Encopresis Questions and Answers

Encopresis Questions

Read some questions from real parents that have been answered by Dr. Collins in the past. This page is no longer attended to by Dr. Collins. However, the facebook group on the Clean Kid Manual is active and can be joined via a link on this website or going to facebook grouops.

The NY foster mother of a developmentally delayed 5-year-old seeks help.

I have a foster child in my care that is 5 years old and soils his pants every day. He is developmentally disabled and, while he says words, he doesn’t really communicate. He is continent of urine if he is toileted frequently. Is your program appropriate for a child who is probably not going to cooperate?

Dr. Collins’ Answer:

Most of what our Soiling Solutions® (SS) protocol addresses is the retentive form of encopresis, which means children are holding in their stool. This is the most common form of encopresis: 70 to 80 percent of cases.

Your child could respond to SS, but you would have to accept that there is no guarantee and that you are dealing more with a trial or error approach.

The parents on our forums will readily report that their children are not cooperative, especially in the beginning. The movement toward cooperation does depend on their capacity for trust in you as the caretaker.

The SS protocol might work on a purely mechanical basis with an adequate, complete bowel movement every day. This is assured in our treatment using very short, timed sits and suppositories and enemas as dictated in the Clean Kid Manual© for one hour a day.

I am sure that there are moms on our SS forums dealing with a child like your foster child. Thank you for your work as a foster mom.

A NY foster mother asks if a 3-year-old boy is too young for Soiling Solutions®.

Our little boy moved in with us when he was 2. He was extremely constipated at that time and cried when he pooped. We thought we fixed the constipation issue with lots of good food while he was still in diapers. We potty trained at 3, and he did GREAT with pee and struggled with poop. He pooped in his underwear for at least a month and then started holding it in. He finally went on the potty but continues to hold his poop for days at a time.

We were told to give him prune juice by his doctor and did this consistently. Usually he would just soil his underwear the last day before he would finally poop, but just recently he started soiling his underwear daily, even after pooping. He’s not yet 4 so I’m wondering what we might be able to do and if this book/program is even appropriate for him at this time.

Dr. Collins’ Answer:

Encopresis is not officially diagnosable until 4 years of age. However, it is not too early to treat your issues with my Soiling Solutions® (SS) protocol, which is covered in the Clean Kid Manual© (CKM). The younger he is, the better it is to proceed with treatment before physical damage and patterns become difficult to reverse.

Many of the parents on our forums wish they had intervened with SS before they were older. The program is difficult and he will not easily comply, but the results of just one hour a day of treatment followed by being soil-free for the next 23 hours will eventually register and be appreciated by all.

A Georgia mother seeking a “whole person centered” approach for her 8 year old son’s encopresis.

My almost 8-year-old son was potty trained successfully at 3 years old. He was attending a Montessori school since 18 months of age and loved his first teacher. Since he was changed to a class with a new teacher at 3 years old who he didn’t connect with, he started resisting going to school. He also started holding his poop around 4 years old. The teacher told us he was “lazy” and didn’t want to stop playing to go to the bathroom. She forced him to stay during recess in the bathroom until he pooped. She encouraged us to do the same at home and we (unfortunately, not knowing any better) did as well. He missed entire recesses at school and screamed and cried at home while this was going on for a few months. Eventually he refused to go to school altogether and we pulled him out. He’s been going to a democratic school that suits him a lot better.

Since this happened (he was 4 1/2) he’s had well-formed stools, but he doesn’t have BM every day: more like every other day, occasionally 3 days. They are also huge stools, bigger than an adult’s. He soils his underwear 2-4 times a week because some poop comes out, not all. And it’s not liquid. So….from what I’ve read so far on your website and others I am pretty sure he has encopresis, with an enlarged colon. I don’t think he has hardened stool because he doesn’t leak liquid feces. (I read that’s a telltale sign).

When we took him to his last checkup his pediatrician just prescribed a laxative, which I didn’t give to him. I believe there is some healing that needs to happen regarding his time at the former school. As he’s gotten older he’s embarrassed about his accidents. We are pretty exhausted of the whole thing – but so willing to do something about it. We need help. I get that your protocol is very behavior oriented, is there also an emotional support component to it? I would love a more whole person centered approach, a holistic one. I can’t find anyone in our area to help. Thanks for any info.

Dr. Collins’ Answer:

You have described a set of events that accords well for the onset and diagnosis of encopresis. Frequently any successful treatment leads to a substantial improvement in overall well-being, because you have removed such a significant source of distress and conflict.

My treatment is successful because the focus on treatment is only for one hour a day, a complete evacuation, and freedom from soiling for the next 23-hour period. Your son is older and more capable of reason, but he will still need you to be very strong, loving, and supportive all at the same time. He has likely been very defensive and in denial so those defenses will rise up very strongly as you proceed.

You will receive a lot of emotional and practical support from other mothers and contributing professionals following my protocol on one or both of our Soiling Solutions® forums. I believe this is where the major emotional support becomes available and very real to you. Good luck to you and your son.

