help4yourfamily

Older Kids with Bathroom Issues: Why Does it Happen? How Can You Help? Part 2

English: Typical Male Restroom in the U.S. (Photo credit: Wikipedia)

Written by, Kate Oliver, MSW, LCSW-C

In last week’s post, we looked at the possible origin for encopresis (soiling after the usual age for toilet training) and enuresis (wetting after the usual toilet training age) in older children with a history of trauma and/or neglect.There is something about an older child wetting or soiling themselves that can send parents into a fury, especially if the incident is perceived to be intentional. This is understandable. We all have buttons, and a big one for many of us involve the transmission of germs whether it’s via spit, mucus, vomit, urine or feces, we don’t want to be around it!

In this week’s post, now that you have a theory from last week about where the issue originates, I want to help you to figure out what to do to help your older child, who will often experience shame as a result of the incident. If you have any questions about implementing any of these strategies, I hope you will ask in the comments section, or discuss it with your child’s therapist.* One of the reasons I am writing this post is because there are very few therapists who specialize in this issue, so if your child’s therapist is not familiar with it, please think about printing out and taking in this article.

As I stated in the first post on older children with bathroom related problems, the first intervention is always to follow the suggestion of your child’s physician as we do not want to fix a broken bone with a band-aid and some medical intervention may be necessary. As sensitive as I know parents are about this issue, children are also very sensitive about it, even if they pretend to be aloof. In fact, I know one of the beliefs parents have that send them into a fury about older children wetting and soiling, is that their child does not even care about the fact that they are doing it when, in reality, often children that have this issue are experts at covering up their feelings so you do not know how humiliated/ angry/ frustrated they are.

Before I give you suggestions, I want to give two important guidelines for all the interventions I use with children. My number one guideline is to follow the PLACE parenting attitude whether your child has attachment disturbance or not. The second is to make sure your child is primed to receive help from you. What I mean by that is, ask your child if they want help. If they say “no,” DO NOT OFFER IT. When you offer children help and they don’t want it, you are only listening to yourself talk and asking to be frustrated. If you offer it, then back off. After you child has refused a couple of times and their refusal has been listened to and honored, their curiosity begins to take over and eventually they ask you what help you have to offer. Then, and only then, are they open to receiving and they will be primed to listen to your advice.

With that said, here is a list of ways I have helped children with enuresis and encopresis:

1. Especially if you recently adopted or started fostering your child, do not panic! You may have a child who is looking for buttons to push to get you upset or make you reject them. If you have an upset reaction, they may see that it gets a rise out of you and will be more likely to continue. Without over-reacting, try to employ natural consequences, i.e. the child has to clean up the mess as appropriate for their developmental age. Remember to use your PLACE attitude, which means that humiliation and embarrassment of your child are not acceptable consequences. In fact, with a child that would purposefully wet or soil themselves, humiliation and embarrassment may actually reinforce the behavior in ways you did not anticipate. To better understand this concept you can read my Caught in the Loop post.

2. My first suggestion for someone with a child with ongoing problems of this nature is therapy. While my sample is quite skewed, I have not seen any children with this issue that did not experience a feeling of fear about the problem, often accompanied by humiliation, even if the behavior is perceived to be intentional by their parents. While moms and dads can be helpful in navigating those feelings, therapists are trained to add an additional and necessary layer of help. Also, as you well know, children are often more motivated to do something someone else suggests over the suggestion of their parents. You know your children do things for their teachers that they would not do for you and bringing the issue to the child’s attention while in therapy often gives a child an extra bit of motivation to work on it. Additionally, if your child has a history of trauma this includes the bathroom in any way, it is important for them to be able to process this history with a trained professional.

3. My most successful intervention in the area of helping older children with encopresis and enuresis is to reintroduce the idea of toilet training. Before you skip this idea because you think your child is too old to re-potty train, let me tell you that I have used this with children in their early teens with success. The reintroduction is delicate and goes like this (and, as I say in many of my posts, the tone is important…think about how Mr. Rogers would say it):

“I wonder if when you were younger and didn’t get what you needed, you might have missed out on some of the signs your body gives you when you need to go to the bathroom.”

