Our 12-year-old daughter has been dealing with retentive encopresis for about 5 years now. She avoids going to the toilet at all. The result is continuous soiling and the production of an amazing huge toilet-clogging log-like object every week. She regularly sees a psychologist to talk about this (and other behavioral issues), but this is one thing she refuses to talk about despite what the psychologist (and the gastro doc, and our ped) tried to do or suggested we do to get her to talk about it.
Consultations with her ped and the gastro doc lay out a clear path of laxatives, regular bathroom visits, and a rewards program. The problem is she refuses to comply with the treatment. I can't get her to take the miralax on school days because I would waste time and she can't miss the school bus (buses come early here), but on days she does take it (which she did today) she holds it in, which doesn't help at all. She did that the entire summer. I tried rewards, such as "if you poop, I will buy you XYZ (something she REALLY wants) / you can do XYZ after you poop" and not letting her do things "you can't do XYZ until you poop" and XYZ would be something she LOVES to do. I can't get her on board with the treatment.
She DOES take the miralax on non-school days, and sometimes on school days. The only problem is she holds in her poop and won't go. She took the miralax all summer but did not poop in the toilet all summer after miralax. We switched psychologists a year ago and still she won't talk about this issue.
Has anyone gone through this? Does anyone have suggestions so she can get on board with the treatment plan when she won't even talk about the issue?
Gamma G: She DOES take the miralax on non-school days. The only problem is she holds in her poop and won't go. She doesn't give a damn about surgery or health complications. Again, when we try to talk to her about it, she won't talk. 2 years ago we tried ucanpooptoo which didn't help at all.
I second mixing the miralax into her drink and not telling her. My 10 yr old, who is the pickiest child in the world and knows when ANYTHING is different with her food or drink can't detect it when I mix it in a glass of milk.
See, we approached this with our son as a medical issue, not a psychological one. Encopresis can CAUSE psychological issues, but it isn't one in and of itself. The time to get her on board with the treatment plan was 5 years ago.
(As an aside, 5 years is not "too long" to have encopresis, these kids can take a very long time to heal, my son was diagnosed at 7 and was considered cured at age 12. Without treatment it usually heals itself by the time the person is 19-20yrs old.)
She has prevented herself from healing, and now it's become a power play with you, not a partnership. Normally, rewards work great when you are requiring the child to do regular "sits", but she is past that age. My son was required to sit on the toilet 10-15 minutes after each and every time he ate anything at all, including in school. We had it written into his IEP. He took Miralax, too. But right from the beginning, he was included in his care plan, and he understood the ramifications of not following it.
If you have honestly tried to help her understand the consequences and she refuses to take part in the healing process, if I were in your shoes I would be tempted to let it go for a while. Give her back a modicum of control over it, and take a break from lecturing and asking her to talk about it. Things can't really get much worse, and if they do then she finds out the consequences of not following the plan. If you can't scare her (have you tried what Gamma suggested with her doctor?) and you can't reason with her, and you certainly can't force her, then I suggest you give her back the control over it.
Tell her you are at your wits end, that you only want to see her healed from this, but if she is going to fight you every step of the way then you are going to step back. Let her know you are open to talking about it or helping her at any time, reinforce that your only intention is healing her, and then give her all of the information she needs to follow the plan and see how she does with it.
This problem might solve itself on its own once she hits puberty. Holding will cease to have the rewards it currently does once she becomes interested in boys.
A boy I know was very similar to your daughter, and had poop issues for about the same amount of time, and he stopped holding at about 13. I've talked to him about it, and it was a choice. He told me he liked doing it. He liked the amount of power he had to annoy people with it. He did it at school, at home, and people's reaction didn't faze him. It took a little while for it to become completely normal, but he doesn't do it at all any more.
It might be worthwhile to stop talking about it with your daughter at all. Right now she is having an immense amount of control with it, considering how much attention it is being given.
So I say stop discussing it, let her live with the consequences, and wait till boys matter. I would really stop all treatment for it, laxatives, etc., since what you are currently doing it clearly not working. She holds it even after taking the laxatives. That's a lot of power, mom.
p.s. What in your daughter's environment is causing her to want to have this control? Make sure you are giving her lots of positive attention, completely divorced from her bowels. She needs to be getting her rewards elsewhere, not from her poop.