An Australian 3-year-old girl with a severe holding issue.

I have a 3-year-old daughter that has been actively holding her poop for about 8 months now. We give her laxatives every day, and have also tried suppositories, and she still actively holds, to the point that she’s nearly crying because it’s so hard for her to hold it in. She sometimes goes for over a week without pooping, even with the medication.

I have seen three different general practitioners who are all unconcerned with the issue and suggest continuing with the above treatment plan despite the fact that we have been doing that for 8 months without any change at all. My husband and I are at our wits end with this issue. In fact, I am in tears writing this email. I have two questions: first, is your program helpful for children who hold their poop despite being given medication? Secondly, what would you recommend we do to get a physician on board with helping us treat this?

In Australia, we need a referral (not sure if it’s the same in US) to see a specialist or pediatrician (or get an X-ray) and the doctors I have seen so far have been unwilling to provide this, as they don’t see it as a problem. You mention that it is preferred to have a physician monitoring; however, we are struggling to find someone that will take our concerns seriously. Any insights you have would be deeply appreciated. Many thanks.

Dr. Collins’ Answer

Your physicians’ apparent indifference may be because they don’t have specific treatments to address your child’s pattern of holding. My Soiling Solutions® (SS) protocol does just that. I have many Aussies on board who have had to rely on their own resources, with the help of my manual and the parents on our Soiling Solutions forums.

Your doctors appear to be especially resistant to the use of suppositories and enemas for fear of traumatizing the kids, but then what is the effect of persisting with ineffective treatment on the children and the entire family? It really is your judgment call on what to do. An X-ray would help to define the degree of backed up stool and if a substantial enlargement of the colon has occurred.

Canadian mum of an 8-year-old boy looking for what to do next.

I have been working with doctors since my son was 4. We have tried basically all types of laxatives. Since Christmas, I have been giving my son 3-4 enemas each week. He continues to have accidents a few times per week. This is a frustrating and difficult situation and I am not sure what to do next.

Dr. Collins’ Answer:

I see that you ordered the Clean Kid Manual© after you submitted your issue. You will see that a daily program of suppositories and enemas (S&E) are needed to adequately clean out the child to free them of soiling for the next 23 hours.

Also, you will need a protocol that transitions your child to self-initiating his bowel movements, which may not be done with just a daily emptying out program. That is only a physical routine. Since children form a deep, virtually unreachable habit, they have to be counter-conditioned from holding to releasing as appropriate when they experience voiding urges. You will see that my program emphasizes relaxation and learning to recognize their voiding signals.

I hope that this will help you to understand what you have been up against, which goes unrecognized by way too many professionals who want to rely only on the top down oral medications at the beginning of the GI tract. You will find yourself very welcomed by the professionals and moms on our forums that come with your order.

California mom looking for a way forward with her 2 year old daughter.

My daughter is now 2 years and 3 months old. She is the youngest of three children. She is so loved by everyone at home. Her older siblings are kind and playful with her. They are 10 and 8 years old. So, there is a 6 year gap between and her older sister.

In our house food, nutrition, healthy lifestyle, exercise, and bowel movements are a big deal. I try to cook warm homemade meals with real ingredients (organic when possible). I subscribe to the work of Weston A Price–restoring nutrient-dense foods to the human diet. And, with this in mind, you can understand how difficult it is for me to see my youngest child suffer tremendously with chronic constipation.

It began at infancy. I strictly nursed her. For my own diet I ate lean proteins, veggies, legumes, whole milk, eggs, fruit, and lots of water. I also supplemented with coconut oil (1 tsp per day), probiotics, and fermented cod liver oil. I wanted to make sure she had the best breast milk possible.

With my two previous children I didn’t take care of my diet as well because I was working or wanted to lose weight, so my milk “dried up”. They had to go on formula and it hurt me. I was determined to breastfeed her for an entire year!.

At around 3 months old, she started to have hard, impacted stools. She strained. Her tummy would swell, and she was fussy and could not sleep. I went to see a Naturopathic doctor who told me to eliminate dairy, soy, coffee, and gluten. I did so about 90%. Nothing changed.

She continued to experience constipation. Things began to worsen as she was sometimes getting fissures or bleeding when having bowel movements. I went to see her pediatrician and he put her on daily dose of Milk of Magnesia (MOM). I gave her MOM for 4 months. He suggested trying solids early in case food enzymes helped. At 4 months old, I started her on solid food–avocado, little bit of bean juice from homemade pinto beans, mango, ripe bananas, papaya.

I did not give her rice cereal for fear that it would make matters worse. She did not improve. I continued with MOM and then added in Epsom salt baths + castor oil rubs on her belly every night. Things did not get better or worse. She was growing well, so her pediatrician did not see it as a big problem. We plugged along with me trying different recipes and trying to breastfeed as long as possible. I was down to one or two nursings by 10 months old and eventually had to stop at 11 months old.

