Does your child have encopresis?
IDENTIFY YOUR CHILD’S PROBLEM
Encopresis - you can beat it!
Game-changing solutions for Toilet Anxiety, Soiling and Constipation in Children
Dr. Kushnir’s intervention model is based on his experience diagnosing and treating thousands of children.
In this book he presents 3 different diagnostic groups:
Toilet anxiety: Children who can only poop in a diaper or in their pants.
Soiling: Children who can use the toilet for defecation but also release feces into their pants.
Soiling and prolonged constipation: Children who refrain from having a bowel movement for many days or even weeks.
Foe each group he provides a unique, practical, step-by-step parents’ guide for solving your child’s problem.
Toilet Anxiety: How to understand and how to eradicate online, step-by-step, digital course for parents
The children who suffer from toilet anxiety are not at all able to poop on the toilet bowl.
Some cannot even sit on it. Some of them can sit on it for long periods of time but eventually poop only in their pants.
Toilet anxiety is a common phenomenon. Its treatment can be quite simple.
What is required here is:
1. A basic understanding of the problem and
2. The implementation of simple guidelines both regarding deeds (what to do and what not to do ) and regarding speech (what to say and what not to say).
In this course Dr. Baruch Kushnir is teaching you, step by step, how toilet anxiety develops, how to identify it, how to control it, how to eradicate it and finally how to navigate your child to normal use of the toilet.
Arielle, 3 years
Arielle is aged three. Her parents came to the clinic on 11th June 2019. She’s still bedwetting but controls her bladder during the day. She has one or two small bowel movements, in her underpants. They occur anywhere and everywhere. This situation has been carrying on for almost a year. During that period there were two isolated incidents in which she had a bowel movement on the toilet. She can sit on the toilet but isn’t capable of pooping there. So far her parents haven’t looked for any professional help. They’ve tried again and again to persuade her, using gifts, explanations, examples, and all sorts of bribes. Occasionally she reacts with tremendous anger. Her kindergarten teacher and her grandparents are involved in the matter, and try to put pressure on Arielle. In general she functions well in various life aspects.
I explained to Arielle’s parents that this is a question of a powerful anxiety that has taken control of the child. In fact there are two anxiety factors at work here. The primary anxiety was having a bowel movement on the toilet bowl. Following reactions from people around her, the lack of understanding that anxiety is the problem here, and the demands placed on her to poop on the toilet, another form of anxiety developed – about pooping in the toilet bowl. It’s expressed in small, partial bowel movements that reveal she’s withholding and trying to prevent any bowel movements at all.
I outlined to her parents the rules of treating toilet anxiety and they left the clinic with a clear, detailed action plan.
On 19 June (five days after the clinic meeting) I phoned her mother, Hodaya. She related that they’d started applying the approach, Arielle was cooperative about sitting on the toilet bowl after having soiled her underpants. She had started announcing, after dropping poo into the toilet, that she’s got more poo, and asked to continue sitting, without underpants, on the toilet bowl. Her mother was astounded to see that Arielle was doing it – of her accord – in the toilet, but that’s what happened. Arielle was so delighted and asked to phone her father and her kindergarten teacher and tell them the news.
