encopresis/enuresis

Discussion in 'General Parenting' started by therese005us, Jul 16, 2009.

  1. therese005us

    therese005us New Member

    Okay, most of you know I am caring for a nearly 8yo cherub with diagnosed encopresis. Now in the past little while she has disclosed some pretty horrible sexual abuse stuff - b & f, if you know what I mean. I feel this would have some bearing on the diagnosis of encopresis.
    This child will also stand up (report from teacher at school today) and wet herself, have it running down her legs, be thoroughly saturated and it doesn't bother her. I have it at home too, where she is thoroughly saturated, and I say, 'do you need to go to the toilet' - no 'have you wet your pants' - no, 'are you sure you're not wet?' no. Okay, so I let her wander about a few more minutes in her obviously wet clothes and try again witht he same questions. No anger, just by the way kind of attitude. still no response/realisation? eventually, i jsut say, well, I think you might be wet, let's go and get changed.

    have any of you had this experience, and could you offer some suggestions about why she might be feeling this way?
    Stress? (definitely) could it be wholly intellect? (she has a diagnosis IQ 66
     
  2. DDD

    DDD Well-Known Member

    I can be of no help on this issue but I am sure you will soon hear from those who have traveled that road. Hugs. DDD
     
  3. Marguerite

    Marguerite Active Member

    A suggestion - since asking questions and prompting isn't getting the message, switch to simply telling her, "honey, you're wet. Let's go get you changed into some comfortable dry clothes."

    When you ask questions you indicate your own uncertainty (that's how it seems to her). If you don't know if she's wet or not, how can she be sure? Something I'm dealing with in difficult child 3 is his belief (still, despite his otherwise intelligence and being a lot older and me trying to explain over and over) that I am omniscient. He always expect me to know the answer to everything, including why the dog just wagged its tail (when I was probably not even in the room nor did I see it or see the context in which the dog was behaving). I'm expected to know everytying and he gets frusteated when things are not absolute and certain.
    Another example - I have explained to difficult child 3 that husband is probably a mild Aspie. I'm trying to get difficult child 3 to understand that his dad needs some consideration too. But difficult child 3 says he needs certainty, he can't just accept "Dad has Asperger's" as a working hypothesis.
    And that's another thing - difficult child 3 fully understands the meaning of "working hypothesis" but still has to have jokes etc explained to him.

    Back to Little Cherub - I think she needs (at least for now) some certainty, something she can rely on to give her the firm cues. So if you simply tell her, it reinforces for her that you know for sure and that you can help HER know for sure.

    When she is older you can move to the "are you wet?" routine and see if she can recognise it.

    If you need to transition from the certainty to the prompting, then as you are changing her try this - "Honey, you are wet. Can you feel it? How does it feel to you? Put your hand on your pants. Can your hand feel the wet? Now, does your bottom feel the wet? We need to change your pants when they are wet because if you stay in wet pants it will make your skin red and sore and I don't want you to be feeling sore and uncomfortable. So we need to find a way to help you know when you are wet and to help you know BEFORE you wet so you don't have to change pants. But for now - we will talk about it and practice how it feels."

    Yes, the abuse could be causing her to 'switch off' from physical sensations in that area, which could be aggravating any Sensory Integration Disorder (SID) she has contributing to the problem. But the problem might still have been an issue without any abuse.

    I'm also thinking - some *&&^*( abusers choose to abuse the (apparently) mentally slower people especially those with reduced verbal skills, because it's easier to get away with it. But if Little Cherub is actually smarter than the average bear (which I suspect) then she WILL remember and be able to tell in more detail, once her language skills improve.

    The toiletting problems could also be quite independent of IQ issues. difficult child 1 & difficult child 3 were both very difficult with toilet training and both measure in the top 1%. And a classmate of difficult child 3's who has Down's Syndrome had few problems with toiletting.

    An autistic boy we know was molested by his assigned driver (the one who drove him from home to his Special Education school placement) and the snake got away with it because the boy was non-verbal. The mother only realised after the boy would get upset as they drove past a certain location. She was only able to get the story from her son by asking him questions and observing his response. He was examined and that clinched it. She got enough evidence to get the bus driver taken off her son's route, but not enough to get him sacked.

    However, her son is now a few years older and beginning to talk. He has said enough about the abuse to make it clear that it happened and he didn't like it. Unfortunately, not enough for it to hold up in court according to the police. They said the boy simply wouldn't make a good enough witness, the defence would be able to claim the boy's evidence was too difficult to understand since his language skills are still very limited and erratic.

    I've PM'd you with a few things too. Among them, I suspect the IQ test is misleading since it was done on a child with language delay. Give her credit for being smarter than you think. She may still be below average, or she may be even smarter than that; but mid-60s score could well be a false low. If you treat her as a bit smarter than that it could boost her self-esteem and this could boost her confidence to try as well as give her access to more stimulation. It all helps. Don't pressure her of course, just encourage. As it sounds you are already doing.

    Here is a link for you -

    http://wilderdom.com/intelligence/IQCautionsInterpretingIQ.html

    It's extra difficult in winter, of course.

    I know those "feel wet to learn" Pull-Ups are supposed to be good, but another thing you could try is giving her undies to wear inside her Pull-Ups, especially at night. And each time they are wet, tell her, "You are wet. Can you feel what it is like?"

    The other trick (which I think you have already been doing) is try to catch it before she wees, to toiet her regularly. while this is partly training you, this may also help her associate the feeling of going to the toilet and then playing in DRY pants.

    If she really is having difficulty in identifying how it feels, this could take some time and you may not make much progress until her brain is ready to help her identify the difference. It's like trying to teach trigonometry to a child who is still in primary school - some kids may cope but most simply are just not ready to recognise the subtlety. And it may only be in that area - the child may be quite capable in other areas. or not. You could have a child with spliinter skills, or global developmental delay. Or simply a kid who has lacked opportunity to learn and develop.

    Another quick point - being exposed to the cold increases urine output in a similarway to alcohol intake increasing urine output. And at your place at the moment, it is cold. That could make things worse while the weather is cold. The warmer she is, the less urine output. But of course if she is warmer because you put more layers of clothing on her, that means not only more washing but also more layers for her to remove so she can successfully empty her bladder and keep her knickers dry. Not easy.

    There will be others with experience here who can help.

    Marg
     
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