Encopresis
A recent onset of bedwetting and encopresis in a 9 year old boy.
I am from the Boston, MA area. My son is 9 years old. He has been having night time urine incontinence for about 1 year. He has been having bowel incontinence while sleeping and during the day for about 6 months. He does not usually have urine accidents during the day - only when he has a bowel accident. He was sent to a pedneuro today, who did not much of anything, just a physical examination (which his pcp already did). They did give him an x-ray but wont know the results until tomorrow. His pcp was worried about some type of seizures. I wonder why they did not give him an eeg. So, he now has had an mri, gastro, and urology appointment. One morning my son had diarrhea in his goodnight and went immediately to the shower. When I went in his room there was a HUGE bowel movement on the floor. So LARGE i have never seen something so big before, it had to have hurt. He did not even know it was there and so obviously said that it did not hurt. 2 days ago i witnessed him go into the bathroom and knew something was wrong when he was running the water for a long time. He told me that he had a urine accident only. I checked his underwear and it did have diarrhea in it (he was too embarrassed to tell me). He said that the urine urge came on too quick and that he did not even know about the bowel movement, it was a surprise. I don't fully understand what it going on and I also think that he is hiding more episodes from me than what I know about. The neuro was very rude and told me that she thinks "he just has a bad habit".
K—Bladder and bowel incontinence tend to occur together because the bladder and colon are close together in the body, the fullness or pressure cues going to the brain get confused, and the voiding response mechanisms are neurologically connected. Your son is holding poo as indicated by the huge BM. Many kids hold both pee and poo at school because of the public nature of the lavatories. You are now dealing with a habit which is perpetuating the hold and accident cycle for both pee and poo. The appearance of this at an older age is unusual and may have led your PCP to speculate about seizures and hence his referral to a neurologist. Your child may have been predisposed to encopresis if he has had a history of toilet clogging or several days between BMs? The X-ray may disclose a considerable back up of stool and an enlarged colon. Your son may be hiding his accidents. Finding a stash of dried out soiled underpants is not unusual. There is so much social inhibition and isolation about this area of the body that this hiding and out and out denial are not unusual. The neurologist’s attitude reflects our social attitudes and overcame her objective clinical training. People do not understand this problem in general and engage in all kinds of assumptions which can include assuming willfulness and bad parenting. He has lost control over the coordination of his holding and voiding reflexes. When in doubt he clamps up, but that becomes overconditioned and out of his control. In sleep, the voiding reflex may dominate as the External Anal Sphincter relaxes and he has a BM. This is much more common with the urethral sphincter for bedwetters. The coordination of his holding and voiding reflexes with awareness of his voiding urges have to be retrained which is addressed by my Soiling Solutions protocol which you will understand better by reading on in this column. Also, I will attach a recent copy of my medical journal article on Soiling Solutions along with a couple of editorials concerning it. DrC.
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