You are truly a wonderful person to care so much for your nephew!
And what great parents you have to be watching over him at this
stressful time, getting up at night to help him stay dry, and to help
him overcome this problem. Between all of you, he has much love and
support. I have every confidence you will find a solution to this.
The following sources may help you in finding some direction and
hopefully, a solution to the problem.
An article titled Help available for kids with constipation, soiling
problems, by Becky Soglin. Pacemaker (May/June 2000), University of
Iowa Healthcare website at
offers some possible answers for bowel control problems. An excerpt
Although rarely life-threatening, defecation problems, particularly
soiling, can cause both physical and social problems such as low
self-esteem for children, according to Vera Loening-Baucke, MD, a
pediatrician with Children's Hospital of Iowa.
"Many parents have trouble determining that children who soil
themselves may also be constipated," she said. "A hard stool may be
stuck in the bowel and loose stool leaks out around it."
Usually, the constipation has an unknown but not serious cause.
It's important to recognize that children are not intentionally
soiling even though it may appear that way," Loening-Baucke said.
"Children simply don't have the control. Successful treatment involves
parent-child cooperation to get results."
The University of Iowa has a special clinic to help treat children
of all ages with bowel control problems. The UI Encopresis Clinic
focuses on treating patients with encopresis-fecal incontinence in
the presence of organic or neurologic disease-and provides
comprehensive treatment for other pediatric constipation and
Lack of exercise and low fiber diets are a common cause of
constipation (with resultant leaking stools). Laxatives and high
fluids can help.
** However, especially for older children, it may take a while to
resolve the problems.
"Many years of problems can't be solved
overnight," Loening-Baucke said. "It takes time to help patients
retrain their bowels, many months, sometimes years."**
Contact information: Parents who want more information about
treatments for children with defecation problems may call the
toll-free UI Health Access phone number and ask for Dr. Vera
Loening-Baucke, or call the UI Encopresis Clinic at 319-384-7888.
A webpage from the Tri-state Incontinence Support Group with the
heading, Help For Children With Soiling Problems Encopresis, at
http://tis-group.org/top_soil.html has several links to helpful
Many parent wrongly assume that children will have an easier time
gaining bowel control compared to bladder control. For many children
reliable bowel control comes long after bladder control. Also many
children have problems with soiling that continue or start long after
they appear to have mastered the basics of bowel control. The
incidence of childhood encopresis [bowel incontinence] in the general
population has been estimated at 20%.
Also read Childhood Problems with Bowel Control, by Jeffrey Brown,
MD. Child (June/July 1990) at http://tis-group.org/soil_ch.html
Another helpful article is Your Child and Encopresis,by Susan
Poulton, RNC, ARNP, CNS II and Jeanne Torrens, RN, MSN, CNS II.
(Updated Fall 2001 by Joni Bosch, PNP,Center for Disabilities and
Development) at http://www.medicine.uiowa.edu/uhs/enco.cfm.
The Childrens Medical Center at University of Virginia has numerous
links to articles dealing with encopresis. Excerpts from What is
Encoprosis and What Causes It? at
When somebody suffers from encopresis it means that he or she can't
control their bowel movements and so they pass bowel movements in
their underwear. Sometimes people use the words "soiling" or "fecal
incontinence" to mean the same thing.
In most cases, encopresis is not primarily a behavioral problem -
children with encopresis do not have their accidents out of spite or
because they are lazy. Rather, many behavioral problems develop
because of the encopresis, and once the encopresis is treated, many of
the behavioral problems may resolve.
With constipation and painful bowel movements, children may not
completely empty themselves when they go to the bathroom. Over a long
period of time the large intestine slowly fills with stool and
stretches out of shape. As the large intestine stretches larger and
larger, liquid stool from the small intestine begins to "leak" around
the more formed stool in the colon. In the beginning, this leakage is
usually small amounts that streak or stain the underwear and most
parents just assume their child isn't wiping him or herself very
As the intestine stretches further, the amount of leakage increases
so that eventually children begin having "accidents" - they pass whole
bowel movements in their underwear! This is called encopresis. Because
the accidents consist of stool that is "leaking" through the intestine
and not getting completely digested, they are usually very dark and
sticky, smell very badly, and they have to scraped off the skin and
A link to another article titled What are the Symptoms of Chronic
Constipation at http://hsc.virginia.edu/cmc/tutorials/constipation/symptoms.htm
also mentions **bladder control problems** associated with lack of
The bladder sits right in front of the rectum so if the rectum
becomes enlarged and is chronically filled with stool, there may be
less room for the bladder to expand with urine. This may cause a
number of urinary problems. Many children with chronic constipation
seem to have small bladder capacities and seem to have to urinate more
often than usual. In some children, constipation may cause recurrent
bladder infections, bedwetting, urinary dribbling, or difficulty
starting their stream.
