Bowel Issues

[Sue1121]

I have a 5 1/2 year old grandson who is pooping in his pants regularly.  We took him to his pediatrician and he told us that he was constipated and his rectum had bowl at the entrance.  Told us to give him Miralax for a couple of days to relieve the bowel.  He did take X-rays prior to, to see how much was backed up and how far up the intestines it was.  X-ray showed pretty constipated.  Did what the dr asked and they did another X-ray and it showed he was completely cleared of bowel both in the intestines and rectum area.  Said it was okay to take him off the Miralax and go back to regular meals and activity.  Soon after that appointment, he was again pooping in his pants.  Actually, it never stopped.  Told the doctor and he sent us to the gastrointestinal specialist who saw him and stated that he needed to have a "clean-out" which consisted of him being on Miralax at 17 grams once a day until stools are watery.  Well, in the process of doing this, he was pooping out bile, and still in his pants to the point that he was getting sick and vomiting, so I stopped giving him the miralax, called the doctor and they said it was normal and to keep him on the regiment and maybe we need to up the dosage.  I told them I was going to check back with them in the morning and he had an appt scheduled for the next week for a check up and we decided to cancel and give his body a rest.  Since then he would poop in his pants and in the toilet for about 3 days than he wouldn't have any bowels and end up vomiting.  We have noticed that if he doesn't have a bowel movement, he ends up vomiting.  I've changed some of the food he eats with more fiber and am now giving him probiotics to help, but I see myself having  to give him miralax every third day or so just to make sure he has a bowel movement, but it always ends up in the pants and some in the toilet.  There are days that he will do all his bowels in the toilet and than all of a sudden, he will have an accident and it will end up in his pants.  A lot of this also happens when he gets too involved in his play and he is very active and hyper.  We think he might be autistic and have a case of ADHD or ADD also.  Do you have any other suggestions that we could try without having to have him go through such trauma and sickness?  His body seems to be getting addicted to the Miralax since they want us to use it on a daily basis.  That really concerns me, because he is already very thin and tall and this just seems to make him thinner.  Thanks for any input you might have to help us with this issue.

Sue

[AnnieBrooke]

Please read the article if you can find it.  The doctor who wrote it stresses the need for someone to be on a stool softener for a really long time, to give the colon and bowel the opportunity to heal.  You don't take a stool softener "every time you need to go poop," you take one (like Benefiber, the kind that are simply a ground-up bean) in your food the way you would fiber, to help the stool stay soft.  In other words, it is more like a food additive to keep the food itself manageable than it is a medicine.  The body doesn't get "dependent" on it.  And someone who has had bowel damage from impaction needs help to buy time for the bowel to heal.  I would not give him a laxative with an active ingredient, but at the very least I would step up his fiber and liquids.  Please don't blame this on autism or ADHD, a lot of kids without autism and ADHD get impacted bowels and attendant damage, and you need to take steps to heal the bowel permanently.  This can mean a stool softener for a long time.  Please, again, ask the GI doctor and read up on the problem.  Good luck.

[Sue1121]

Thanks for the input.  I'm a little afraid to keep him going on the regimen that they suggested because it was causing him to become ill and vomit and if we put him in pull ups again he might start urinating again.  He is fully potty trained and has had no accidents, it just the bowel movements we have an issue with.  I've been researching and have found out that he might have nerve damage in that area that causes him to poop in his pants because he has no feeling of needing to go...Every time he poops in his pants, I ask him why he didn't tell me before hand and if he felt the urge to go and he says all the time that he didn't know he went and didn't feel it.  He sometimes doesn't even notice that he pooped and will sit in his dirty panties until I finally smell him or ask him to go to the bathroom and find out then.  He has a little bit of autism and we think ADHD or ADD.  His autism is the social kind, but still he shows signs of it.  I'm concerned to not have him get accustomed to having to take a stool softner every time he needs to go poop.  But thanks again for your input.

[AnnieBrooke]

There is an article about encopresis in the March, 2010 issue of Parents magazine, called "When Your Child Just Can't Go," or something very similar to that.  It's written by a doctor who had to deal with this issue in his son.  It can take a year for a bowel that has been damaged by impaction for it to get well enough to function normally.  Please see if you can find the article, and keep going with the GI specialist (not all pediatricians understand this issue).  Keep the boy in pullups for now, so he won't be humiliated by accidents, and talk to the doctor about the bile and the issues.  I don't think he will get addicted to Miralax, but if you are worried about this, ask the doctor if you can switch to Benefiber, which is a ground-up bean (no stimulants or anything.  I don't know if Miralax is the same way or not.)  Please take seriously the need for treating this daily for a much longer time than the pediatrician said.  The bowel needs not only to stop having an impaction, but it needs to heal and regain the function of compressing normally.  If you cannot find the Parents magazine at the library, try googling online about encopresis, and about fecal impaction or bowel impaction.  If you treat this correctly, it can heal, but if you don't, the child might have a dysfunctional bowel all his life.

[margypops]

Seems like he is upset ...there is a big focus on the issue it may help to back off it is possible anxiety has been created about it .