Thursday 14 December 2017

Dear David: Our six-year-old is still having wee and poo accidents every day

Clinical psychologist David Coleman on how to help a six-year-old who is still having wee and poo accidents.

Clinical psychologist David Coleman
Clinical psychologist David Coleman
Dealing with wee and poo accidents can be misery

Clinical psychologist David Coleman on how to help a six-year-old who is still having wee and poo accidents.

Q. Our six-year-old son is still weeing and pooing in his pants on a daily basis, including having accidents in school too. He struggled with poos from day one. We've tried everything, including star charts, praise and giving out. We've had him at the GP. Nothing has worked. I don't feel he has a fear of the toilet or going it just doesn't seem to bother him if he is wet or with a dirty bum or pants. I wonder if he doesn't feel the poos coming as they are usually very runny or loose, not formed. I just don't know where else to turn.

 

David replies: Dealing with wee and poo accidents can be misery. We can end up spending so much time, reminding our children to go to the loo and then cleaning up after them when they don't go. I am sure you have been so frustrated over the last few years.

The most important thing to determine, at the outset, is whether this is some kind of physical issue for your son, or is it a developmental delay in getting control of his bladder and bowel.

I know you said you were at your GP, but did she or he have any opinion about the runniness of the poo? In my experience, runny poos are either the result of overflow faeces, squeezing past an impacted, hard poo, or they are the result of some dietary imbalance.

Had your GP an opinion? Did you get any tests done to determine the cause of the runny poo? This might help to determine is this is a physical problem or if it is just a case that he never really got the hang of toileting the first time around.

I'd recommend returning to your GP and asking for further tests and opinions about these runny poos. I think you might be right that if your son doesn't get the necessary sensation from his lower bowel that there is a poo there, then he won't have an internal signal that it is time to go to the toilet.

Solid stools stretch the lower part of the colon as they move down and the stretch receptors in the bowel send the signal back to the brain that a poo is coming.

That is what creates that "needing to go" feeling of pressure and urgency. This is what your son needs to be trained to notice. He may also need the same training in relation to his bladder and the "bursting to go" feeling that he also needs to learn to respond to.

The good news, at age six, is that your son is a little more able to understand the physiology of pooing and weeing. He should be able to follow simple diagrams about how poo gets formed and what happens to it. He may also be interested in what happens to poos once they get flushed down the toilet.

The purpose of these kinds of explanations is to encourage him to take a bit more interest in, and be a bit more engaged by, the whole process of weeing, pooing and using the loo.

Assuming that there is no physical problem for him, his toileting is something that he just needs to take ownership of. There is a possibility that if you have to keep after him, reminding him to go to the loo, and bringing him there, that he just hasn't taken on board the fact that dealing with wees and poos is actually his own job.

Encouraging him to take more responsibility is difficult if he doesn't seem to be bothered by sitting in wet or dirty pants. Most children dislike the discomfort, or are embarrassed by the smell, and so are very motivated to avoid being in such a situation.

Your son clearly needs some other motivation to use the loo. So perhaps it is worth focusing, again, on some positive outcome for him for using the loo. Reinforcing each successful use of the loo with some kind of immediate reward (something small but desireable) may be the best bet.

At his age, star charts may not be very reinforcing, but if you can find something else he desperately wants, then that could become the source of your reinforcement of his toilet use.

Stick with him, even if you feel frustrated and demotivated yourself. While the toileting hasn't yet clicked for him, with a bit more understanding, on his part, of what is going on, and the lure of a reward, it might all fall into place.

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