Incontinence

Is it common for children with CdLS who have been successfully toilet trained for a number of years to have problems with soiling?

I am assuming your son has never had soiling in his underwear since being toilet trained and no previous instances of incontinence. It would be helpful to know his usual (prior to 6 months ago) pattern of stooling. Stool incontinence after being trained (known as encopresis) may be a chronic problem. Constipation can cause it, and sometimes the stool seen is due to overflow (with a huge impaction of stool, some leaks around the blockage and seeps out). Sometimes constipation can lead to hard painful stools, and the child withholds the stools so it won’t cause pain. After awhile this will cause impaction, but also dilation of the lower bowel and eventually overflow. Stool incontinence after being toilet trained may also be regressive and behavioral (anger or defiance). The typical treatment for encopresis is to reestablish the normal stool pattern and behavior, and retrain the bowel at the same time. The constipation needs to be removed and a cleanout is important. I think that probably your son’s pediatrican should be informed and your son should be examined to make sure nothing else specific is going on. The pediatrician can supervise the cleanout (usually enemas, mineral oil, stool softeners and positive reinforcement for improved behaviors and stooling). The pediatrician might also want to make sure there is no bowel or urinary tract infection.

TK 7-13-10