[mango7777]

My step-daughter, age 12, has had a problem with going to the bathroom in her underwear for about 5 years. Her dad and I married in 2004 and she lives with us 50 percent of the time. She claims it is an "accident" but I know it is not an accident. My concern is I feel it is psychological. My husband and the ex wife know and we all have talked about it. Since I am the "Step Mom" I don't get final say so, but they don"t seem to want to seek prof. help for her. I feel it is stemmed from anxiety and emotions. We have asked her to deal with her "accidents" by washing the underwear. But she hides them, and we have found them too late. It obviously make her ashamed, that she has to hide them, but still won't take care of the tangible problem. It is out of my hands and I am frustrated because she is not being taken care of as a child of 12. This conversation is Old news within the three of us, but no action for her emotional and mental state is being taken. Please tell me the cause and what can I do as a step mom.

[J_9]

This is usually a psychological issue as you expected, however the name escapes me and I am 650 miles from my texts at the moment.

You should start, though, by taking her to her doctor for a full physical exam and discuss with her doctor. There are other things that may cause this such as IBS or impacted colon that need to be ruled out first.

So this may be a good first step.

[Megg]

I'm no mother or step mom, but deff get her to the doctor just for a check into it. Maybe something else you don't normally think of is wrong. It's hard for young kids to have parent's that split and step parent's. I'm sure you care for her as if she were your very own. So in that case, make sure she knows that you are there for her just as her own mother is. Make sure that she knows your there for her to talk to. Just be there for her and eventually she will come around and talk to you and perhaps answer any questions you may have. Good luck.

[Fr_Chuck]

As a step mom there is nothing you can do, expcet force your hubby to do his duty as the father and get his daugther professional help.
Of course a phsyical cause should not be over looked either but I would say some real pressure on the dad.

[mango7777]

Thank you for your views. Dad and mom have taken her to a doctor and she is fine. No internal complications. So now what, do I back off? I have asked her to consider a therapist. Am I the only one here who sees that this is not just a "lazy issue". She is hurting inside, and she cannot express her feelings. As far as she is concerned, she is unable to tap into the truth. And she doesn't know why she does what she does. Dad doesn't want to take her

[J_9]

It is good to know that there are no internal issues. However, this now becomes a psychological issue. It is a shame that dad does not want to take her, do you have a good report with her mother?

[Greg Quinn]

The mind can do some incredibly odd things to people physically. I have no answers for you... But I admire you trying to get this fixed. That poor girl is probably so sensitive to this subject, I hope you find the solutions to this very serious problem. It certainly can not be ignored.. And I will try to research it as well. I do know one thing... The longer people wait to help her the worse it will be. It does seem that J_9 is of some assistance though.

Greg Q

[Greg Quinn]

Mental disorders

I found this link and I know it's in here some where... I put a little time in on it but couldn't find it. I have to go to bed and will try to research it tomorrow after work.

[Greg Quinn]

You might want to read the following. Perhaps it applies to your situation. This condition applies to 1 out of 100 children aged 12. I encourage you to read the whole article and if you need more information Google the word "encropresis".
Hope this is helpful.
Greg Quinn

FAECAL SOILING (ENCOPRESIS)



What is encopresis?
Types of soiling.
Background Information
Effects
Causes

Physical causes
Psychological determinants
Environmental factors

Suggested case study

What is it?

Soiling occurs because the child has lost the normal anal reflex through excessive constipation and subsequent dilation of the bowel – 'retention & overflow.'

Primary encopresis – when bowel control has never been established

Secondary encopresis - when bowel control has been established for at least 6 months before the soiling begins

Who does it refer to?

"…any child over the age of four and under the age of 16 who regularly soils his / her underwear and / or bed."

(Herbert,1996)



Types of soiling.

Where there is adequate bowel control, but the child, nevertheless, deposits faeces in inappropriate places
Where there is a failure to gain bowel control; the child is unaware that he/ she is soiling, or is aware, but cannot do anything about it
When the soiling is due to excessively fluid faeces
(Hersov, 1994; Levine and Bakow, 1976)



BACKGROUND INFORMATION

Encropresis is not uncommon – 3 in every 100 children entering primary school, aged 5, will still be soiling
Between the ages of 7 and 8, approximately 2 out of 100 children are soiling
At 12, approximately 1 in every 100 boys, and some girls are still soiling
Recorded figures are likely to be underestimated due to the shame and secrecy in families around soiling
Constipation, or hard bowel movements, cause pain, irritability and a decreased appetite
Stress / trauma resulting from distressing individual / family / life events affecting the child's emotional state, can affect the functioning of the bowel (e.g. sexual abuse)
Due to the secrecy around soiling, parents / carers are more likely to think their child has a unique problem, as most have not heard of another with a soiling problem
Sometimes associated with behaviour problems (e,g. defiance, non-compliance)
It is more common in boys than in girls
Soiling is found in children of all levels of ability and from all walks of life
Highly significant association between enuresis and encopresis
Relationship between soiling and low-birth weight