This is the letter I received from her mother, after that phone call:
Our story started ten months ago. We started toilet-training Arielle following urinary tract infections caused by diapers. Arielle wasn’t so ready but we had to take that step. In terms of peeing, Arielle started to pee in the toilet but not pooping… She stubbornly refused to poop on the toilet, only in her underpants. We tried everything: we encourages, promised gifts, we were angry, we read stories absolutely everything, but nothing helped. That’s how we’ve spent the past ten months, and as parents we experienced immense frustration. As a result, Arielle grew frustrated too, and disappointed in herself. We came to Dr Kushnir totally unoptimistic, but he gave us hope – asked questions about Arielle’s problems, and finally the problem got a name – toilet anxiety. He said we shouldn’t talk to Ariel any more about the bathroom and the toilet bowl, and every time that she soils her underpants we should say “Great – the main thing is that you pooped.” He said as well that we should change her when she sits on the toilet bowl, pull aside her panties and let the poop fall in; we should laugh at the splash! created by the falling poop, and get rid of her anxiety that way. In addition he said that if it happens and she does poop in the toilet, we shouldn’t be too thrilled, just say words of reinforcement and that’s it. I was surprised when he said not to involve the kindergarten staff because I’m a kindergarten teacher, but he told us that this was so that Arielle will feel comfortable at home and not so much in the kindergarten. As we left the meeting, we started implementing the method, and then once there was soiling in her underpants we did as he said. Arielle was entertained by the splash when we changed her on the toilet. The second time we changed her she continued pooping in the toilet, and said to us “I’ve got more” … we were in shock, but only inside, we didn’t reveal how delighted we were. We remembered that Dr Kushnir said to curb our enthusiasm, so all we said was “Way to go, Arielle!” Later she pooped a little more in her underpants and then went onto the toilet bowl. And today I could have almost screamed with joy… Arielle came to me and said “Mom I need to poop.” I asked her “And where do you want to poop?” She said in the toilet. I took her hand and she sat on the toilet bowl and suddenly there it was – poop. At that moment I wanted to burst with happiness but again remembered to be restrained, and said “Well done, Arielle, you’re a champion!” She looked at me and wanted me to be more overjoyed and then she said “Mom I’ve pooped in the toilet!” I reacted by just saying “Yup, you’re a champ.” She said “I deserve a present, Mom, and I want you to phone Dad and the kindergarten teacher and tell them I pooped on the toilet.” I phoned them, and Arielle shared the news with them. She got encouragement from her teacher, who promised that the next day she’d get a medal from her. I phoned Dr Kushnir to let him know and asked his advice what we should about the gifts she’s expecting and – more than this – how to continue. Dr Kushnir said to tell Arielle that the biggest gift is that she successfully pooped in the toilet, but she’ll get a gift because she asked to poop of her own initiative. And he also said we should still restrain our enthusiasm with her, when she poops again in the toilet, and to give her reinforcements. Even if she does it again in the toilet we should say “The main thing is that you did a poo,” but not to remind her about the toilet.
From here on we’re continuing the process… and there’s no doubt we’re totally thrilled.
Dr Kushnir, thank you so much for everything, we’ll let you know what happens ahead.
Good night and loads of thanks.
Raphael, 2.9 years
Raphael still has a diaper at night. During the day he restrains himself for long hours – both peeing and bowel movements. He’s just terrified about having a bowel movement. For the past two days consecutively he hasn’t had a bowel movement. Finally it escaped and soiled his underwear. Everything began a week ago when his mother removed the diaper of her own initiative. The boy himself showed no sign he’s interested in going diaper-free. Immediately he started releasing urine and feces in his underwear. His reaction was hysterical when he felt he needed a bowel movement, and when he asked for a diaper his mother refused. The situation is going from bad to worse. He holds it in for entire days, at home and in kindergarten, both bladder and bowels: he’s in tremendous psychological distress and has also resumed using his pacifier. His mother, Sharon, told us that although he’s very aware that she’s a single mother and lives peacefully with this situation, he’s now starting to constantly demand a father (who of course doesn’t exist in his life). In view of his tremendous misery, his mother asked for a Skype session with me on a Friday before the weekend began, in order not to wait a few more days for a meeting at the clinic. In general she described him as a well-developed joyful, a sportive boy, active, full of self-confidence, who functions well in all aspects of his life.
I provided Sharon with the usual instructions about getting rid of the anxiety for good.
Three days later, on Sunday, June 16, his mother told me that she’d carried out all the instructions and was expecting a significant reduction of mental stress in the boy, who resumed pooping in the diaper.
A few days later, on June 20, Sharon called me again to report that her son is completely free of mental of anxiety now. He’s pooping in a diaper without holding it back. He asks when he needs to go, and has also started peeing freely in the toilet – at home and in kindergarten. We agreed that we’ll let the situation stabilize over the next two weeks and then gradually start introducing other activities to eradicate his toilet anxiety.
