I'm happy that you have asked me to assist you with your grandchild and hope that you can benefit from my many years of helping grandparents like you.
Other than the enemas is he on any other medications or treatments?
I see he's tried a number of treatments but is he on any routine daily medication now or just enemas?
no other medications
His conditions is called encopresis and no, he does not need to see a proctologist as they only see adults with surgical rectal conditions such as hemorrhoids, polyps, etc.
we are currently not doing enemas was told that they were no longer needs enemas.
This is due to chronic constipation, as I'm sure his doctor has explained, but it does not sound like he is being treated adequately if he is no longer getting enemas or any oral medications on a daily basis but continues to soil his pants.
no other meds were provided or prescribed.
While he may be cleaned out temporarily the chronic stool withholding causes the colon to become very enlarged which in turn causes the nerves in the colon to no longer function. This lead to no sensation that he needs to poop or control of his anal sphincter to prevent soiling.
This condition takes many months to remedy as the treatment involves daily medications, such as Miralax (my favorite) and occasional enemas to keep him cleaned out, all of which over time will allow his colon to shrink and the nerves to begin to function again so he will have control.
your recommendation on # XXXXX times daily for miralax,
The issue is not following the treatment program faithfully, which I can only assume is due to poor instructions by his doctor. It is frustrating as it takes months to correct but I have a regimen that has proved to be very successful over my 33 years of dealing with such kids. I'll post it here as a copy and paste so I apologize if it seems impersonal but it will keep me from missing any important points. The doses and daily regimen are spelled out here as follows:
Chronic constipation is a common problem in children, especially boys. The protocol for treating this, while fairly simple, does require strict adherence to it for many weeks or months before the problem improves. Here it is and please let me know if you have questions:First, all children with soiling have chronic constipation and have colons full of stool. This needs to be evacuated completely so buy a few Pediatric Fleet's Enemas and give him one now, one in the morning and then you can continue to use an enema if he goes more than 4 days without a stool. Second, eliminate all dairy products from his diet for now as the calcium in dairy caused the colon to slow down and the calories from dairy products only spoil their appetite for other foods. Increase his intake of juices, especially apple juice, as this will help with keeping his stools soft along with the next step.Start him on Miralax, 2 teaspoons daily in juice, to help keep his stool loose or soft and moving.Over time his colon will shrink back down and he will regain his control over his bowels in time, but you should expect this protocol to work only if he is willing to participate fully in it. He should sit on the toilet after each meal for 5-10 minutes to help retrain his bowel to respond to the natural urge of needing to empty after meals. It may take weeks or months to see improvement but if you stick with this protocol I've yet to see a child not get better eventually.
Sorry, pasted it twice!
If his doctor has not done a rectal exam on him then that also needs to be done just to rule out the very small chance that he might have a problem with his rectal tone, meaning the nerves might not be keeping his anus closed until he needs to poop.
This can be seen with some neurological problems, such as Spina Bifida and other spinal cord problems but I would think this would have been evident long before now.
I'll give you some time to digest this but chat will kick us off if neither of us posts a reply within 4 minutes. I'll stand by though and will be notified when you post a reply.
the dr has done a rectal exam and said that the rectal area is fine.
Great. Just copy and paste the conversation above in an email or other document for his parents to see and tell them to be patient.
His dr is from Africa and said that he was just lazy, but I just dont believe that is the real issue here. I will take the advice and pass it on to my daughter! Thank you for your time.
I can assure you that nothing else is likely going on that would cause his symptoms as he has classic encopresis due to withholding and it is not due to laziness but rather a problem that developed over time to the point that he honestly does not feel the urge to poop or know when he has passed a stool.
You are quite welcome.