I then gave her raw, whole milk. All along she was thriving, but her chronic constipation grew worse. There were many times that I had to stick my finger into her anus to pull out huge, dry poops. We started seeing a GI specialist at Rady’s Children’s Hospital in San Diego. At a little over one year, we took her off dairy again and began to give her almond milk. Things did not get much better.

The specialist introduced the idea that she may be withholding poop based on her past experiences. I was in disbelief. The specialist suggested we switch her from MOM to Miralax. I hesitated because I have read FDA info on certain ingredients being toxic. However, after one particularly painful event (and allergic hives from MOM) I decided to give her Miralax. We started with 1 tsp each morning. Things got better for a little while.

She is an extremely talkative child who is very aware of everything around her. After she does poop (in a corner or away from people), she will say “that was easy!” Because she is now 2 years and 3 mos old, I can encourage her. I also give her incentives (3 skittles). Her poops are usually the consistency of hummus, sometimes a bit drier, but never really rock hard like they used to be when she was very little.

We see her GI specialist (or nurse practitioner) every 3 mos. On their recommendation, I have done routine “clean outs” but things just eventually progress back to regular–doesn’t poop for 3 days, I start giving her senna syrup and capful of Miralax. When she hits days 5, 6, and 7 with no poop she begins to stink a bit. Rarely she will fart. I always felt this was wrong. My two other children did so a lot.

I wonder if there is an underlying nutrition/food issue that I have not addressed. Or, is this encopresis at its best?

We have done blood work and have tested her stool. The nurse practitioner tells me her tests are normal and do not show signs of inflammation or other markers for Crohn’s and similar issues. She believes it is all about encopresis.

I believe she may be holding it in, but I also believe there may be a food allergen/intolerance issue. She has bumps on her upper arms and cheeks. Not a ton, but definitely her body is telling me through skin issues that there is something going on.

I have also tried baby acupuncture. Things got a bit better, but eventually went back to her normal. I was giving her “Gentle Warriors, Easy Going” Chinese herbal medicine (homeopathic) and it really stunk. She did not like to take it but eventually consented. I was proud of her, but stopped taking the meds because I did not see results.

She is not a great eater any more. As a 2 year old I really struggle. She puts her hand to her mouth and refuses to eat the wonderful homemade foods I made on a daily basis.

Honestly, at this point I am so lost. So tired. So helpless. I don’t have any potty training ideas in my head. I don’t really care if she is 20 years old and still in diapers, as long as she goes to the bathroom on a consistent and healthy basis.

I’m scared of the long term effects of her holding it in, plus the large doses of Miralax.

If you can help me, I would be forever in your debt. I am searching for guidance and answers.

Thank you for reading and for caring enough to help.

Dr. Collins’ Answer:

You have certainly gone to heroic lengths to help your daughter. The holding behaviors and going only in the corner and away from people is fairly characteristic of these children. Her decrease in appetite is also reflective of backing up from holding. The inability to relax and release on the toilet is very much a sign of encopresis, which is defined as diagnosable only at 4 years of age or older. I would indeed be concerned over long-term effect of not having a regular daily toileting habit.

You appear to be very reliant only on stimulant top-down oral laxatives. Talk to your nurse about a summary of my Soiling Solutions® (SS) protocol. If she and her physician are open to considering it, she can request a copy of the full manual for free from the website for their own reference as needed within their office. Parents should purchase their own personal copies.

The full program may be too much for your daughter at this time. Until she is older, I would consider the use of a daily glycerin suppository to trigger bowel movements since it has much more of a clear and timely effect than top down oral agents that are delayed by 6-8 hours. It will create clear and timely voiding urges with fairly immediate success.

You will likely see an increase in appetite with regular daily emptying. At this point, I would not be concerned about suppository dependence. It is even less of a concern than oral agent dependence, which is not enhancing the proper awareness of urges with elimination.

An intimidated mom with a scared, resistant 9 year old son.

Our son has had functional constipation with encopresis for almost 5 years now. We started out with naturopathic treatment, and have since seen two pediatric gastroenterologists, including the Constipation Clinic at Johns Hopkins Hospital.

After several clean-outs, and long-term therapy on Miralax, he continues to have impacted feces. I would like to try your approach, but he vehemently refuses for me to help him with “down below” treatment because of his modesty. I imagine you have come up against this before. How could we go about convincing him to try this method?

Dr. Collins’ Answer:

Children can be emotional, impulsive, and not act in their own best interests. Even college-age students are sometimes prone to impulsive, bad judgment.

You are the adult and no one will really question you are acting in his best long-term interests. This area of the body is fraught with sexual and cleanliness concerns that it even impacts the use of direct treatments by professionals.

Not acting definitively will have many more long-term emotional and physical negative consequences than any short-term confrontation can cause. You have given very prestigious medical authorities every opportunity to arrest his encopresis.