It may take a few times of gently suggesting this to your child for them to begin to get curious with you. Suggest you could help them to learn how their body knows it needs to go. Think about this. Your body knows it needs to go when your bladder feels full. I teach kids to playfully ask their bladders out loud in my office, “Bladder, do you have to go to the bathroom?” You would be amazed how many children have quickly realized by asking that question that they do, indeed need to go…right then…and we end up taking a quick restroom break.

You can also point out that sometimes you have been able to tell when your child needs to go and that when kids are young and have parents that take good care of them, the parents often point out when a child is doing the potty dance. For some kids, we come up with a signal that the parent can make, rather than asking out loud in public whether a child needs to go. This works well with a child who has a history of being shamed or traumatized in relation to going to the bathroom,or who was never potty-trained appropriately.

4. An additional technique to use with children who were not properly potty-trained, is to teach each your child about controlling their bowels. One way I do this is to have children picture a balloon full of water. I tell them to picture the balloon turn over so that the opening of the balloon is on the bottom. If you are using your fingers to pinch the balloon, it is like the muscles around your bladder holding the pee or poop in. If you were to let go with your fingers, you would see the water come out of the balloon. For some balloons, you would have to give an extra squeeze from the top to empty it out. Bladders can be like this too. When I work with kids with issues controlling their bowels, I suggest to them that they picture the balloon as their bladder every time they need to go to the bathroom. Muscles hold the urine until you get to the toilet, then they let go and we make sure your bladder is emptied completely. For kids with urinary issues that are feeling brave, I also suggest kegals, where they start urinating, then try to stop the urine one or two times every time they go in order to build up the muscles (consult with a physician to make sure this is a good idea for your child).

Also, and many adults do not know this, there is a right way and a wrong way to empty your bowels. To most easily and completely empty your bladder, teach children to sit, leaning forward with their forearms resting on their thighs. Have a small stool near the toilet so children can put their feet on the stool making it so their knees are higher than their hips. This will help kids that hold onto stool and urine, to most easily and quickly relax and let go when they are going to the bathroom.

5. For kids with bowel issues, especially kids that hold it until it gets painful, I teach a quick exercise to help them control bowel functioning. This is good for relaxation as well. Lie on the floor and counting slowly to five, suck your belly in. Picture your belly button touching your spine. Then, again to a slow count of five, push your belly out until your belly button is actually sticking up. See if you can make the pulling your belly in, equal in time to the pushing of your belly out. Ideally, kids who are learning to control their bowels will do this exercise for 3 minutes a day. The typical response I get from kids when I teach them this exercise and they actually do it in my office is a moment afterward when they start to get excited (like the potty dance) then a request to go to the bathroom. Success!

For children where this does not work, see about helping them find a Pilates class in your area. Many of the Pilates exercises, strengthen the core and pelvic muscles allowing for greater control.

4. I find the toughest kids with bathroom issues are typically the ones who are doing urinating and soiling on purpose, although often the times they do it are few and far between. As I recommended in my previous post on this issue, it is important to figure out the why, but really the intervention for purposeful urinaters and soilers is to make sure they are in therapy with someone who works on teaching them to state their feelings. Often these kids need remedial learning in the expression of feelings, and, while parents can do some of this, a child therapist will have the training to find ways that work for your child to teach them the proper expression of big feelings. Sometimes this means helping them to understand that they will not be harshly punished for the expression of their feelings, and others it will mean having a therapist identify that your child may be experiencing a traumatic reenactment.

I know that this is a sensitive topic for many families and people do not want to be identified by leaving comments, however, if you have questions, or a suggestion that works that I forgot, please let me know. You can feel free to leave a comment or to contact me privately via email: helpforyourfamily@gmail.com

*see disclaimer

Related articles

• Older Kids with Bathroom Issues: Why does it happen? How Can You Help? Part 1 (help4yourfamily.com)
• Caught in the Loop: Why People Repeat the Same Bad Choices Over and Over (help4yourfamily.com)
• PLACE Parenting for Children with Attachment Disturbance(help4yourfamily.com)
• Finding a Therapist for a Traumatized and/or Attachment Disordered Child (help4yourfamily.com)
• Chronological Age vs. Developmental Age (help4yourfamily.com)

January 31, 2013 - Posted by help4yourfamily | attachment disorder, child development, discipline, mental health | Child, Child Health, Children Youth and Family, Family, Health, Home, List of credentials in psychology, parent