Aline, 4 years
Aline controls her bladder completely, both night and day. She poops in her underpants. She tends to restrain herself for several days then develops serious constipation. She’s incapable of sitting on the toilet bowl. During the day there are several incidents of escaped feces pellets in her underwear. She’s never had a bowel movement on the toilet. She also suffered prolonged bouts of constipation in early infancy, and was once diagnosed with a fissure (a fissure is a sort of bleeding from the anus when large and very hard feces passes through – which happens after prolonged withholding). The situation described today has been like this for two years ever since they removed her diaper. To date, the parents haven’t sought professional advice. Both her parents and the kindergarten teacher remind Aline time after time to poop in the toilet and after she poops in her underpants everyone makes a point of asking her repetitively if she knows where she should poop. Sometimes they have outbursts of anger.
In general she’s described as a cheerful girl, naughty, sunny-tempered, intelligent, with rich language. She is very stubborn and opinionated, sociable, and loves music and dancing.
I gave the parents advice how to implement a moderate treatment moderate form of treatment
On 20th February in a phone call with her mother, Victoria, she shared that Aline is pooping much more freely now, and has no constipation attacks. She even asks now and then to poop in the toilet though she doesn’t actually do much. There were also cases of wetting.
On March 6th (around three weeks after the clinic meeting), I spoke with Victoria about the implementing the principles of the moderate approach. At home, there were two occasions when she pooped on the toilet at her own initiative. In kindergarten they decided to give her a diaper since she soils several times a day and this also draws insults from the other children. At home she wears underpants and does large bowel movements and with a higher frequency than before the moderate treatment began.
We decided together to continue with the same method.
There were cases of soiling, and ups and downs.
9 April (two months after treatment started) Aline’s mom reported that she’d managed to poop in the toilet of her own initiative, twice that day.
On 10th of June (four months after treatment began) her mother again reported that Aline had pooped in the toilet of her own initiative, twice that day.
In view of this further progress in the matter, we decided last Friday, June 20, in coordination with the kindergarten teacher, that Aline would wear underpants to kindergarten.
Her teacher told Victoria that she’d done three poops in the toilet, all of which she initiated.
On the morning of June 23, 2019 Victoria emailed me:
After we’d tried all sorts of methods – prizes, gifts, a potty – nothing worked and we looked for professional advice. Dr Baruch Kushnir gave us instructions to cease all pressure on the kid and to give her legitimacy to poop when and where she wants. The main thing is that she poops. I have to admit that it was a very tough task for us, her parents. Because of course changing clothes five or six times a day is really heavy, but slowly we learnt we need to let go, not to put pressure on her. Everything has to come from her own understanding. We tried not to talk about it at home and if sometimes there were small successes, we didn’t hand out prizes or celebrate, we try to keep a regular routine.
It took quite a long time because the whole question of pooping is very traumatic for us and we knew it’s a process that needs a lot of patience – we didn’t want to use the option of enemas.
After three or four months suddenly she decided that she was going to the toilet and she pooped there even without asking. She just sat down on the toilet and it started – once a week, twice a week – until ultimately with the instructions from Dr Kushnir, we sent her on a Friday to kindergarten with underpants. In fact it was the kindergarten teacher who told us she’d pooped three times in the toilet. I have to note that the kindergarten didn’t collaborate with us and pressured Aline to wear diapers, because the staff were fed up with changing her. It was only at home that the whole issue was handled. In the kindergarten, the behavior was very different. And nonetheless we managed to give her the confidence to poop in the toilet – not in diapers, not in underpants. It’s very clear to us that there may be cases of regression but overall I see that she has the understanding – and that’s what we wanted to achieve
Alex, 3.2 years
Alex’s parents came to the clinic on September 6, 2018. They told me that Alex is still sleeping at night with a diaper. During the day he almost completely controls his bladder. They constantly remind him to go and poop in the toilet. He restrains himself and has bouts of constipation lasting three days: then when there’s no other choice, he poops in his underpants. In most cases it’s a full bowel movement. Soiling happens everywhere and generally he doesn’t bother to announce it and continues walking around with it.
