Real Poop Stories

Children who only poop in diapers or pull-ups

Parents find it difficult to change the behavior of children who have become dependent on, and will only poop and/pee in a diaper or pull-up.  Treatment of these children occurs in three different phases each of which requires the effective use of incentives (pages 120-122)  and star charts (131-133) as shown in my book:

Phase 1. Teach them to poop/pee in the bathroom while wearing a diaper or pull-up.

Phase 2. Teach them to poop/pee sitting on the toilet while wearing a diaper or pull-up.

Phase 3. Teach them to poop/pee sitting on the toilet without a diaper or pull-up.

The time it takes to successfully complete each of these steps varies with the age of the child, their level of anxiety about pooping without a diaper or pull-up and about pooping in the toilet. Parental patience and a willingness use "carrots" rather than "sticks" are essential. 

The email below was sent to me by a real mom following a telephone consultation regarding her 6 year old son who would only poop in a pull-up. 

Hi Dr. Tom,

I wanted to give you a further update on Kyle’s progress.  Just 7 weeks after starting the strategies you and your book helped us design, Kyle is pooping on the potty every day!  This is a child who could barely tolerate a brief sit on the toilet for over three years!  I am AMAZED by how far we have come.  As I reflect on what really made things work for us, four points come to mind.

1) Book and Phone Consultation. I want to tell you that I literally cried when I read your book.  I was ashamed that my six year old could not poop on the toilet. The combination of reading stories from people struggling as we were, and thinking that your strategies might work for us was powerful.  But I had reached a place of exasperation, confusion, and fear of doing the wrong thing.  I still was not sure exactly how to proceed.

When I discovered that I could purchase a phone consultation through your website, I decided to give it a try.  How thankful I am that I did!  It certainly shows that you have been working with kids like Kyle for 30 years.  You knew things about Kyle that even I didn't.  Your understanding, guidance and support were invaluable.  Perhaps most importantly, you gave me the insight and encouragement I needed to be patient.  Luckily for us Kyle has made tremendous progress quickly, but I got off the phone feeling that even if it took many months that would be OK.  We just needed to take baby steps in the right direction.  It is normal for these kids to progress in such a fashion. 

2) Chart Power.  As you mentioned to me, there is a good reason why the chapter on positive motivation is the longest in "The Ins and Outs of Poop".  Finding the right motivation for your child is crucial.  I had tried charts before, but not designed in the way you describe.  Several small steps, most of which I knew he could either do already or that would be easy for him, was key.  He was still resistant, but that is where the abundant stickers and immediate reward came in.  These were more powerful than I could have imagined.  Seeing the beautiful sticker waiting to go on the chart in the moment after his effort meant so much to Kyle.  He got over the hump of his reflexive resistance to all things potty!  Once that happened and he started to focus on the extra video game time he would earn when his chart was filled, he willingly did his push practice every day. 

3) Miralax.  When allowed his pull-up, Kyle would poop every day or two.  He didn't complain of painful BMs even when I asked him directly if discomfort was a problem.  When I asked my pediatrician about a stool softener, she saw no need due to his regularity.  You assured me that kids like Kyle need Miralax.  Were you ever right!  I started at a low dose and slowly increased as you suggested.  It took longer than I had anticipated, but we finally got Kyle's poop to the right place on the "stool chart".  What a difference this made for Kyle.  Even though he could not verbalize his discomfort before he started Miralax, he sure could talk about how much easier it was to push the poop out once we had the Miralax on-board.  I am convinced that he would not be pooping on the potty today without it.

4) Chart Power II.  After about 4 weeks Kyle was much more comfortable sitting and practicing pushing on the toilet.  His poop was much softer, and he reported easier pooping.  He had even gotten a little bit of poop into the potty on a couple of occasions :).  But he did not want to "push practice" when he really had the urge to poop.  In those instances he was still using a pull-up.  I tried to wait, encourage and reason, but to no avail. 

Then it dawned on me - we need another chart!  I designed a “Kyle's Good Pushing When He has to Poop"  chart.  It had to be formatted a bit differently than our "Push Practice" chart, but utilized the same principles.   I made lots of small steps, most of which he was doing already.  We used more beautiful stickers.  And because what I was asking him to do was so tough and important, I made the reward more enticing - cash for toys.  He still resisted at first, but one day, when I had that chart (already primed with a few stickers!) on the bathroom floor waiting for him, he gave in to my suggestion to "just try".  At first he wanted to finish in the pull-up which I said would be no problem.  More quickly than I expected, he didn't need the pull-up at all.  Kyle was pooping on the potty!!! 