You ask me how you can convince him into doing what is best for his long-term interests. You cannot. I cannot! His modesty is not what is at stake here! It is an argument that he is making to ward you or any effective treatment off. It has worked well for him and his power over you will cause him untold problems in the future.

Children do want to get better. They just do not know how. Become a “pain in the butt” if necessary!

A Florida mother with a 5-year-old boy is close to the edge.

My son for over two years has had problems going poop in the potty. He constantly soils his underwear, and then lies that he is dirty or will not tell someone he had a accident. Our physician said he was constipated and to give him Miralax to help him go potty. I was hesitant about my son getting used to always having to take something to go to the bathroom. The Miralax has helped with pain.

My son says it does not hurt anymore, but when he has an accident in his pants, he claims he didn’t feel he had to go potty. The strange thing is, if my son is wearing underwear he has an accident, but if we put a long shirt on him with no underwear, he goes poop in the potty just fine. It is like the underwear plays this mysterious barrier for him in going poop in the potty.

He is five and cannot go around in life without wearing underwear. Our family is frustrated and I don’t want to take my frustration out on him. The doctor says to keep giving Miralax every day and eventually he will learn. Not sure how much more I can take and willing to try anything, but how safe is it for a child to take a stimulus every day to make them go?

Dr. Collins’ Answer:

Yes, soiling is an extremely frustrating condition for all. It can become chronic, with no easy or immediate solution, as you have experienced. Many parents find that having their child go bare prompts them to use the toilet when out of the comfort of diapers or underwear. But, many solutions are only temporary!

He is likely more relaxed about accidents with his underwear on. Also, his stool is likely too soft or liquefied with the Miralax, and it does not provide sufficient awareness and resistance to hold back successfully. Miralax is a stool softener, not a stimulus. It removes awareness and makes accidents more likely! Coughing, sneezing, jumping, laughing, inattention, etc. makes it much more likely that he will have “oops” moments.

Even if there is some awareness, it would occur after an accident. He is likely to hide or deny accidents because everyone is so upset over them. In addition, taking an oral medication delays pooping urges to 6 or 8 hours later. It is not connected properly in time for cueing voiding.

My program utilizes suppositories and enemas which provide more immediate voiding urges and are applied in a daily Power Hour. The soiling ends so much more quickly with my protocol, so that continuing treatment becomes so much more acceptable. It is designed to move the child away from a daily artificial stimulus. The bottom medications are over the counter and quite safe even with prolonged use. Some people are on them for life.

This is all spelled out in my Clean Kid Manual©. Please read the first chapter online here. The manual is a wonderful aid that physicians can appreciate because of the demands on their time that it saves.

A stressed NZ mum is frustrated by medical dismissal of her concerns for her 3-year-old son.

I have a 3 1/2-year-old son who has had severe stool withholding behaviour for the past year. It has been ruining our lives, and fearing the emotional and physical consequences for him has been so awful. We have felt so alone in dealing with this.

I’m interested in your program. I am just wondering what type of suppositories and enemas are used on your program and whether they will be readily available at my local pharmacy. I don’t feel like I’d be able to tell the pharmacist they were for my son. I think they would tell me to go to the doctor. Our GP will probably not support us with your program. When I visited after a year of my son being on Movicol with him still withholding, she said, “It’s just constipation. Just keep giving him Movicol.”

Please help. If I know exactly what suppositories are required, and that I could purchase them here in New Zealand easily, and could do the program without medical support (the medical people here just say “use Movicol”) , then I think we could try your program.

Please help! Sorry for rambling, but I am so stressed about this.

Dr. Collins’ Answer:

We have a number of Aussies on the Soiling Solutions® (SS) parent forums and there are some New Zealanders as well. I just do not know about NZ on availability of various medications. I’ve not heard of any issues, and there really should not be any. I know you have solid glycerin (glycerol) suppositories and Fleet enemas, and you can substitute Microlax or bisacodyl suppositories at the fourth sit if appropriate. It is not a problem in Australia which I believe parallels your country in many ways. Hopefully, the New Zealanders would respond to you!

There are always bag enemas, which can be very effective where you make up your own solutions. You will need the Clean Kid Manual to understand all of this and the sits involved in the “Power Hour” which relieves you of worry for 23 out of 24 hours per day. Yes, there are many SS parents who have done the program using just the Clean Kid Manual© (CKM) and the SS forums. I would prefer that your physician would be on board so I send out free copies to them if they complete a form located here. This is expensive, but worthwhile in ethical and reassurance terms for both parents and physicians.

Your experience with your doctors is quite universal, but I do feel that I am slowly gaining their attention and trust. They do appreciate Soiling Solutions as an adjunctive approach because it makes their job somewhat easier. Their time demands are so great that they don’t have the time available to explain everything that is better covered through my manual and the forums. Everyone is grateful to the program primarily because it ends soiling so quickly by comparison to any other approach.

A North Carolina mom does not want to wait two more years for biofeedback.