That situation has continued for some four months, since we stopped giving him diapers. The kindergarten teacher and his grandparents are also involved in the problem and constantly try to persuade him to sit on the toilet. His father thinks they should resume full use of diapers, and postpone the whole issue of training. The mother thinks otherwise. The mother is the one who changes his clothes generally and she sometimes has angry outbursts. So far they haven’t contacted professional people. He is described as a very smart child, with rich language, who adores music. He’s a little clumsy in motor terms. He has been diagnosed with extreme sensory sensitivity.
I gave the parents directions about implementing moderate treatment.
On September 30, 2018 (three weeks since the clinic meeting) Alex’s mother reported a significant improvement in his bowel movements which became more frequent, with less constipation, and less stress. He’s collaborating cheerfully with dropping the poop into the toilet.
November 1, 2011 (two months after the first meeting at the clinic) his mother reported another major improvement and this is what she wrote:
Since our meeting at the clinic two months ago there has been a super significant change for the better! Unbelievable! We thank you so much! From a child who would soil his pants often two or three times a day, with constipation of 2 to 3 days consecutively, he’s is now sitting on the toilet every day. And it’s all his initiative and under his for control, today (and in the past month) he soils himself maybe once a week only, the cases of constipation are few and far between and it’s all his full initiative. It’s a brilliant method that gives parents a well-structured format, totally practical and super professional. Our Alex is 3.3 years old and it’s hard to believe where we were just two months ago Huge thanks to you, from the bottom of our hearts.
Soiling and Constipation
Amit, 3 years
Amit’s parents visited my clinic on 4th June 2019. Their son has perfect bladder control, day and night, they told me. He tends to withhold bowel movements for several days, and has a few small soiling episodes each day. Even though his parents put him on the toilet every evening, it doesn’t help. Once a week, when he can’t hold it in anymore, he has a bowel movement on the toilet. Amit’s condition isn’t stable, and there are fluctuations: sometime he evacuates his bowels completely on the toilet every day over a whole week. His menu is varied, with a good amount of dietary fibers, and his bowel movements are usually regular. Occasionally they give him Normalax, and when they don’t, his condition worsens. His big brothers and grandparents talk to him about their expectations for him to poop in the toilet. Amit’s prolonged withholding makes him very nervous as if physically frozen. His parents say he’s a very sociable child, full of self-confidence, smart, and with mature rich language.
I gave his parents instructions to start the intensive method, combined with behavioral treatment and the use of micro enemas.
When the treatment began, Amit strongly objected to the micro-enemas but his parents didn’t waver and enforced on him a daily complete bowel evacuation. They used the small bottle of micro enema, 5 ml., and gradually he became more cooperative. After a few days they began using a half dose.
13th June (nine days after treatment began) his mother reported that he’d had a full bowel movement in kindergarten. I advised her to continue lowering the enema dose gradually.
23rd June (17 days since our first meeting) his mother updated me that he was continuing to cooperate, and was pooping independently almost daily, without having to resort to an enema.
Almog, 3.8 years
On 23rd April 2019 I met Almog’s parents at my clinic. They told me about the episodes of withholding, constipation, and difficulty in evacuating his bowels. Every so often Almog poops in his diaper at nighttime, when he’s sleeping. In the past month the problem has worsened. During the day he soils his clothes several times, in small amounts. Things have been like this for eight months, and there was never a time when he pooped in the toilet. When he was only in diapers, up to age two and ten months, his bowel movements were regular. Over time they got in touch with various consultants. Today they are trying to persuade him to poop on the toilet. For his part, Almog makes tremendous efforts to avoid pooping at all, and holds it in. He eats reasonable amounts and his diet is varied and balanced. His bowel movements are always very hard. He’s a sensitive child, smart, very active in sports, opinionated and high-handed.
I instructed the parents to begin the intensive method, combined with behavioral treatment and the use of micro enemas.