Negative attention is a real thing, and right now it sounds like your daughter is getting a ton of attention over her poop. So why should she stop? Ignoring is a valid tool and is often one of the best tools for extinguishing a behavior. If you try this approach, and you should, you will have to be prepared to be patient, and definitely consistent in ignoring it. Just do a lot of laundry (I wouldn't involve your daughter in the laundry, that's bringing more attention to the poop.) Your daughter has been doing this for 5 years, so it won't stop overnight.
ETA: If her doctors think it's so bad that her health is at risk, then definitely start with Gamma G's approach, with the X-rays and the scary talk with the doctor about ostomy bags, etc. However, after that, her rewards need to come from something other than poop.
I think that it's time to stop seeing the psychologist to talk about this and see a psychiatrist, a medical doctor with prescribing privileges. This is serious stuff. My daughter has serious medical conditions, and even though my husband and I both have college degrees, there is no way we could talk with her about what she deals with. We can support her and encourage her, but her diagnoses are way beyond our comprehension and we rely on good doctors. So your talking with her about this, since it's a real medical and psychiatric issue, and trying to reward her, is like trying to talk to a diabetic about teaching his or her pancreas to produce more insulin. You wouldn't do that You'd encourage him or her to see a specialist, and you'd be supportive and serve sugar-free cookies when visiting, and you wouldn't tease him or her about having to take insulin. Your daughter needs professional medical help. A psychiatrist will know how to deal with this when she's refusing to talk about it.
I know this is difficult. I know how tired you must be.
ETA: by the way, my daughter has Gastroparesis, and she's supposed to take Miralax. However, she can't stand it. She's really sensitive to the texture. No matter how well it's mixed or what it's mixed in, she hates it and can tell it's there. We use similar meds that come in capsules or tablets, and we've also found that 100% Aloe (with no other ingredients - available in good health food stores, but you really have to read the labels to find the type with no additives) also helps her, and that doesn't bother her. She cannot detect the Aloe. So possibly, your daughter is sensitive to the Miralax and just hates it. Finding another similar aid with a doctor's help might work better.
You know that miralax doesn't work immediately, right? It doesn't matter if the bus comes early. She should take it every day, then over several days or a week or more it will start to work. Mix it into anything she drinks and she won't even know it's there.
Make her take the medicine when she gets home from school. This is a health issue and she must be made to comply.
Also, perhaps you need another psychologist. It doesn't sound like she has connected with the one she has.
I'm surprised that both doctors want you to continue a treatment that isn't working for your daughter.
Considering she is creating problems with her body that could cause her harm, I would start looking for a psychiatrist (a medical doctor). A good psychiatrist might be able to create a treatment plan in conjunction with her gastroenterologist or pediatrician.
I know this is a psychological issue however, many psychological issues start with a deficiency in nutrients. The brain not only needs vitamins and amino acids but fat....Have you thought to see a Naturopath or a Clinical Nutritionist? There are also better things than Miralax...that's to relieve constipation that the body has caused and will weaken the body's process of evacuating. A natural diuretic like psyllium husk (I use one with extra antioxidants and emollients) will keep the intestinal tract healthy and working. She's been holding things so long that its safe to assume that the intestinal tract isn't working right. That also can be toxic to her system.
Both my daughters had slight symptoms of this. I really thought for a long time that they outgrew them. The more I think about it now, the more I realize the end of their issues coincided with me getting better after I detoxed our home and started on a nutritional regimen.
Just my two cents....
M.
Miralax has tablets/capsules. How long does that take to take? 5 seconds?
At 12, she can take capsules.
sounds like you guys are in a power struggle and she is winning. My Granddaughter did this for a short while. I finally just stopped nagging her about it. I made it HER responsibility to clean up after herself. I refused to say anything negative to her about it. No rewards, nothing. It Worked! Finally she became more willing to do what was necessary to help herself. Maybe this would work for your daughter.
5 years is a long time to be dealing with this.
She's getting into middle school age now, not to mention she's old enough to be getting her period.
Have you been going to the same psychologist this whole time?
Maybe it's time for a psychiatrist.
Has anybody explained digestion to her step by step from start to finish?
She can't just not eat - we need to eat to grow and be healthy.
And since we have to eat, and nothing is totally digestible, what ever is undigested is passed along and pooped out.
Everything we poop is something we chewed and swallowed at some point.
It works the same for cats, dogs, cows, fish - everything I can think of.
This refusal to deal with something that's so basic and necessary is just kind of crazy.
It must be causing her all sorts of pain.
I'm not sure what else you can do but good luck with it.