I have an 8-year-old son who has suffered with constipation since he was born. As an infant, his constipation was treated with Nutramagin formula. At about age 2 1/2 (as we were attempting to toilet train), he was put on Miralax, and has been on varying doses since that time.

In the last 5 1/2 years, he has been treated by our pediatrician, several mental health professionals, a doctor in the Constipation Clinic at UNC Chapel Hill, a pediatric gastroenterologist at UNC Chapel Hill, has had more abdominal X-rays and home clean outs (with Miralax) than I can remember, and, about a year ago, had a five-day stay at UNC Hospital for a clean-out. He has had a blood test for Celiac disease, which came back negative.

After each clean out, he has improvement, but regresses soon after. We are currently being told to stay the course with Miralax and that our next course of action is biofeedback. However, UNC will not attempt biofeedback until he is 10 years old. We are unwilling to wait two years to try something new.

I am curious to know about your work with children who have suffered constipation since birth and are now dealing with encopresis. My son has never had a contrast X-ray, and I wonder if there would be any benefit to that – perhaps detecting an anatomical abnormality?

Dr. Collins’ Answer:

I think waiting 2 years is ridiculous. I am surprised because I have lots of respect for the UNC GI Motility program and the work of its director, William Whitehead, PhD. They did pioneer research on manometric biofeedback (balloon insertions and monitoring). There is another form of biofeedback that is being increasingly used by Physical Therapists (PTs) using electrical muscle recordings (EMG-Electromyography) that could be applied at a younger age.  If you go that route be sure to get a pediatric PT who specializes in pelvic floor dysfunctions—dysnergia with EMG biofeedback).

Otherwise, there is my program, which is also a training program to connect urge recognition and proper muscle coordination awareness in a direct fashion. Dr. Whitehead knows about it. I can provide a free exam copy to your supervising physician if he is open to trying my Soiling Solutions protocol spelled out in the Clean Kid Manual. He/she may really appreciate having an alternative approach to try as opposed to more waiting and a passive approach.

Leading, internationally-known colorectal surgeons running bowel management programs at Nationwide Children’s and Cincinnati Children’s Colorectal Center view a contrast X-ray as the single most important diagnostic test for fecal incontinence. Of course, they are surgeons so anatomy is very important to them and they can tell a lot from contrast X-rays. They recommend a soluble medium for contrast as opposed to Barium which is highly constipating.

I wish you the best and do not see waiting as a viable option when you want your whole child back ASAP!

An Australian mom of an 18-month-old concerned with an effective clean out process.

I have a query about doing a clean out with my 18-month-old son. I have been reading through many things from here, but am still confused, and trying to sort out the info I have from here, along with the info from our pediatrician.

My 18 month old was an irregular pooper from birth, and this didn’t change when solids were introduced. Over time they got harder, and it became a problem.

He is on 15ml of Lactosule per day, and is now going every 3-4 days. The consistency varies from overflow out the nappy, to quite solid and uncomfortable to pass. I have contacted the pediatrician and said “I want to do a clean out,” and he advised me to use Microlax (sodium citrate 450mg, sodium lauryl sulfoacetate 45mg and sorbitol 3.125g.) do an enema twice, and continue on the Lactoluse. I am not sure that is enough, but am not sure how else to proceed because of his age, and because the products recommended in the US are not the same as what we have. Ex-lax for example isn’t available here and the most similar thing i can find has senna in it, and all such products say not to use in children under 12. I haven’t been able to find a pediatric laxative (and forgot to ask the pediatrician if we should be adding one in when I spoke to him).

What would you recommend?


After a number of difficult poos, I took him to the doctor, who tried him on a few weeks of lactose (a week of 10ml, a week of 5ml), which didn’t do much for the timing (was still weekly) but the consistency was better. We then tried Coloxyl (Poloxymer) which didn’t do much more. I was then referred to a pediatrician who put him back on lactulose, with a dose of 10-15ml. This was based on what worked getting him to go at least every 3 days with good consistency. That was 3 weeks ago, and although he is now going every 3-4 days, I am not happy with the consistency (the last one 2 days ago was hard and very uncomfortable for him, while the previous one overflowed out of his nappy). He also only goes in his sleep now.

Dr. Collins’ Answer:

The active ingredient of Ex-lax is Senna in either a chocolate bar (squares) or pill form. You could use it with a physician’s approval, and it is regarded as safe by leaders in the field who run internationally well-recognized bowel management clinics. His very young age could be an issue, but it is certainly safe for older children under a physician’s supervision. Your pediatrician is doing the generally recommended protocols. See if he would approve the use of an emulsified mineral oil, such as Kondremul, which will mix in with the stool and soften it as well as provide lubricant properties that would be very helpful for your child.

For periodic clean outs the use of solid glycerin is quite safe for bottom up. Again, get your doctor’s approval. A combination of top down and bottom up approaches is best for clean outs.