On 1st May 2019 (a week after the first meeting) I had a talk with his mother. After the first four days in which she administered a full enema (micro enema – 5 ml), when he resisted vigorously, he started cooperating and we cut the dose to half.
On 5th May 2019 (two weeks after our first meeting) his mother wrote to me:
Hi, I gave him just a quarter of the dose, he played for about five minutes and then asked to go to the bathroom. He did a medium size bowel movement there, very quickly. He remained sitting there for seven minutes and then said he hasn’t got any more. I told him that when he feels he has to go, he should tell me and we’d go to the bathroom again.
On 12th May 2019 (three weeks since our first meeting) Almog’s mother wrote again:
We can feel there’s been an improvement. Yesterday at around 3:30 we already noticed some movements of discomfort because of needing to poo. We told him it’s time to go to the toilet. At first he objected, and then we said we’ll give him the medicine and he go on playing until he feels he has to go. We gave him a very little amount, and five minutes later he asked to go to the toilet, and within five minutes he pooped everything.
On 20th May 2019 (a month after the treatment started) his mother wrote me again:
Good evening – here’s the latest update on today. After he refused most days to go into the bathroom he finally agreed to go there in the evening without “the medicine.” He sat on the toilet for about 20 minutes. It caused him some discomfort and he complained it wasn’t comfortable. And in the end he got up on the toilet seat, squatted down, and managed to go. Afterwards he was really happy and contented. We’re thinking about a solution to the question of the toilet-seat …. And we’ll look into it this week.
On 27th May (five weeks since the first meeting) and owns mother wrote to me:
Hi – well, it was a complicated weekend. We were away from home, travelling. We continued as we said, so every two days he could have a bowel movement. On Friday morning his underpants were soiled but he still didn’t want to go. We pretty much forced him to go, because it was getting really impossible by then.
The next day, Saturday, he asked for an enema and really pooped a lot. We noticed that when he functions as usual he’s not interested at all in going to the bathroom, and he’s ready to defer the whole matter constantly. Only when we give him an enema he looks at us with a helpless expression and realizes he needs to go to the bathroom. We have to find a solution that will create a situation where he wants to go to the bathroom.
On 3rd July 2019 (six weeks after our first meeting) his mother wrote again:
In the end we didn’t get in touch on Saturday… At the moment it doesn’t seem we need to use Normalax. Altogether he’s having a bowel movement every evening. He doesn’t go on his own and it always reaches a situation where we confront him with the fact – and he has to go. Yesterday he was at a birthday party at the pool and he really held himself in not to poop, until he went to one side and expelled poo into his underpants. Of course we saw immediately and we went to the bathroom and explained to him that it’s good that he pooped, but next time he just has to go to the bathroom before… We’ll see how things go today and whether he’ll see himself that he needs to go.
On 24th July (two months after the first meeting) – his mother reported that Almog is pooping every day in the toilet – without using a micro enema. There are hardly any incidents of soiling, although he still doesn’t take the initiative and his parents still need to demand forcefully that he goes to the bathroom.
Aviel, 7 years
Aviel’s parents came to my clinic on 6th September 2018. They told me that their son was completely dry at night and day. Regarding bowel movements – he restrains himself for periods of five days, and serious constipation results. He soils his clothes several times a day – in varying amounts. He doesn’t rush to change his clothes and walks around with soiled clothes for hours. Once every two weeks he does a really large bowel movement in the toilet. From 2½ to 3 years he was totally trained. He’s the youngest of four boys. When he was three, the family went through a very troubled period. There was great tension between the children, and that’s when the withholding and soiling phenomena began. His parents have tried various treatments. His pediatrician recommended using MiraLAX. They’ve tried homeopathic therapy, acupuncture, occupational therapy, and psychological treatments of different kinds. There were some periods of improvement in response to the treatments, and due to prizes and all sorts of reinforcements. His usual menu is carb-intensive, and he doesn’t like eating vegetables. His poop is very hard. He is described as a highly intelligent boy, with a rich language and excellent expressive abilities. Aviel is sociable, loves talking to people, is connected to his emotions, and has a vivid imagination. He loves going to the beach and can spend hours there with his father. He strongly needs discipline and structure. Is very sensitive to noise – shouting in particular - and tends to have anger outbursts.
