ASK THE EXPERT:Build your child's confidence to use the toilet by making him take responsibility
MY SIX (nearly seven) year old son soils constantly – up to five/six times a week, sometimes once a day, occasionally twice a day – and though we have attempted various solutions, nothing seems to work.
He would appear to have difficulty responding to the bodily signals that his poo is coming and then it is too late. I should also point out that he has always suffered from this – in that sense he was never fully “trained”.
My husband and I do not think it is a response to a particular trauma, like bullying, for example. He is, needless to say, very embarrassed by his “problem” and is becoming angry and resistant to any attempt to talk about it or solve the immediate problems it creates (namely having to change his clothes; wash him down; and wash underwear).
I am very tuned in to the signs now, as his is childminder, but he might be in soiled underwear for several hours before I get home from work to help him.
I have been advised by my GP during a preliminary discussion that it is probably not physiological and is more likely to be behavioural.
We do not know, therefore, what to do except that I am thoroughly convinced that we must do something. Any advice you might have would be very welcome.
Soiling, or to give it the proper name encopresis, is usually classified as either a primary encopresis or a secondary encopresis. Primary encopresis is where bowel control has never fully been established (what you describe with your son) and secondary encopresis is where a child had been successfully trained and then later begins to soil.
It is more rare for secondary encopresis to develop and it is also, often, associated with trauma or emotional upset of some kind. Primary encopresis is more common and resolving it requires developing a new habit of going to the toilet for a poo.
As you describe with your son, some children either don’t get strong bodily sensations of needing to use the toilet or they misinterpret the signals they do get.
Unfortunately, then they receive many different types of reinforcement (perhaps from the reactions of parents/teachers or their peers) and so not going to the toilet can become the habit.
I wonder if your son’s pooing gets reinforced by how “tuned in” you are. It is almost as if you are more aware of his poo than he is and this can set up a cyclical dynamic whereby you, inadvertently, take a lot of the responsibility for his toileting.
For example, you may find that you are reminding him to go, being focused on and aware of his poo rhythms, cleaning him, cleaning his clothes, worrying about his social standing and whether he is being teased and so on.
Being in charge of his poo is really his responsibility. So everything you do should have that goal at the back of your mind. Your aim is to remove yourself from the process entirely. The first step is to get him going to the toilet independently of you. Start by telling him that things are going to be different and that pooing is going to return to being his job to sort out.
Then, practise a regular routine with him where he goes to the toilet three or four times a day, irrespective of his need, to get him back into the habit of sitting on the loo in private. Don’t have any expectations that he will use the loo, just expect him to go and sit.
If he does use the toilet successfully then be low key but positive in acknowledging it. If he doesn’t do a poo then don’t comment but do acknowledge that he went and sat anyway.
The harder part is not to react if he poos in his pants. You need to stop checking him (even if you can smell it) and you need to stop helping him to clean himself (even if he doesn’t do a good job alone). If he comes to you after soiling himself, or if you can’t help but notice at bedtime for example, then you respond warmly “All right, now you need to go and get yourself clean.”
If he asks for help then decline, nicely, saying that you know he is big enough to sort it out himself.
Leave a bucket in the bath for his soiled clothes and make sure that a stock of wipes (or old facecloths), towels, clean pants and trousers are also easily available to him in the bathroom.
It is quite likely that he will be very upset, initially, at not getting the help, the attention and the interaction he normally gets. Hopefully you can balance this with more positive attention at other times of the day.
If he is upset or cross that nobody is helping him with his poos, it’s okay to be understanding of this. Let him know that you can see that he is upset and that he will be okay. But do resist taking responsibility for keeping him clean. His upset will diminish as his confidence in using the toilet increases.
David Coleman is a clinical psychologist and broadcaster with RTÉ television
Readers’ queries are welcome and will be answered through the column, but David regrets he cannot enter into individual correspondence. Questions should be e-mailed to healthsupplement@irishtimes.com