Soiling incidents plus prolonged constipation and withholding bowel movements
Amit, 3 years
June 4, 2019
Amit’s parents visited my clinic on June 4th, 2019. Their son has perfect bladder control, day and night, they told me. He tends to withhold bowel movements for several days and has a few small soiling episodes each day. Even though his parents put him on the toilet every evening, it doesn’t help. Once a week, when he can’t hold it in anymore, he has a bowel movement on the toilet. Amit’s condition isn’t stable, and there are fluctuations: sometimes he evacuates his bowels completely on the toilet every day over a whole week. His menu is varied, with a good amount of dietary fibers, and his bowel movements are usually regular. Occasionally, they give him Normalax, and when they don’t, his condition worsens. His big brothers and grandparents talk to him about their expectations for him to poop in the toilet. Amit’s prolonged withholding makes him very nervous as if physically frozen. His parents say he’s a very sociable child, full of self-confidence, smart, and with mature, rich language.
I gave his parents instructions to start the intensive method, combined with behavioral treatment and the use of micro-enemas.
When the treatment began, Amit strongly objected to the micro-enemas but his parents didn’t waver and enforced on him a daily complete bowel evacuation. They used the small (5 ml.) bottle of micro-enema, and gradually he became more cooperative. After a few days, they began using a half dose.
On June 13th (nine days after treatment began), his mother reported that he’d had a full bowel movement in kindergarten. I advised her to continue lowering the enema dose gradually.
On June 23rd (seventeen days since our first meeting), his mother updated me that he was continuing to cooperate, and was pooping independently almost daily, without having to resort to an enema.
Almog, 3.8 years
April 23, 2019
On April 23rd, 2019 I met Almog’s parents at my clinic. They told me about the episodes of withholding, constipation, and difficulty in evacuating his bowels. Every so often, Almog poops in his diaper at nighttime when he’s sleeping. In the past month, the problem has worsened. During the day, he soils his clothes several times in small amounts. Things have been like this for eight months, and there was never a time when he pooped in the toilet. When he was only in diapers, up to age 2 and 10 months, his bowel movements were regular. Over time, they got in touch with various consultants. Today they are trying to persuade him to poop on the toilet. For his part, Almog makes tremendous efforts to avoid pooping at all and holds it in. He eats reasonable amounts and his diet is varied and balanced. His bowel movements are always very hard. He’s a sensitive child, smart, very active in sports, opinionated and high-handed.
I instructed the parents to begin the intensive method, combined with behavioral treatment and the use of micro-enemas.
On May 1st, 2019 (a week after the first meeting), I had a talk with his mother. For the first four days, she administered a full enema (micro-enema—5 ml) and he resisted vigorously. But after that, he started cooperating and we cut the dose to half.
On May 5th, 2019 (two weeks after our first meeting), his mother wrote to me:
“Hi, I gave him just a quarter of the dose; he played for about five minutes and then asked to go to the bathroom. He did a medium size bowel movement there, very quickly. He remained sitting there for seven minutes and then said he hasn’t got any more. I told him that when he feels he has to go, he should tell me and we’d go to the bathroom again.”
On May 12th, 2019 (three weeks since our first meeting), Almog’s mother wrote again:
“We can feel the improvement. Yesterday at around 3:30 we already noticed some movements of discomfort because of needing to poo. We told him it’s time to go to the toilet. At first, he objected, and then we said we’ll give you the medicine and you go on playing until you feel you have to go. We gave him a very little amount, and five minutes later he asked to go to the toilet, and within five minutes he pooped everything.’
On May 20th, 2019 (a month after the treatment started), his mother wrote to me again:
“Good evening—here’s the latest update on today. After he refused most days to go into the bathroom he finally agreed to go there in the evening without “the medicine.” He sat on the toilet for about 20 minutes. It caused him some discomfort and he complained it wasn’t comfortable. And in the end, he got up on the toilet seat, squatted down, and managed to go. Afterward, he was really happy and contented. We’re thinking about a solution to the question of the toilet seat…And we’ll look into it this week.”