Of course, Kyle is still at a tender place.  We still have a lot of Miralax, laxative/stool records, and sticker charts in our future.  But Kyle has achieved so much that eluded us for so long.  You changed our lives Dr. Tom, and we can't say "Thank You" enough!



Real Poop Story: Enemas for a 3 Year Old Boy

Parents rarely talk to each other about their experiences giving their children enemas.  It's understandable, but it's also unfortunate as there is a lot to be learned, especially when considering giving one for the first time.  I asked a parent I have been working with if she'd be willing to write a little about her experiences giving her 3 year old son enemas and she agreed.  Below is her story:

I recently spoke with Dr. Tom and he asked me to write about our experience with enemas. I was initially reluctant to do them. I've never had one myself and giving them to a 3 year old seemed daunting. Prior to using enemas, we went for months using Miralax, trying to come up with a strategy to get him to move toward the potty when he was about to poop.

If his bottom was naked, he would actually run and poop in the potty. But if I put him in underwear, a pull up, or just pants on him, he would poop wherever he was when he felt the urge and none of my strategies got him to budge. So I finally decided to try an enema. I figured that with an enema I could control when and where he would get the urge and so that when it came I could immediately start moving him toward the bathroom.

We talked about it a lot before doing the first one. We practiced in front of the television with a towel to lie on and a pillow. We explained how we would put the "water medicine" in his bottom and then put his pull up back on. We told him that he could keep watching TV until he felt poop trying to come out. But that as soon as he felt poop coming, we wanted him to run into the dining room before he pooped. Up until this point in the conversation, he'd been agreeable or only mildly reluctant about everything, but he flat out said, “No” to the request to go into the dining room before he pooped. I then told him that if he pooped in the dining room he would get a toy car. He brightened up. "Okay!" I consider that moment the turning point in our efforts.

Initially, getting him into position and then accepting the enema took some time. I used the television as immediate positive feedback for getting closer to the right position (he'd get maybe 20-30 seconds of his show for each tiny step in the right direction) and for allowing me to get the enema into him. He pooped in the dining room that morning, in the kitchen the next day and in the bathroom the next morning.

Transitioning to pooping in the potty took a few more days. I eventually figured out that I had to do two things: I had to be in the bathroom when he pooped and I had to make it easy to get the reward he was interested in. So, as soon as we did the enema and put his pull up back on, I went into the bathroom. He was told that he could get one toy for pooping in the bathroom or two toys if he pooped in the potty. He chose the potty!

We used enemas daily for several weeks. Getting him off the enemas was actually harder for us than getting him started. We had to increase his Miralax dosage a lot. He would beg me for "water medicine" and had several accidents during the transition. But as soon we found the right dosage he started pooping in the potty spontaneously.

Unfortunately, after a few months, he started withholding again so we had to restart the Miralax and the enemas. The return to withholding made everyone unhappy, including him. He remembered what it was like to be able to go when he felt the urge and was clearly frustrated. Right now, he gets one toy for pooping with an enema or two for pooping without one. We've recently gotten a couple of spontaneous poops in the potty but most days require an enema. We'd all love to be done with them, but I expect it will happen on his timeframe and no sooner.

Thanks so much to this parent for such a well-written and detailed description. My book also features a chapter on enemas, including other ideas on how to allow your child some control in what can otherwise be an uncomfortable situation.

13 Year Old with Encopresis Cries While Reading "The Ins and Outs of Poop"

I recently received a request for a telephone consultation from the mother of a 13 year old girl who had been withholding her poop for eleven years. She said that her doctors had recommended Miralax, ultra sounds, x-rays, therapy and even a barium enema when her daughter was only 4 years old, which, she said, "was horrible beyond belief and probably made everything worse".

Because she had not yet read my book, I suggested that she do so before we talked by phone. Shortly thereafter she sent me the following email:

Dear Dr. Tom,

Just to let you know that my 13-year old daughter wept like I haven't seen her weep as we read your book together and we read about kids who were like her, who are great achievers and great kids, but who have greatly struggled with functional constipation. When she read that a girl had actually recovered, she just started sobbing. There it was, a possibility she had never heard of... she has felt so alone. We all have because most people aren't willing to talk about this, so, we haven't known that this was a problem others were facing.

There has been so much shame. Doctors have mostly just sent us away telling us to feed her more prunes or giving us sheets on normal constipation which we knew somehow was very different. There has been much trauma and loss of trust with the medical world over the fact that doctors couldn't hear us, for example, when we told them that she was able to hold in an enema for 13 minutes as a four year old.

It has been a week and we are all supporting my daughter in going to the bathroom every day with Miralax.  We are going to continue for 6 months with her going every day and see how this goes and contact you again if we need guidance along the way.

"One phone conversation turned everything around for good. Thanks Dr Tom!