I think my protocol is just too aggressive at this point for his age. I would consider it at 3 years if your son’s situation persists.

A Canadian girl’s issue of holding is a cause for encopresis.

Hi there. I have read through your website and I don’t know if this protocol will help my daughter. Soiling isn’t entirely our problem. The holding is. She will go every 3-4 days. We have tried everything, and I mean EVERYTHING, and what I have fully come to understand is that this is emotional. We did enemas, lax-a-day, magnesium, etc., and the ONLY thing that WAS helping was ERT emotional release technique, but now that is failing us as well. My 3-year-old has been holding since we brought her brother home a year ago and there is really no end in sight. I thought this product you offer would help but more drugs and sitting for an hour (which we already do every day) seems like a lost cause. If you can offer me any reassurance or support, I will gladly take it.

Dr. Collins’ Answer:

I cannot imagine a child sitting on the toilet for a solid hour. It sounds very punishing. I have four short sits with relaxation periods over the course of what my parents have come to call the Power Hour (PH). But, that is it – for but one hour out of a day, assuring an adequate BM with no worry or hassle for the rest of the day and a clean, happy child. The drugs I use are over the counter, very short acting, and directed to where the problem is, at the bottom! The moms in the forums are quite trustworthy and very helpful to one another!

I am not going to sell you the manual! You are doing the right thing through educating yourself. Too bad there is so much trial and error with this problem because of a lack of knowledge about sound treatment options when Miralax/Osmolax fails. Keep reading.

Follow Up Statements by Parents:

by poopfixer

Oh poor Mama & child, One hour of sitting, daily? Everyone on this site already understands what your doctor’s problem is: “extreme, herculean, automatic holding”. The constipation &/or soiling is merely the end result of the HOLDING. That’s precisely why this program works b/c it corrects the daily holding by ensuring a void DAILY. It will take her automatic “mind-control” some time to appreciate the relief of a DAILY void, but she WILL get there in time (that time schedule varies for every child). This will be the best money you’ll ever spend to fully understand this solution. PLEASE read Dr.C’s first chapter over & over till you understand it then purchase the program. Think of the time and money wasted going from doctor’s appointment to doctor’s appointment or specialist appointments without a resolution. This program is effective because it is based upon scientifically proven research. Best regards for success.

by kblank

Ditto! Soiling is just one symptom of the condition (which she probably will develop eventually if the underlying problem isn’t corrected). The SS program addresses both the physical and behavioral elements of this very frustrating condition. The short “sits” and progressive interventions used during the Power Hour ensure daily emptying (and prevent further damage to the colon) while working on correcting the holding behavior. I can’t recommend it highly enough!

A Georgia mom wants her 4-year-old daughter to reason her way through encopresis.

I learned of your program from an online group for encopresis. My question is, will SS work for my 4 year old daughter, who has no trouble with constipation/regularity, but has been withholding stool for the past 5 months only as a dysfunctional coping mechanism? She was potty trained until we moved out of state after she turned 3. At 3 1/2 years, she suddenly started withholding, but she herself doesn’t even know why. She does not need laxatives, although we’ve used them, including an enema. She eliminates just fine thanks to her healthy diet, but she is constantly struggling to hold it in every day, unless we force her to sit on the potty.

I think she may need therapy, since I know laxatives will not change her irrational desire to withhold. However, if SS offers an approach to deal with the emotional withholder, then this may be the product for us. Thanks for your advice.

Dr. Collins’ Response:

I am a retired therapist and therapy is not the route to go. She has to learn by doing, not reasoning her way to a solution. The insight and understanding will come about later. This is the reverse of our ordinary way of thinking. The occasion for her onset of holding is not unusual. The issue is that once started, for whatever reason, a new set of maintaining factors enter in to make the holding chronic and resistant to change, because it has become very habitual and not subject to conscious control or understanding. The condition is now well-recognized as dysnergia, a pattern of involuntary, conditioned holding tensing the pelvic floor, external anal sphincter, and abdominal muscles which prevents the release of stool on a routine basis.

A Parent Responds:

by akholde

I agree with Dr. C. You will drive yourselves crazy trying to reason out the underlying cause of withholding. Power hour will give you a time to focus on pooping every day. It ensures that she poops, and if she starts going on her own, you just get to skip the formal power hour that day. While it may seem unpleasant to use suppositories and enemas, they certainly work to prime the body and get stuff moving again. Don’t put it off, just commit and you’ll see improvement. In the end, it doesn’t really matter WHY she is holding, but that her body can be retrained to relax and void every day.

An Irish mum calls out for help with a screaming 3-year-old.

Hi, my son is 3 and in the last 2 months he has been screaming going to the toilet, hiding, and crossing his legs. He does this about 5-6 times a day, but when he goes, it’s only a tiny bit, sometimes barely a mark. He also says, “Mommy, I pooped.” and cries. I’ve tried Lactulose, but it has not been helping much. Please help, I don’t know what to do.