In older children, long-standing constipation can be associated with
leakage or smearing of stool in the underwear. As the large intestine
gets stretched larger and larger, liquid stool from the small
intestine begins to "leak" around more formed stool in the large
intestine. In the beginning, the leakage is usually very small and
most parents just assume their child isn't wiping his or herself very
well. As the large intestine stretches further, the amount of leakage
increases so that eventually children begin having "accidents" - they
pass whole bowel movements in their underwear! This is called
encopresis. Since these accidents represent "leaking" of soft stool
through the colon, children don't usual feel the "accidents" happening
- rather, they just happen.
Another indication that constipation (leading to loss of bowel
control) and incontinence can often be linked can be found in the
article Pediatric Incontinence at
Some of the same factors that contribute to nighttime incontinence
may act together with infrequent voiding to produce daytime
incontinence. These factors include:
Pressure from a hard bowel movement (constipation)
How Do We Treat Encopresis? at
provides a comprehensive overview of the steps taken to help overcome
bowel control problems. Since it is very lengthy, and full of
information, I will avoid excerpts and suggest you read it in full.
A very comprehensive article called Incontinence by the Tri-state
Incontinence Support Group at http://tis-group.org/child.html#group
offers a wealth of information with numerous links to articles,
medical centers that treat incontinence, and even ***camps*** for
children with incontinence.
One article on the page, titled Diurnal Enuresis, examines some of
the reasons for poor urinary control:
Your normal school age child has long been potty trained but he or
she continues to wet his/her pants. Repeated trips to the doctor find
no obvious physical problem. You have a behavior problem, right? Dont
be so sure. Many a child who has long mastered the basics continues to
have accidents, or leakage Diurnal enuresis. Many will show no gross
medical problem. We have seen medical articles that believe that 'at
least 1% of healthy children have chronic daytime incontinence after'
five years of age. That is a significant number. Unfortunately most
articles deal with this problem only as a side note.
Daytime problems are harder for everyone involved. Even parents who
accept that bedwetting is not the child's fault often believe that wet
pants during the day are at best a sign of carelessness and at worst a
deliberate act of defiance.
We feel that many of these problems have a physical cause and while
some are "functional" very few are behavioral. Problems have many
causes including stress, emotional trauma, too lax training, too rigid
training, developmental delays, bladder infections, a small bladder,
an over active bladder, and many more. All the problems that can cause
bedwetting also often cause daytime wetting. In fact, many bedwetters
also have problems with daytime control as well.
Keeping the Child Dry at http://tis-group.org/where.html offers
excellent supportive advice for parents, and suggestions for
disposable and reusable protective undergarments for older children.
As the article says, Children need to know that they are not alone.
They should know that one of the most famous presidents of the United
States (FDR) had to wear diapers. They need to know that many
otherwise normal children have these problems and many of them wear
diapers. Tell them how many medical problems secondarily cause bladder
or bowel problems. If a parent or friend has/had a similar problem
tell the child. Most bedwetting children have at least one close
relative who has or had the problem. We have heard many reason why the
children aren't told and all of them are lame.
Camp Kirk http://www.campkirk.com/
Camp Kirk is a small residential camp which welcomes children ages
6 to 13 with learning disabilities, ADD, ADHD and those with bladder
and/or bowel control delays. It offers a nurturing and accepting
community where everyone can develop socially, emotionally and
physically, It is a place where children can make friends, have fun
and develop a sense of belonging without fear of being ostracized or
ridiculed. The camp program is varied, well structured and, for the
most part non-competitive. It focuses primarily on social skills and
on raising self-esteem.