I was truly at the end of my rope when a Google search finally brought me to Dr. Tom (I had done several in the past, just not the right combo).  I cried myself to sleep some nights wondering how this would ever resolve.  My son was 5.  I had taken him to his Pediatrician, a GI specialist, gotten him custom self-hypnosis CD’s, tried aromatherapy, a chiropractor that did energy work, 2 child psychologists, an occupational therapist to help him “push”, and this was all after trying all of the known methods for potty training.  I was very concerned about Kindergarten and his delicate self-esteem.  One 45-minute PHONE session with Dr. Tom turned everything around for good!  Within 2 days, my son was mostly accident-free.  After a few weeks, we have worked out a regimen that has had him regular, mostly accident-free, & so much more happy & confident.  Dr. Tom has been extremely accessible to all of my questions/concerns which has made a HUGE difference.  The impact Dr. Tom has made in our lives is beyond words.  This has been such a big deal for so long and now we have moved on to other, more interesting things like learning math!  Thanks, Dr. Tom!

When Should A Child Take Responsibility for Treatment?

A mother I know recently became so exasperated with her 6 y/o daughter’s off and on cooperation with treatment that she told her, “I’m done! You know what you have to do to stop having poop accidents so you take care of it yourself!”

Up until then, this smart, usually compliant but shy first grader always needed to be told to take her laxative, sit on the toilet after meals, listen to her body and not hide her soiled underwear. When she complied she had daily bowel movements and no accidents, sometimes for as long as a month or more. However, when her parents tried to reduce their own involvement, these “good” months would always be followed by a period of two or more days between poops, having accidents and hiding her soiled underwear.

What happened after her mother said, “I’m done!” is amazing. On her own initiative, her daughter now takes her laxative every morning, goes into the bathroom to poop when she feels the urge, and has no accidents. In my experience, this strategy generally does not work with most children (see my post here about the inefficacy of negative approaches) but it’s worth a try with older, independently minded children who generally want to please their parents.

Parents who try this approach cannot use these kinds of statements lightly or often, or their effect is lost. Parents will need to remain committed to what they have said, at least for a period of time that is long enough for the child to recognize the parent's seriousness.  This may mean the child will have accidents again. Remember, it is always okay to change your approach, especially as extended stool withholding can cause real physical harm.  It's also okay to change if your child requests your help again (for example, they have an accident at school and are embarassed).  

Painful constipation, soiling and daytime wetting: Q&A with Dr Tom

A parent recently asked me if soiling at home but not at school and frequent daytime wetting might be related to "painful constipation":

Question: My daughter had some painful constipation several months back which seemed to be the beginning of her soiling issues. After that time she started soiling frequently, as many as 4 or 5 times a day. She is soiling less now but there are two questions I have about the soiling. The first is that she rarely soils at daycare, she typically only soils at home. The second is that she is now wetting her pants frequently, something she didn't do when she started soiling. I think that all of her soiling issues point back to those constipation issues but I don't know if these two behaviors are in line with that idea.

Answer: Painful bowel movements will often lead to withholding followed by soiling (encopresis). Since your daughter continues to soil, albeit less than at first, she is still constipated.That she tends not to soil at school is also typical in the early stages of functional constipation. Ongoing withholding and soiling are often associated with day and night wetting. This is because a distended or stretched rectum will press on the bladder causing occasional leaking during the day and/or bedwetting at night. This is all covered in my book.



Real Poop Story: My 3 Yr-Old's Worst Rectal Exam

Unfortunately, many pediatricians and/or their staff are not trained or experienced in treating complicated poop problems like encopresis and chronic constipation.

Here is an email I recently received, reprinted with the parent's permission:
Hi Dr. Tom,
I'm currently pretty livid, and a little bit defeated. My 3.5 year old son's pediatrician referred us to a pediatric GI clinic to rule out any other underlying causes for his constipation. He's on a very large daily dose of Miralax and his poops are extremely soft.
We saw the nurse practitioner at the clinic. The good news is that she doesn't think there is anything else going on in addition to what we already know: his rectum is stretched out, so things do not work exactly the way they should.
We were in a pretty good place before the appointment. He was having a large poop daily and, with a few recent exceptions, he was going in the potty. It took us months to get there. But she did a rectal exam and not in a way that I liked. At all.
She didn't actually tell him she was going to do it. She made him cry trying to get him on his side, until I stepped in and got him to roll over without tears. Then she just told him, "This is going to feel like pooping backwards," and stuck a finger in. Given that he has fear issues regarding pooping, that does not seem like a wise thing to say to comfort him.

Continue reading "Real Poop Story: My 3 Yr-Old's Worst Rectal Exam" »