Dr. Collins’ Answer:

Your child is demonstrating very profound “holding” behaviors to fight off all voiding urges. This kind of start will result in an enlarged and damaged colon, although the constant leakage caused by Lactulose as a stool softener may slow that process. But at the same time, it makes life for all virtually impossible.

I think you must go immediately to the use of glycerin suppositories, which will assure daily complete emptying that will allow him to be clean and less desperate. He will fight voiding, but he won’t be able to resist it and he will feel much more comfortable and normal when he does go, and that may help him to be more accepting of a voiding habit.

A UK 10-year-boy is offered surgery for encopresis.

We have a 10-year-old with leaking and soiling which his pediatric gastroenterologist hasn’t been able to treat. It is felt that he has a pancreatic enzyme deficiency, that he is treated for with creon capsules. He has no sensation of needing the toilet, and the first time he is aware that he has ‘soiled’ is when he has the sensation of sitting in poo. His stools have always been quite offensive, so we often know before he does, based on the smell. He rarely, if ever, goes to the toilet to poo because he simply doesn’t know he needs to go. He used to get awful stomach cramps but these seem to have stopped with the use of creon.

The pediatric team is suggesting a stoma for presumed megarectum, but we feel there may be another way forward that is less invasive.

Are you aware of any UK centres that could help us, or is your guide suitable for a psychologist to implement a treatment plan with us?

Dr. Collins Answer:

It is “felt” that he has a pancreatic enzyme deficiency? Oh my, I would certainly consider a more active approach to treating what appears to be simple encopresis before going to surgery. I have sent free examination copies of my Clean Kid Manual (CKM) out to several agencies in the UK. Your group would certainly be welcome to request one.

Yes, a psychologist could proceed with my treatment protocol. I’ve had parents so frustrated that they have ordered my CKM and proceeded with treatment on their own with the help of parents and professionals on my Soiling Solutions® Parents’ forums. I do prefer that professionals provide the guidance, which is why I provide the examination copies for their own internal staff use, while parents purchase their own copies with confidence that their provider is knowledgeable and on board!

Recent Exam copies for the UK have been sent out to:

Devon ICS, Exeter, school nursing.

School Nurse, Kent Comm. Health Trust, Swanley

Action for Children-Open Door Family Center-Welshpool/Powys

A California Down’s Syndrome and cerebral palsy 6 year old daughter are ‘…stuck in a hard place right now.’

Hello – I have a 6-year-old daughter who I believe has encopresis. She was recently put on Miralax, but still holds in her poop even when soft. She also has Down’s syndrome and cerebral palsy, and doesn’t speak or see well. What I wanted to know was: would this program benefit her in any way, because we are stuck in a hard place right now. Thanks, hope to hear from you soon.

Dr. Collins’ Answer:

She would be helped by my program in assuring a daily emptying out of her colon, such that this will eliminate her accidents fairly quickly. Given her handicaps, there is more of a question of how soon she will be able to reach the stage of spontaneous self-initiation of her bowel movements without your being very vigilant. Life for all of you will become much more tolerable much earlier with my Clean Kid Manual© (CKM). Your daughter’s doctor can get a free examination copy of the CKM to help guide you. Many doctors stop at the use of Miralax, but need to go further when necessary.

A NC mother with a 9-year-old daughter needs to confront her doctor.

My daughter was diagnosed with encopresis 2 years ago. She is 9 years old now. We were on Miralax for a year and I thought she was “cured”. However, I was mistaken because her encopresis has returned. I found your website because I am at a total loss. I do not want her to go back on Miralax. She is currently on it, but I do not think she is cleaned out. I want to start your program, but I do not know what to purchase or even how to start. Please help!! Also, I don’t think my doctor would be very willing to listen to me about this program. They always recommend Miralax, and when I asked for a referral they seemed to think it was unnecessary. What should I do about that?

Dr. Collins’ Answer:

OK, time for your Mama Bear to show up and confront your doctor! With that relapse, you are clearly dealing with a chronic disorder and he is not showing sufficient aggressiveness to deal with this problem, which can do long term damage the colon and require future surgery.

He is now going well beyond the Physicians’ ethic of “First, do no harm!” He has done that, now what? To his credit, he has done what is standard protocol for encopresis.

Have him request a free exam copy of my Clean Kid Manual© here and have him monitor or follow up with your purchase of my manual (digital or bound or both). You will be helped by professionals and the other moms on the forums, which comes with a purchase. Your doctor should examine my website and request a free exam copy of the manual.

Twelve year old Texas boy forever close to ending encopresis by will power and reason alone…NOT!

My son is 12 years old and has had encopresis since he was a toddler. We have tried many different things over the years, but nothing has worked. He is currently seeing a therapist every other week. He takes a probiotic daily. He says he has accidents because he does not want to stop what he is doing. We have had countless conversations with him about his problem. Can your program help him at this point in his life?

DrC’s Answer:

What your son hears you say is blah, blah, blah, blah! His response is much the same!