Camp Brandon for Boys http://tis-group.org/brandon.html
Camp Brandon is a new summer sports camp targeting boys eight to
eighteen years of age who have bedwetting or incontinence
Many children who have bedwetting or incontinence suffer
from a poor self image. Camp Brandon claims to be a place where a
bedwetting boy can "find sports and activities that he will enjoy plus
he will feel a sense of satisfaction in developing new skills. He will
also gain strength and confidence in a friendly atmosphere, while
taking that first big step of living away from home." All this in an
environment where he need not fear teasing from other campers.
I am sure your pediatrician would have mentioned Irritable Bowel
Syndrome if that was considered a possibility, but an article titled
Irritable Bowel Syndrome in Children at
http://www.healingwell.com/library/ibs/info2.asp may be worth reading.
An article dealing with bedwetting and bowel control, written by the
Child Care Centers Association of Victoria, Inc. at
has an interesting excerpt:
Soiling which is not caused by an illness or disability is called
encopresis. Children with encopresis may have other problems, such as
short attention span, low frustration tolerance, hyperactivity and
poor co-ordination. Occasionally, this problem with soiling starts
with a stressful change in the child's life, such as the birth of a
sibling, separation/divorce of parents, family problems, or a move to
a new home. Encopresis is more common in boys than in girls.
School-age children with soiling or bowel control problems should
have a complete physical evaluation by a family physician or
pediatrician. If no physical causes are found, or if problems continue
after examination by a family physician, the next step is an
evaluation by a child and adolescent psychiatrist. The child and
adolescent psychiatrist will review the results of the physical
evaluation and then decide whether emotional problems are contributing
to the encopresis.
Child and adolescent psychiatrists treat encopresis with a
combination of educational, psychological and behavioral methods. Most
children with encopresis can be helped, but progress can be slow and
extended treatment may be necessary. Early treatment of a soiling or
bowel control problem can help prevent and reduce social and emotional
suffering and pain for the child and family.
Also read Incontinence and Voiding Problems in Children. University
Childrens Hospital. UCI Medical Center at
http://www.ucihealth.com/HealthcareServices/peduro11.htm for some
Now, for my own two cents
My daughter continued to wet her bed until
she was about 8 years old. It occurred every night, and several times
a night. I tried getting her up to go to the bathroom, and attaching
bedwetting alarms to her underwear. Nothing worked. I wish I had tried
protective undergarments at the time, but they didnt have older
size diapers at her age. Only later, did they invent pull-ups, which
were a help. One strategy that helped me get back to sleep a bit
sooner, was to put a waterproof mattress pad down, and then a second
and third set of sheets already on the bed, protected by plastic. That
way, I didnt have to re-make the entire bed in the middle of the
night, and disturb her sleep so much. I usually just cleaned her with
a warm, wet washcloth and put her back into dry pajamas. However, I
those disposable youth diapers mentioned on
http://tis-group.org/where.html seem worth a try. It should provide
your nephew and your parents some much needed sleep until you get this
under control. I also remember my daughter being ashamed that she
couldnt spend the night at a friends house for many years. Aahh
is where the love of an adult is so important by helping them maintain
My second suggestion would be to have your nephew bring some
disposable, child-size diapers to school in an opaque plastic bag in
his backpack, or arrange for the school nurse to allow him to use a
special, private bathroom in the school where he can store the
pull-ups and some cleaning supplies, like pre-moistened cleaning
cloths. This would avoid a lot of embarassment for him. My daughter
occasionally wet her pants at school, and I arranged to send clean
underpants and pants for her to change into discreetly in the
Also, my son, from about 8-10, refused to even have a bowel movement
at school, and would come home with excruciating headaches. I am
telling you this just to reassure you that many children have a host
of urinary and bowel problems, some of which disappear with age, and
others which need an extra measure of help from parents and doctors to
find a solution.
And here is my last word! It drives me nuts when doctors say they
have no idea what the problem may be! I managed to find several
sources of possible causes, and I am not a doctor. What is the problem
with doctors these days? I have seen so many people, of all ages, with
all conditions, leave the doctors office with no helpful advice or
..until somehow, they manage to find it on their own, or run in
to someone with a similar problem.
Thats where I end this
More power to all of us for helping one
another out when doctors seem unwilling to go the extra mile.
My best wishes to you
..and admiration for you and your parents for
loving this little boy so much! And also, my fellow researcher,
hummer-ga, is to be greatly admired for expressing such care and
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