because even though they see kids with constipation all the time they are pretty ignorant about what works when it comes to really stubborn constipation. Much of the information I offer came from the head of pediatric gastroenterology at UCLA. They have a special clinic there that is devoted to the treatment of constipation in children. I have a different perspective than some of the others. We too dealt with what appeared to be encopresis for over 6 months before it became clear that something more was wrong with difficult child 2. It turned out that he had an autoimmune disorder called Crohn's which affects the intestines. It is highly unlikely that your child has this but it is possible. It is also possible that she has an undiagnosed motility problem like Hirshsprungs or an allergy related condition like Celiac disease. That's why I second a consult with a PEDIATRIC gastroenterologist. Not an adult GI. And if the pediatrician GI doesn't do anything to investigate your child's symptoms beyond listening, doing a brief exam and then telling you to use Miralax you might want to get a 2nd opinion, preferably at a large university hospital with a pediatric gastroenterology program. in my humble opinion the pediatrician GI should do a KUB (an xray of her abdomen) to confirm the extent of the constipation and to do a very rough screening for obvious abnormalities of the intestines, do a screening for blood in the stool and do a rectal exam - at the minimum. While you are attempting to treat the constipation, if it is long-standing then it is my feeling that more serious potential causes of severe constipation should be ruled out. I would not go more than 6 months with unsuccessful treatment. At that point in my humble opinion the pediatrician GI should be taking a second look at the causes for her symptoms and do further investigation up to and including doing colonoscopy. I would stop doing the enemas personally. As you have already figured out this is highly traumatic to your child and if there's any other way to deal with the problem I would do it. This is not a long term solution and is likely to make your child more angry and uncooperative. Above all you want to work with your child cooperatively to solve this problem. Even though she's only 4 she is probably acutely aware of the social implications of soiling and feels ashamed. So if you need someone's permission to stop - you have it. My son's main symptom of Crohn's was severe constipation to the point of obstipation. Obstipation is when the intestines just shut down because they are full. For a long time his pediatrician gi at the time insisted that the constipation could not possibly be a symptom of his Crohn's and put difficult child 2 through many invasive tests intended to identify a motility disorder. They even proposed surgery to place an ostomy into my son's cecum (the part of the intestine where the small and large intestine join) so he could flush his colon daily they were so convinced it was a motility problem. difficult child 2 was on 5 doses a day of laxatives and a high fiber diet at the time he became obstipated and had to be hospitalized for 6 days to clean him out. So for 2 years we went through the ringer and tried every possible treatment around except the surgery. Here are my suggestions: 1. Use a combination of Miralax and Benefiber or something similar to Benefiber. What happens with Miralax is that it makes the poop slippery as you may have noticed. That's why she's having accidents on the Miralax - the poop just slides right out. When you also give her Benefiber it thickens the poop without getting rid of the slipperiness. So it reduces the chances of leakage and makes it easy for her to poop at the same time. 2. Give her the Miralax with a minimum of 8 oz's of fluids like water or juice. Same with the Benefiber but you don't need to give them together in our experience. She needs to drink the Miralax within 20 minutes to get good effect from it. No dragging it out over the course of the morning. If she gets a snack and hasn't gone following her breakfast, I would give her the Miralax with her snack and put her on the pot afterwards. 3. If you are not already doing so, have her sit on the toilet immediately after meals and snacks for a minimum of 10 minutes. Eating triggers the intestines to contract and move food through the system. So within 20 minutes of eating she is the most likely to need to go poop whether she feels like it or not. This should help eliminate the constipation which is your true enemy. You can offer her a small treat as a reward for sitting the full time. I suggest using a kitchen timer that you set and put in the bathroom with her so she knows when her time is up. She also needs something entertaining like books or a special toy that she only gets to play with when she's on the pot. 4. As someone else said, once you have long standing constipation the bowel has been stretched out and the normal sensations that tell you to go poop are just not there. The bowel has to be "shrunk" through prevention of constipation and then retrained so the child feels and recognizes the sensations that go with needing to poop. Once the constipation is stopped it can easily take a year or more to retrain the bowel to give normal sensation signals. That's why the enemas are a really bad idea in my opinion. They do not help retrain the bowel and that is what is going to fix the problem. 5. Make the following dietary changes if possible: Avoid constipating foods like applesauce (yes it's constipating), bananas, carrots, dried fruits or any other foods that you notice seem to add to the problem. Some people have problems with milk so you could try using an alternative like rice or soy milk. You could also try lactose free milk. Add food to her diet that promotes good bowel health. Give her this every single day: 6 - 8 oz a day of apple, apricot, pear or plum (aka prune) juice or nectar At least one serving a day of the following fruits. They can be served raw, cooked, canned or stewed: apricots, pears (with the skin on), cherries or prunes 6. If you see blood in or on her stool then back to pediatrician gi you go with a demand that further investigation be done NOW. If she has fissures (tears in the skin around the opening) and if she has little pouches of skin called skin tags do not let the gi tell you it is just from constipation. Fissures may be but skin tags are usually signs of inflammation. And persistent fissures that do not heal are also potentially signs of a more serious bowel condition. 7. You can massage her belly to help encourage proper motility of her bowel. The large intestine (colon) goes up the right side of the belly (the ascending colon) across the top of the belly right below the ribs (the transverse colon) and then down the left side of the belly (the descending colon). If you do some gentle but fairly deep massage you want to follow the natural formation of the bowel. so you would start on the lower right side, move up that side across the top and then down the left side. You can also do a circular sort of massage that goes in the clockwise direction. 8. Since she is only 4 I would be using pull-ups myself. But you should have her check them frequently and have her change as soon as possible after she soils. And I would have her do as much of the clean up as she can do. Buy the flushable wipes and put a handheld shower head within her reach so she can take a shower on her own to a certain extent. You want her to take ownership of this problem - it is her body and you are trying to help her get in touch with it. This is a lesson that will serve her well all her life and it is not too soon to start teaching it. If you continue to have problems and get to the point that you feel the pediatrician GI should be checking for motility problems, post to the board and I will be happy to tell you about that. Or you can probably get good info on the encopresis board someone else mentioned. Good luck. [/QUOTE]
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