I instructed his parents to start the intensive method, combined with behavioral therapy, use of micro enemas, and to make a point of regular, consistent use of MiraLAX.
On 8th September 2018 (two days after our first meeting at the clinic) – his parents described two days of tough battles with the boy. Using the enemas, they managed to produce a partial bowel movement but it was only after two days they got the impression there’d been a real bowel evacuation – with a huge, full bowel movement.
9th September 2018 (three days after our meeting) – again, a half hour struggle. They managed to introduce the enema. Within five minutes, he had a complete bowel movement. He was very proud, and shared his great achievement with his brothers.
11th September 2018 (five days after the clinic meeting) – his parents suggested to Aviel that he tries to poop on his own. He sat on the toilet about ten minutes and pooped without using an enema. A good amount was expelled but they weren’t sure that he had completely emptied his bowels. He was happy and proud.
20th September 2018 (two weeks after our first meeting) – in the past few days, there were peaks and troughs. Sometimes he pooped independently in the toilet, other times he was helped with an enema. Sometimes he objected to the enema and fought it, but other times he wanted the enemas help. But without exception – he was happy and contented after pooping on the toilet. At the moment there’ve been only rare incidents of soiling.
On 13th October 2018 (six weeks since the clinic meeting) – his mother wrote me the following:
It’s been a fabulous week!!! There was a surprise today – he started to poop, told me, and went straight to the bathroom, where he had a proper bowel movement!!! I’m overjoyed – what would usually happen is that he would sit and nothing would come out – but today, because he’s acquired the habit, everything came out!!!! Thrilling – and what’s going to happen tomorrow?
In the preceding days we gradually reduced the enema dose. We reached a situation where a quarter of the bottle (8 ml.) was enough to stimulate a bowel movement. And many times he managed to poop without the help of an enema. What was special this time was that he reacted to pressure in his stomach, took the initiative, and went to poop on the toilet. Now and then we suggest that he tries to blow up a balloon while sitting on the toilet and it helps him to relax his pelvic muscles and to poop.
31st March 2019 (seven months after our first meeting) – Over the past two months the situation has improved constantly. Occasionally it’s still necessary to supervise, remind, or demand that he goes to the bathroom. Hardly any soiling incidents. And there are many events in which he takes initiative and goes to the toilet. There’s little need for enemas and if there is – a minimal dosage only.
Rebecca, 11 years
I met Rebecca’s parents at my clinic on 19th June 2017. They told me that Rebecca doesn’t wet at night. There are intermittent periods when she wets her clothes in the day. She does bowel movements in the toilet once every three weeks – and even then, very small and partial poops. She is constantly withholding, and constipated. In the past few years, on several occasions her parents had to take her to the emergency room to have feces removed. The doctors had to anaesthetize her and manually remove huge chunks of feces. Gastroenterological tests ruled out any organic reasons for the problem. Her parents have tried various therapeutic interventions. She takes large amounts of MiraLAX. Every so often they’ve tried enemas. Different kinds of psychological treatment. Rebecca was already constipated and retained feces while she was still nursing. At age 18 months she started getting MiraLAX. Her diet is varied and balanced, with good amounts of nutritional fibers.
Rebecca is described as a sensitive girl, delicate and smart. She’s very popular with her friends. In some areas, she avoids responsibility. Her mother says that the issues of holding in, soiling, and continuing constipation, are ruining so much in Rebecca’s life, and the lives of her family.
I instructed her parents to start the intensive method, plus behavioral treatment and using micro enemas.
On 20th June 2017 (the day after the clinic meeting) I instructed her parents to use the 133 ml. dose on the first day, since there was clearly a major accumulation of feces due to her prolonged withholding. Initially they used half the amount of the bottle, then after one hour of partial pooping they used the other half. Her parents said she expelled huge quantities of feces, and compared the experience to childbirth. They received instructions to use the 8 ml. dose of micro enema on the following days.