EFFECTS

Can lead to fear embarrassment, lowering of self-esteem in a child, which may lead to negative social consequences
Children who soil often try to hide soiled underwear / bedding due to fear of ridicule / punishment
Children are likely to be teased and bullied at school because of the problem
In some cases children have been suspended, as the staff found it so difficult to manage
The family can feel bewilderment, frustration, failure, revulsion and anger
Soiling tends to engender negative responses from parents and is one of the most common precipitants of incidents of physical abuse

(Claydon & Agnarsson, 1991)



SOILING – CAUSES

Identifying causes

*no uniform causation

*comes about in different ways / for different reasons

*influencing factors linked with the problem can be:

Intellectual (e.g. learning disability)
Physical (e.g. constipation)
Psychological (fear of the toilet)
Social (neglectful / coercive training in toilet habits
PHYSICAL CAUSES

Majority of soiling cases are due to chronic constipation and withholding stools
Children who have hard movements (pain may also be caused by an anal fissure) may respond by stool withholding (to avoid pain.) The longer the child withhold, the harder and more painful the stool becomes (as the role of the colon and rectum is to absorb water from the stool) Therefore a vicious circle is created of more painful bowel movements, more withholding etc.
When the bowel is frequently overloaded, the rectal muscles become overactive while the anal muscles relax reflexly in response to the rectal activity. The muscles go on churning to eliminate the blockage, the child has no voluntary control and they soil.

PSYCHOLOGICAL DETERMINANTS

These are psychological factors associated with soiling may be secondary to the soiling, an 'emotional overlay' as opposed to a cause, which contributes to the onset, maintenance or exacerbation of the symptoms.

Coercive training / punitive rememdies on behalf of the parents
Role of anxious / overprotective mothers and overly strict fathers (Bellman, 1966)
Tendency of soilers to be nervous (Bellman, 1966)
Tendency of soilers to be food refusers (Bellman, 1966)
Tendency of soilers to suffer from learned helplessness (Sluckin, 1981)

ENVIRONMENTAL FACTORS

Predisposing influences:

Stressful environments
Poor toilets at home or at school
Separation (and other traumatic) experiences
Dietary factors: eating a diet deficit in fibre and drinking excessive milk can cause constipation in older children.



SUGGESTED CASE STUDY - SOILING

You might want to think about a case you have had or are currently involved with and consider the following:

Identification and analysis

The child's age
Is it primary or secondary encopresis?
What toileting skills have they already achieved?
Does the parent / carer praise progress made / offer the child encouragement?
When is the child most likely to soil? E.g. time of day / night
What are the motions like?
Could there be any physical causes?
Are there any emotional influences?
Can you identify any psychological determinants?
Do any environmental factors come into play?

Interventions

Consider A.B.C. model
Help the parent to think about ways to involve the child
Help the parents to explore how they can reinforce good behaviour, including encouragement during periods of relapse
Explore with the parent's the child's self-perception and the relationship this has with soiling
Consider additional techniques (e.g. behaviour programme, cognitive restructuring, helping and encouraging the child to recognise body signals /clean themselves up, modelling, story <Sneaky Poo>)



[back][toileting skills][enuresis]

[J_9]

Greg, that is the word I was looking for!! That is EXACTLY what this is. I am 650 miles from my texts so I had no way to look it up.

Also, Greg, it would be helpful if you add the link to your source in your answer.

Anyway, that is what is going on with this girl.

[mango7777]

Greg
Thank you, Thank you, so much for your research towards my concern and my bewilderment. You gave me information that was crucially needed for me to understand the "why's and how's" of the situation.

I would very much like the link from where you got this information so I better arm myself to present this information to the parents. I feel this will change the way the family dynamics is thinking and addressing this sensitive issue. You truly have eased my heart, not just in the idea that this information may "fix" the problem, but to know this little girl just might get closer to the solution.
With the information, so far, I feel she is a stage 2 category and the "signs" described are quite on the money.
Thank you my friend-My gratitude is abundant for your effort. Keep up your good work. :)

[J_9]

I did a little bit of research and I have found the link to Greg's post. Again, thank you Greg, good job and kudos to you!!

Here's the link

FAECAL SOILING

[Greg Quinn]

That little girl is lucky to not to have to go through this on her own. Good luck.

[Greg Quinn]

I have to say though... They really keep that one "hard to find", LOL. Imagine what I had to go through to get there. Laugh's.