Hello. How can I help? If you are available for a chat, we can discuss your concern in real time. Otherwise, I can just leave you a reply.
Sorry he is having trouble. There are a number of possible causes but only a few that are likely. One of the more common ones is constipation. Believe it or not, having large caliber stool in the rectum can lead to problems both with urination and defecation. Incontinence typically occurs when liquid stool leaks around a hard stool mass. Similarly, a hard stool mass in the rectum can place pressure on the bladder neck, causing incomplete or dysfunctional voiding. If this is at all possible, encouraging stooling with softeners or stimulants like prune or pear juice or miralax.
We also ask about recent stressors. If there has been change in school, home situations, parent custody issues etc, these can cause a child to feel that he needs more control over things and these are functions over which he can exert control. Certainly, asking him or parents about these things can be helpful.
While unlikely, it is also important to inquire about the possibility of abuse, sexual or physical, is a possible cause.
Changes in diet, illness, parasite infections are potentially at play but, sadly, many times there is ultimately not a cause and something that will improve with time. Strong punishment is often not necessary, the embarrassment of stooling or urinating on oneself is often enough negative reinforcement. Please let me know if you have follow up questions or concerns.