27th June 2017 (a week after the clinic meeting) – her parents reported that Rebecca was moving her bowels every day in the toilet – a full evacuation, helped by enemas. She’s cooperative and it’s clear there’s been a great improvement in her mood and her general daily functioning. We lowered the dose of enema to half the amount of the 8 ml. bottle.
On 10th July 2017 (three weeks after the first meeting) – Rebecca’s parents described several events in which she managed to poop in the toilet without having used an enema. She didn’t go of her own accord, but after her parents reminded her. We cut the dosage to a quarter bottle.
On 20th July 2017 (a month after our first meeting) – her parents reported the new and welcome pattern that had developed. She no longer pooped as soon as she was given the enema. She went about her affairs, and only a half hour later when she felt pressure in her stomach she went of her initiative to the toilet. Now and then she is going to the bathroom to evacuate without having received any enema at all.
On 25th August 2017 (two months since the clinic meeting) – the parents told me that she’s going more and more to poop in the toilet independently, and there’s far less need to remind her: the use of enemas has dropped significantly.
Yuval, 7 years
I met Yuval’s parents in the clinic on 30th May 2019. They told me that he’s still wetting the bed. He poops in the toilet, but soils his clothes as well. The situation is typified by ups and downs, and every so often there are short periods when the problem completely disappears. This has been happening for four years, and the soiling occurs in different places. He carries on walking around with soiled clothing, and denies it when he’s asked if he wants to shower and change. The pediatrician recommended Normalax, but apart from that they haven’t sought professional help. His mother is going out of her mind and has frequent outbursts of anger. None of the reinforcements and reminders of various kinds help at all. Yuval is a goodhearted boy, intelligent, outstanding in math, with a great memory; sometimes he’s impulsive and temperamental.
I advised his parents how to implement disciplinary treatment
On June 4 (five days after the clinic meeting) I spoke to Amir, the father. He said that from the day of the preliminary conversation, when he and his wife declared they would be applying a very serious therapeutic program, the boy became completely clean. He takes care of himself and makes a point of having his bowel movements in the toilet.
On 23rd June (three weeks after the clinic meeting) the father reported that since the most recent conversation until today there’d been two soiling episodes. Twice the parents took him to the bathroom according to the program’s instructions. Besides that, the boy is completely clean. He goes to the bathroom at his initiative and keeps himself clean. He also cooperates with handling bedwetting and in tandem he’s making very good progress there. An improvement in his mood is discernible. He’s really proud of his achievements and positive implications are visible in other areas of functioning.
Zoei, 8.6 years
I met Zoei’s parents at the clinic on February 5, 2019. They told me that their daughter has complete control of her bladder, by day and night. She poops only in her underpants. It’s not clear in what quantities, because she deals with it herself. Almost daily she returns from school with soiled panties, and also soils in the afternoon and evening. In fact the soiling happens everywhere. She continues walking around with dirty clothes. Up to six months ago the problem didn’t exist at all. It started during the summer vacation when she had to attend a summer camp but didn’t want to go there at all. She suffered tremendously, and later developed prolonged episodes of constipation. The pediatrician ruled out organic factors and recommended Normalax. The retention and constipation got worse and worse, and the soiling episodes worsened. For several months she’s been having regular sessions with a psychologist. In the past week there’s been some improvement in her initiative to go to the bathroom. She’s described as a very well-tended girl. Strongly aware of her appearance and clothes. Highly charismatic with great sense of humor. Her language is well developed. She is very theatrical, much loved by people around her.
I instructed her parents about applying disciplinary treatment.
In a conversation with the parents on 17th February 2019 (two weeks after the clinic meeting) her mother, Miriam, told me that they’d started applying the rules of discipline. The girl’s reaction was very positive. She’s completely clean, but had to go every day to the bathroom at the designated time, where she immediately emptied her bowels – remaining clean until the following day. Zoei is overjoyed with the change, and even asked to meet me personally.