On May 27th (five weeks since the first meeting), Almog’s mother wrote to me:
“Hi—well, it was a complicated weekend. We were away from home, traveling. We continued as you said, so every two days he could have a bowel movement. On Friday morning, his underpants were soiled but he still didn’t want to go. We pretty much forced him to go, because it was getting really impossible by then.The next day, Saturday, he asked for an enema and really pooped a lot. We noticed that when he functions as usual he’s not interested at all in going to the bathroom, and he’s ready to defer the whole matter constantly. Only when we give him an enema he looks at us with a helpless expression and realizes he needs to go to the bathroom. We have to find a solution that will create a situation where he wants to go to the bathroom.”
On July 3rd, 2019 (six weeks after our first meeting), his mother wrote again:
“In the end, we didn’t get in touch on Saturday…At the moment it doesn’t seem we need to use Normalax. Altogether, he’s having a bowel movement every evening. He doesn’t go on his own and it always reaches a situation where we confront him with the fact—and he has to go. Yesterday he was at a birthday party at the pool and he really held himself in not to poop, until he went to one side and expelled poo into his underpants. Of course, we saw immediately and we went to the bathroom and explained to him that it’s good that he pooped, but next time he just has to go to the bathroom before…We’ll see how things go today and whether he’ll see himself that he needs to go.”
On July 24th (two months after the first meeting), his mother reported that Almog was pooping every day in the toilet without using a micro-enema. There were hardly any incidents of soiling, although he still didn’t take the initiative and his parents still needed to demand that he went to the bathroom.
Rebecca, 11 years
June 19, 2017
I met Rebecca’s parents at my clinic on June 19th, 2017. They told me that Rebecca doesn’t wet at night. There are intermittent periods when she wets her clothes in the day. She does bowel movements in the toilet once every three weeks; and even then, they are very small and partial poops. She is constantly withholding and constipated. In the past few years, on several occasions, her parents had to take her to the emergency room to have feces removed. The doctors had to anesthetize her and manually remove huge chunks of feces. Gastroenterological tests ruled out any organic reasons for the problem. Her parents have tried various therapeutic interventions. She takes large amounts of MiraLAX. Every so often they’ve tried enemas, as well as different kinds of psychological treatment. Rebecca was already constipated and retained feces while she was still nursing. At age 18 months she started getting MiraLAX. Her diet is varied and balanced, with good amounts of nutritional fibers.
Rebecca is described as a sensitive girl; delicate and smart. She’s very popular with her friends. In some areas, she avoids responsibility. Her mother says that the issues of holding in, soiling, and continuing constipation, are ruining so much in Rebecca’s life, and the lives of her family members.
I instructed her parents to start the intensive method, plus behavioral treatment and using micro-enemas.
On June 20th, 2017 (the day after the clinic meeting), I instructed her parents to use the 133 ml. dose on the first day, since there was clearly a major accumulation of feces due to her prolonged withholding. Initially, they used half the amount of the bottle, then after one hour of partial pooping, they used the other half. Her parents said she expelled huge quantities of feces, and compared the experience to childbirth. They received instructions to use the 8 ml. dose of micro-enema on the following days.
June 27th, 2017 (a week after the clinic meeting), her parents reported that Rebecca was moving her bowels every day in the toilet—a full evacuation, helped by enemas. She was cooperative and it was clear there had been a great improvement in her mood and her general daily functioning. We lowered the dose of enema to half the amount of the 8 ml. bottle.
On July 10th, 2017 (three weeks after the first meeting), Rebecca’s parents described several events in which she managed to poop in the toilet without having used an enema. She didn’t go of her own accord, but after her parents reminded her. We cut the dosage to a quarter bottle.
