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My 9yo with aspergers still uses a pull-up

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My son has been potty trained since he was 3. He has control, but will not have a BM in the toilet. He will only go in a pull-up. He will go days without going if I try to withhold the pull-up. Major upset to make him try on the toilet. No incentive works. I have run out of ideas. Anyone with a similiar issue? Ideas?

by on Apr. 29, 2012 at 12:27 AM
Replies (11-14):
riri732
by on May. 2, 2012 at 9:25 AM


Quoting hwifeandmom:

Thank you so much for the reply!!!  I am so afraid to give him laxative because I am afraid of him having an accident in school.  I know when I take one occassionaly, it makes me go numerous times a day, than I have a hard time going for a few days because I am so emptied out.  I think I will try it this wknd, though.  When he has an accident it is hard to tell if it came out "pudding like" because it is like clay, stuck everywhere. I am thinking maybe the Milk of Magnesia because it is faster acting, but I don't know that I could get him to drink this.  I checked when he got home yesterday from school, he was clean, I checked 2hrs later, still clean, but then an hour later when he was taking his clothes off, there it was again...a little more than a skid mark he says..ugh :/  The doc had me cut back on miralax slightly until we can get him fully emptied...I will have to wait for the wknd because he has football playoffs and mandatory practices...

 

 


Quoting riri732:

My 10yr old with Aspergers has been potty trained since 2. He has always had poopy anxiety and will hold it for up to a wk at a time.  Now what has happened is he "leaks" stool into his underwear constantly. He has no idea he does this and will often sit in it..I don't get the sitting in it part..how can you not feel it??

They don't feel it because their sensory awareness is off and because they become immune to it.  You don't tend to notice your own body odors very well.  Also, this is what they're accustomed to, so while it might not be normal for you and me, this is their "normal." 

 

We change and clean him at least 4 times a day...I fear someone smelling it in school, therefore I use alot of powder after we clean up.  Finally took him to a GI (mind you he eats good with a lot of fiber and loves water :/)  The way she explained it to me is that his lower colon/rectum is so dilated from him holding it that there is nerve damage and he most likely does not feel the urge to go.  The poop that is backed up is compacted, the loose stool that leaks out is the newer stool that leaks out around the sides of the compacted.  She said it could take up to 2 yrs to have his nerve endings go back to normal.  The way she wanted me to do this was to empty him out with a Fleet enema, although he put up a little fight, it wasn't that bad. 

Another option rather than an enema is to use chewable, chocolate Ex-lax squares.  It's yummy and non-invasive.  Ex-lax is a stimulant laxative, which forces bowel contractions to eliminate stool.  It's not as fast-acting as an enema, but it's a lot easier on child and mom!  

 

Than she wanted me to give him a capful of Miralax everyday...well the first wk was even worse..the stool was so soft it was leaking out more.  I called her back she said that I probably didn't empty the compacted poop completely and to give him another enema...we did this and he was ok for 2 days..I cut back on miralax but then last night, right after shower, another mess...now it's not loads full but enough to smell up the room if you are nearby. 

If your son is still having accidents, you might want to ask the doc to order an abdominal x-ray to see whether all the impacted stool is gone.  When your son soiled himself, was it solid stool, liquid, mushy, or a mixture?  If there's any solid stool, then he probably still has old stool and isn't sufficiently cleaned out or isn't getting a sufficient quantity of Miralax.  Also, if it's very smelly, that's often an indication that it's old stool that's been decaying awhile.  At this point, he should have very soft stool, pudding-like in consistency.  A few people experience negative side effects with Miralax.  If you think the problem is the Miralax, you might want to try a different stool-softening laxative, such as Benefiber, Milk of Magnesia, Fiber Choice, or Metamucil's new "Clear-and-Natural" in the BLUE bottle with Inulin powder (same ingredient as Fiber Choice, but flavorless).  My son only needs 1/2-1 dose to get his bowels moving, while my daughter needs multiple doses daily.

 

She wants me to pick a certain time of day and get him to sit and relax on toilet for up to a 1/2 hr daily...IDK..tried but nothing happened. 

It is sometimes recommended that you do toilet sits a few minutes after meal time.  Eating is supposed to provide the body with a natural laxative effect (why babies poop after eating).  Even if your son doesn't poop, this gives him a chance to try to get in sync with his body's rhythms.  If he has another time of day that he's more likely to poop, though, use that as his toilet sitting time.

 

What she says makes sense but I am at my wits end with trying to get him to recognize that something came out. 

He'll improve as his bowels heal.  As my kids outgrew their problem, their awareness of their bodies improved.

 

I think it happens more when he is engrossed in computer or tv/games.  So I think I will make him sit on toilet as soon as he gets home from school and let him know this has to come first..It is retraining all over again.  He is mortified and embarrassed by it which makes for some great meltdowns.  He also fights me when it is bad enough that I have to hose him down in shower..ugh

Although it's still embarrassing, it helped my kids to know that there are LOTS of people with this problem.  No one wants to talk about it because it's embarrassing, but they're definitely not alone.  

 


chinhkq
by on May. 3, 2012 at 11:04 PM

my daughter wore diapers until age 9. right now she is in 7th grade and she's 12 but she cannot make friends. she can acknowlege this and she is extremely hurt by this.

riri732
by on Jun. 22, 2012 at 7:57 PM
Amazingly for the last three wks my son has had no accidents and actually has been going almost everyday around mid-afternoon. I think because I helped him recognize when it was happening and the need to STOP what he was doing and go, he actually realized he needed to pay more attention. Also the fear of me explaining how he was stretching out and damaging his nerves and rectal muscles may have scared him. Plus I told him I was limiting all chocolate till he was able to start going regularly. He is starting middle school so I had a serious talk about repercussions of having to change everyday for gym and God forbid the kids noticed anything. I did spend about a wk just making him sit after his after school snack and try to go.
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trebelcleff
by on Jun. 22, 2012 at 8:08 PM

Just out of curiosity, when he does poop in a pull-up does he do it standing up?  My oldest (who does not have aspergers) was difficult to poop train for many reasons, but one of the big ones was because he was so used to pooping standing up that he couldn't physically go while sitting on the potty... we ended up having to use this pediatric lubrication (it was in this dropper thing that you had to stick in their bum sort of like an enema, but not as terrifying) to help him (he was also frequently constipated, so the lube helped with that as well).  I am certainly not suggesting this (it was difficult enough doing it to a 3 yr old!), but the physical position of his body might have something to do with why he is avoiding the toilet.

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