A.B-D, age 4

Attended the clinic on 12 February 2019
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
Follow-up

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.

On 9th 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. 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. She pooped there even without asking. She sat down on the toilet and it started, once a week, twice a week. Following the instructions from Dr Kushnir, we sent her on Friday to kindergarten wearing 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 we handled the whole issue. 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.

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