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6 year old with Encopresis. History of rectal lining prolapse. Taking miralax. Suffering from lack of concentration, bedwetting, fatigue. What should I do?

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6 year old boy I am thinking he has encopresis. When he has 3 years old had rectal lining prolapse. It was fixed, and no problems. About 4-5 years he started having soiling in underwear. He has been on miralax. I have kept him on a bathroom schedule, He still has accidents at school, home, etc... I have so frustrated with this. I try to ignore his accidents. I have punished him. I don't what else to do. Other symptoms is he is tired, inability to concentrate, ridges in his fingernails, occassioinal bedwetting, irrable. Any remommendations of what could be happening. He says he doesn't realize he has to go to the bathroom. His grandmother as a child had a rectal prolapse and absorption problems. I need any recommendationis in what to do? we have been seeing a GI specialist for 2 years and its still not better.
Posted Thu, 31 May 2012 in Child Health
Answered by Dr. Taher Kagalwala 1 hour later

Encopresis often requires behavioural modification therapy which is within the purview of psychologists, preferably Pediatric-trained ones and perhaps under the guidance of a child psychiatrist. Once the GI specialist has determined that the child's gastro-intestinal tract is normal, there is no point in the GI specialist being with your son as long as the direct interventions by him are no longer considered helpful/necessary.

I am sure that with psychologists' intervention, the boy will gain insight into his problem, and will help the specialists in solving his own problems. The enuresis is secondary to the encopresis, and will right itself as soon as the stool problem gets controlled.

Continue giving him miralax in the meantime,

Yours truly,

Dr. Taher
Above answer was peer-reviewed by
Follow-up: 6 year old with Encopresis. History of rectal lining prolapse. Taking miralax. Suffering from lack of concentration, bedwetting, fatigue. What should I do? 17 hours later
Is there anything else I can do besides the miralax. He has been on miralax for 18 months and he sol has accidents. He does really good then it starts all back again. Does specific foods, exercise, etc.... anything help. Also could the lining prolapse he had cause problems now. He tells me he doesn't have sensation to poop. How can he regain that sensation?

Answered by Dr. Taher Kagalwala 2 hours later
Your follow-up question does not change the diagnosis because lack of the sensation of fullness of the rectum is a typical symptom of functional constipation with encopresis in this age group. In fact, encopresis MEANS involuntary passage of stool and liquid.

Exercises may not help much, but addition of fibre to his diet will add bulk to the stool and aid the action of Miralax. You can increase the intake of fibre-rich foods such as carrots, turnip, radish, tomatoes, brown rice, whole wheat based breads, dry fruit and nuts, figs, lady fingers, sweet potatoes, potatoes, etc. Isabgol also adds bulk to the stool and may be useful, but you need to take a prescription from a doctor before using it.

The other thing that can be tried is to evacuate his bowels completely by administration of a hypertonic saline enema every night for 4-5 consecutive nights. Once the bowel is completely evacuated (this can be followed up by ultrasound or plain radiographs of the abdomen), the child can start afresh with toilet training and miralax-like medicines.

You will need to see his pediatrician for a proper regimen of these therapies.

That's all I can suggest for now. If you have further questions, please write back to me, and if not, do take the time to rate my answer and close the query.

Thank you so much, and take care.

Dr. Taher
Above answer was peer-reviewed by
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