On March 12, 2019 (a month after the first clinic meeting), there was a really thrilling meeting with the parents and Zoei herself, at the clinic. She told me how she’s been freed from the problem and that it’s contributed to other aspects of her life: it has totally changed her life. She described the experience as resembling as a huge knot in headphone cables – that she managed to unravel. We decided to cancel implementation of all the disciplinary rules for the moment.
On 23rd June (4½ months since the first clinic meeting) Miriam told me that since our joint conversation with Zoei at the clinic, the situation has improved even more because the topic is now completely off the family’s agenda. Zoei still recalls now and then her huge sense of achievement when she overcame her problem.
Ethan, 5.6 years
At a meeting with Ethan’s parents on May 23rd 2019, they told me that Ethan controls his bladder by day and night. He poops in the toilet, but in additions there are several small bowel movements in his underpants during the day. He goes to the bathroom only when his parents absolutely force him to. Prizes and reinforcements don’t really work. Until two months ago he was absolutely clean. The parents think everything started after his father slapped him. The pediatrician referred Ethan to me. He’s very opinionated and stubborn. Extremely independent. Unwilling to accept authority. A very smart child with a terrific memory, good coordination, excellent ability to concentrate. He is rather jumpy and agitated.
I instructed the parents about implementing disciplinary therapy.
On 28th May 2019 (five days after our first meeting at the clinic) Ethan’s mother told me that right after the first conversation a drastic improvement in the situation got underway. The boy changed his behavior and makes a point of keeping clean and having full bowel movements in the toilet. And that is even before he heard about the program’s details.
On 23rd June (a month and a half after the first meeting at the clinic) there were two relapses and then they launched the program. He experienced the punishment three times, and since then has resumed full control of his bowel movements. Since two weeks ago, they stopped applying the regulations at all. Even when they were on vacation, away from home, he behaved perfectly. He’s very proud that he managed to overcome the problem. Family members feel that the problem has disappeared. Ethan himself is really happy with his achievements and reports a huge improvement in his self-perception and in other areas. He asked for a prize for his achievement and his mother explained that the real prize is staying clean and controlling his bowel movements. In any event he has received – and will receive – prizes and gifts in all kinds of areas, without connection to the question of poop.
Rotem, 8 years
At our first meeting on 14th August 2018 his parents told me that Rotem fully controls his bladder by day and night. He only poops in the toilet when he’s really forced to. He does several bowel movements in his clothes during the day, in differing amounts. He does it everywhere and walks around with soiled clothes. That behavior has always been present. The pediatrician ruled out a range of organic problems. He has been diagnosed with ODD – Oppositional Defiant Disorder. This is characterized by a recurring pattern of negative defiant behavior “on purpose – just to be difficult.” He takes medication to alleviate the ODD. The parents have consulted with various psychologists. He’s a very smart, highly sensitive child, outstanding in math, a football fan. Highly competitive, with a very low frustration threshold. His parents are at their wits end about the question of pooping.
I gave the parents instructions about applying disciplinary therapy.
On 29th August (some two weeks after the clinic meeting) we came to the conclusion that the first disciplinary measure – a long period in the bathroom – hadn’t changed his behavior significantly. We decided to add to that punishment also a ban on screens (we forbade him to use the tablet, computer, and smartphone).
On September 5th about a week after the screen ban, his father reported a significant change in Rotem’s behavior. He was actively working at emptying his bowels in the toilet, and keeps himself clean and tidy. Over time, the need to implement disciplinary principles lessened.
On 21st January 2019, his parents got in touch to report a deterioration in Rotem’s behavior. He resumed his old habits. We started reapplying the disciplinary principles and the prohibition of screens. Within ten days he resumed functioning properly – doing full bowel movements in the toilet and staying clean.
On 20th 20, 2019 Rotem’s parents reported that he is persisting with his perfect cleanliness habits and the need to implement the disciplinary rules has now vanished.
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