4.5 year old son with IA won't use toilet

My son was born with an imperforate anus, but has done very well and has sensation, etc. He trained to urinate in the toilet, but not to use it for poos. He had some incontinence, but mostly he knows when he needs to go as he hides and pushes. We put him in pull-ups so he could use the toilet, but if he had an accident, it wasn't a big deal. Now he refuses to pee in the toilet either.

I'm pretty certain this is a mental thing, not necessarily his IA, because when I talk to him he says he doesn't want to use the toilet he likes diapers. His younger brother is toilet trained though he still poos in a diaper at night occasionally. My son isn't responding to rewards or other motivations and I'm at the end of my rope. If he were to actually pee in the toilet still, it would be alright, but his refusal to do even that means we are going through diapers/pull ups at a tremendous rate.

Thanks to his IA, if we put him in underwear, he will literally be dirty all day long and I don't think I can handle that . . . any ideas would be welcome.

[Kevin Kennedy, Ph.D.]

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