Accidental peeing and pooping in a kid: physical or emotional or what?

June 18, 2011 7:49 AM

Could my son’s bladder and bowel control problems be a manifestation of emotional distress? Or could there be something physical going on that we’re missing? We’re going to the doctor soon, but I’d like to hear some ideas from others who might have dealt with something similar.

My son is 9 and is generally an active, healthy, bright kid. He suffered some major emotional losses early in life (not any abuse, that we know of, anyway), and we adopted him a few years ago. We’ve been working with a children’s therapist who specializes in helping kids recover from early trauma and stress, and he seems to be getting a handle on his losses.

He’s had problems with bedwetting the whole time he’s been with us, which isn’t uncommon in kids adopted at older ages, or really all that uncommon in kids generally. We’ve talked to his pediatrician about the bedwetting, and my son is getting better at setting an alarm or waking himself up to stay dry. We’ve tackled this is as an isolated problem and haven’t talked to the therapist about it. (I was a long-time childhood bedwetter, so I'm sympathetic.)

But lately, say for the past several months or year, he’s also had some bowel control problems. At first I thought this was an urge problem—he was ignoring when he had to go until it was too late. But now he’s somewhat regularly (maybe 1-2/month) leaking stool/pooping a tiny bit in his underwear. He doesn’t seem to suffer from constipation, and he eats about as well as can be expected for a nine year old. His regular bowel movements smell spectacularly awful, which has me wondering if there’s some parasite or other weirdness. A few years ago he pooped in a swimming pool, so he has had bowel issues of some kind for a while.

I have been reading about encopresis (though, again, though I don’t think he's been constipated). Could there be a link between bladder and bowel control issues? Like some weak muscle? (We don’t have a ton of medical history for his birth family and can’t get more.) Or could this be connected to early life trauma? Or an allergy?

As I said, we’re going to our regular family doctor soon, but I would welcome any insight or ideas. Thanks.

(Anonymous, because, well, I’m talking about my kid pooping his pants. I don’t want this to follow him his whole life.)

posted by anonymous to health & fitness (14 answers total)

(IANAD) Bedwetting - get rid of dyes. No Koolaid, jello, etc. Dyes and flavorings irritate the bladder. A urologist recommended this, and it worked. If it doesn't work, hey, no dyes and no crappy food - yay

Bowel incontinence. More, rather than less, fiber for general bowel health. Probably not too much fruit or fat. I'd really consider a trial of no dairy. Lactose intolerance can cause this.
posted by theora55 at 7:55 AM on June 18, 2011

Food allergies are definitely a possibility.
posted by MexicanYenta at 8:39 AM on June 18, 2011 [3 favorites]

It is well within the range of expected reactions to trauma and a chaos in his early life for a kid to have some enuresis/encopresis issues. Therapists who work with kids who have gone through trauma see a TON of enuresis/encopresis, and there are plenty of established methods of treatment. I would strongly recommend that you let the therapist know about it so she can help you all work on it together.
posted by so_gracefully at 9:35 AM on June 18, 2011 [6 favorites]

Get him tested for food allergies, especially dairy.
posted by easily confused at 9:47 AM on June 18, 2011

You could try rotating out milk, eggs, wheat, corn, etc. and/or do some controversial IgG allergy testing (which an allergist will laugh at but they're useless for anything except for IgE allergies). Then leave out or rotate stuff that comes back on the IgG test to see if things improve. As a 30yo male I definitely had some weird neurological/bedwetting stuff going on that was food-related. And a few brands of probiotics (slowly introduced, making sure there isn't too much iron in them on the label) can't hurt and could help a lot.

If you leave out, say, milk from the kid's diet, make sure he's getting enough calcium and saturated fat or it will mess with his digestive system (leaky gut) even more.
posted by zeek321 at 10:55 AM on June 18, 2011

(Contrary to popular belief, if there isn't enough healthy bacteria in the gut, increased fiber causes more problems--e.g. inflammation and flatulence--not less. The opposite of a high fiber diet is a "low residue" diet.)
posted by zeek321 at 10:58 AM on June 18, 2011

He may have an aversion to pooping. I was a very anxious child and I would avoid it at as long as I could, and ended up with the same sort of accidents.