On July 20th, 2017 (a month after our first meeting), her parents reported the new and welcome pattern that was developing. She no longer pooped as soon as she was given the enema. She went about her affairs and, only a half-hour later when she felt pressure in her stomach, she went on her initiative to the toilet. Now and then she was going to the bathroom to evacuate without having received any enema at all.
On August 25th, 2017 (two months since the clinic meeting), the parents told me that she was going more and more to poop in the toilet independently, and there was far less need to remind her: the use of enemas had dropped significantly.
Aviel, 7 years
September 6, 2018
Aviel’s parents came to my clinic on September 6th, 2018. They told me that their son was completely dry at night and day. Regarding bowel movements, he restrains himself for periods of five days and serious constipation results. He soils his clothes several times a day in varying amounts. He doesn’t rush to change his clothes and walks around with soiled clothes for hours. Once every two weeks, he does a really large bowel movement in the toilet. From 2½ to 3 years he was totally trained. He’s the youngest of four boys. When he was 3, the family went through a very troubled period. There was great tension between the children, and that’s when the withholding and soiling phenomena began. His parents have tried various treatments. His pediatrician recommended using MiraLAX. They’ve tried homeopathic therapy, acupuncture, occupational therapy, and psychological treatments of different kinds. There were some periods of improvement in response to the treatments, and due to prizes and all sorts of reinforcements. His usual menu is carb-intensive, and he doesn’t like eating vegetables. His poop is very hard. He is described as a highly intelligent boy with a rich language and excellent expressive abilities. Aviel is sociable, loves talking to people, is connected to his emotions, and has a vivid imagination. He strongly needs discipline and structure; he’s very sensitive to noise— shouting in particular—and tends to have anger outbursts.
I instructed his parents to start the intensive method, combined with behavioral therapy, use of micro-enemas, and to make a point of regular, consistent use of MiraLAX.
On September 8th, 2018 (two days after our first meeting at the clinic), his parents described two days of tough battles with the boy. Using the enemas, they’d managed to produce a partial bowel movement but it was only after two days they got the impression there’d been a real bowel evacuation—it was a massive bowel movement.
September 9th, 2018 (three days after our meeting); again, a half-hour struggle. They managed to introduce the enema. Within five minutes, he had a complete bowel movement. He was very proud and shared his great achievement with his brothers.
On September 11th, 2018 (five days after the clinic meeting), his parents suggested to Aviel that he tried to poop on his own. He sat on the toilet for about ten minutes and pooped without using an enema. A good amount was expelled but they weren’t sure that he had completely emptied his bowels. He was happy and proud.
September 20th, 2018 (two weeks after our first meeting): in the past few days, there were peaks and troughs. Sometimes he pooped independently in the toilet; other times he was helped with an enema. Sometimes he objected to the enema and fought it, but other times he wanted the enemas help. But without exception, he was happy and contented after pooping on the toilet. At this point in time, there were only rare incidents of soiling.
On October 13th, 2018 (six weeks since the clinic meeting), his mother wrote me the following:
“It’s been a fabulous week!!! There was a surprise today—he started to poop, told me, and went straight to the bathroom, where he had a proper bowel movement!!! I’m overjoyed—what would usually happen is that he would sit and nothing would come out—but today, because he’s acquired the habit, everything came out!!!! Thrilling—and what’s going to happen tomorrow?
In the following days, we gradually reduced the enema dose. We reached a situation where a quarter of the bottle (8 ml.) was enough to stimulate a bowel movement. And often he managed to poop without the help of an enema. What was special this time was that he reacted to pressure in his stomach, took the initiative, and went to poop on the toilet. Now and then we suggest that he tries to blow up a balloon while sitting on the toilet and it helps him to relax his pelvic muscles and to poop.”
March 31st, 2019 (seven months after our first meeting): over the past two months the situation had improved constantly. Occasionally, it was still necessary to supervise, remind, or demand that he go to the bathroom, but there were hardly any soiling incidents. And there were many events in which he took the initiative and went to the toilet. There was little need for enemas and if there was, a minimal dosage only.