I was too young to realize it, but when my anxiety gets bad I clam up. Even at my age now (30ish.) Bad-smelling stools are sometimes stools that have been in there for a long time. Does he get cramps?
posted by TheRedArmy at 11:16 AM on June 18, 2011

Could my son’s bladder and bowel control problems be a manifestation of emotional distress?

I can say that, when I was his age, my bladder and bowel control issues were. My therapist tells me that this is not uncommon.
posted by The Great Big Mulp at 11:26 AM on June 18, 2011

Just a thought: are you sure he's leaking stool? Could he just not be wiping all that well after bowel movements?

I am absolutely not discounting the possibility of emotional residue, just throwing that out there.
posted by cooker girl at 12:16 PM on June 18, 2011

Encopresis can be medical or emotional, and if you've ruled out constipation or having previously passed painful stool that might making him too scared to go, plus his history of losses and trauma -- it seems likely that it's not medical. The leaking happens when he holds onto it for a long time, and pooping in the pool may have also been because he was holding onto it until he was too uncomfortable. I'd talk to the therapist asap about it. I wish you all much luck.
posted by Ink-stained wretch at 2:15 PM on June 18, 2011

Have you ruled out constipation, or are you just thinking that it doesn't seem like constipation? My 4-year-old had some bad soiling problems several months ago, and I was at my wits' end because let me tell you, she was definitely not constipated. . . but after daily treatment with Miralax for a week, whoops, turned out that she was. If the doctor agrees that constipation isn't the issue, then disregard everything I'm saying, but otherwise maybe don't take that issue off the table just yet.
posted by KathrynT at 2:24 PM on June 18, 2011

Correlation with cow's milk allergy

childhood trauma and irritable bowel syndrome (HPA dysregulation)

correlations between parenting techniques and bowel/stool control

childhood abuse and increase in health disorders

This study (among many others like it) found that stress in rats alters physically functioning of intestines and colon causing functioning that resembles IBS in humans.

Something important to consider is that an emotional origin does not mean this is not a physical problem. Abuse dysregulations in the immune system and HPA axis cause changes in normal endocrine and immune function and varying different (very real) physical health problems. Emotional stability is essential-- but working on physical manifestations of these problems is important too. Considering gut bacteria, immune functioning and many other physical origins of this problem is important even if that doesn't rule out that the origin of the physical problem is emotional.

There is also the possibility that sexual abuse could be related to this.

Please note, I'm just giving you ideas to discuss with professionals-- I certainly don't know what the cause is!! I wish you luck and I am glad that you are doing your best to find the best care for your son. I can assure you that among the people I know who are foster alumni and foster parents--- this is very normal. Talk to your childs therapist about it, and definately talk about treatment options and problem origins with your doctor!!

It might help your son to know that this is a common problem and many other foster/foster to adopt kids have dealt with this too. I was looking for narratives on the internet but of course they're hard to find (written by foster alumni or adoptees rather than the parents). There's a lot of info on dealing with this online, but I'm not seeing as much research on treatment options as I would have hoped, however that is likely because this can be caused by so many different things. I hope your doctor is able to help you find some effective and compassionate sources/solutions for this!
posted by xarnop at 3:00 PM on June 18, 2011 [1 favorite]

Things to look out for:

1- Is he afraid to ask to go to the bathroom at school?
2- Lactose intolerance.
3- Fructose intolerance.

(Contrary to popular belief, if there isn't enough healthy bacteria in the gut, increased fiber causes more problems--e.g. inflammation and flatulence--not less. The opposite of a high fiber diet is a "low residue" diet.)

You want insoluble fiber. Not the "fiber" they put into products to call them high in fiber, which are closer to sugars than to fibers.
posted by gjc at 7:37 PM on June 18, 2011

Ask your dr for a referral to a specialist, even if it means a trip out of town. A good pediatric gastroenterologist knows what to look for, much more so than your usual pediatrician or an adult GI doc. Children's hospitals also often have specific programs for families working on this issue, which can be a great support network for both you and your child.

Here's a link to Children's in Detroit about constipation - a good overview.

Miralax is often used to help kids with this issue; a dose every day or every other day. A regular routine of potty-sitting time (ie: 15 min. every evening after dinner) can also be helpful.

Last but not least, a local family or pediatric counselor may help you and your family look at your routine, evaluate when and why accidents are occurring, and fine-tune things to help your child be successful.
posted by hms71 at 9:55 PM on June 18, 2011