However, I know that both of you have been trying to cope. Who could possibly want this problem and all the conflict that it creates!?! You are trying to address the whole gastrointestinal tract with probiotics, which affects the consistency of the poo coming out at the end of the tract.

However, the problem is mechanical at the end of the tract and involves a non-verbal area of the brain, which you have not been addressing and most treatment protocols do not. Your son is holding and he is very good at it! However, he is unable to pull the release switch because of a widely recognized, but poorly dealt with condition called dysnergia.

My Soiling Solutions® (SS) protocol deals directly with the use of rectal primers to activate that switch with powerful urge signals and directly promoting release of the poo. However, it requires a conditioning sequence to promote the child’s learning the recognition and motor skills to properly void over repeated conditioning trials.

This requires the purchase of the Clean Kid Manual© (CKM) here. This also admits you to one or both parents’ forums where other mothers are happy to consult with you. The moms include health professionals. You can get your physicians on board by asking them to request a free exam copy from the website. Surely they must be frustrated at the lack of response to their standard one-size-fits-all protocol of Miralax and counseling.

How long for a colon to recover in an 8 year old boy with encopresis?

Hi there. I live in New Zealand and after having read lots of your Q&A’s, I can see that encopresis is a worldwide problem with very similar treatment plans being given, many of which don’t work!! A friend has an 8-year-old boy who was partly toilet trained when long haul flying saw him back into Pull-ups and he then developed encopresis.

This lovely child has been on a top down approach for a year now but to no avail. How long can it take for a megacolon to resume size, tone and function? And if it isn’t back to a more normal state from a neural perspective, would suppositories be effective? I’m supporting my friend and after having read your literature feel confident as it makes good sense. Thank you so much for your advice. I’d love to see an end to this for the family’s sake.

Dr. Collins’ Answer:

Your example of the 8-year-old boy regressing to Pull-ups from long haul flying well illustrates one of the many different ways that encopresis can get started. He became very dependent on the “holding reflex” which can then take on a life of its own, where it becomes extremely difficult to get it to “switch off” to allow the voiding reflex to take over whilst sitting on the toilet stool. I can imagine bathrooms for international flights becoming very scary and his becoming resistant to toilet stools. Add to this the psychological and physical consequences of a “megacolon” and you have additional complications. An overstretched colon is weakened and less able to push stool down, even as the stool dries out, causing clogging and painful bowel movements. This can both initiate and maintain a vicious cycle which is hard to appreciate by many.

The megacolon can take months to recover function, and may never fully recover its original elasticity or strength. Could suppositories be effective? Sure, but if you are just using them to produce bowel movements, then that is purely mechanical with no retraining involved. That is also the trouble with the present overemphasis on the “top down” use of stool softeners or laxatives. You are just viewing the body as a sink or toilet that needs regular flushing. It leaves the brain out of the picture. The body and brain connection has to be reset, so that the use of suppositories or enemas trains effective voiding while sitting on the toilet. That is what my Soiling Solutions® (SS) protocol is all about. Your friend’s child now has an opportunity to take positive rational action and get better.

A Virginia mother wants a 100 percent awareness and follow through by her almost 7-year-old boy to overcome his encopresis in all situations.

My son is nearly 7. He has encopresis and diurnal enuresis. Everything (poo and pee) is fine if we prompt and remind him to go to the toilet (he used to refuse, but no more). However, when we back off, accidents start happening again. It is sometimes obvious that he needs to go to the bathroom (pee and poo ‘dance’), but he will never go by his own initiative. He wears a watch that reminds him to go and he is able to follow the alarms at school. At home, he ‘does not hear the watch,’ he says.

So the issue for me is responsibility. I am unable to tell how much of an issue the accidents are for him but, he does not take ownership of the problem. Am I expecting too much?

I am happy to try this program, but would like to understand how it will help him to just go to the bathroom by his own initiative and not trying to hold anymore. He is a very normal kid otherwise.


Dr. Collins’ Answer:

Engendering responsibility in your son is a good cause and it is wise to continue to pursue it. However, it looks like your son needs some help that mere urgings will not provide. Your prompts are good and clearly you wish for him to take over his voiding responsibilities. The danger is that if he continues to relapse, especially to the point of having both bowel and bladder accidents, this can lead to a more permanent chronic condition beyond his control. The combination of both bladder and bowel accidents indicates enlargement and a weakening of both organs, especially the colon.

When they both fill and overly stretch, they infringe on one another in that limited lower abdominal space, which creates recognition confusion and instability, promoting both kinds of accidents. The school may also enter into your son’s condition in a negative way because of natural inhibitions about using a public lavatory and teachers’ general tendencies to have children “hold” until the next scheduling break.

My Soiling Solutions® (SS) protocol works by reinforcing the mechanism of urge recognition and a successful voiding response. Often the muscles abetting the voiding reflex, especially for the bowel, become confused. Daily, adequate, and reliable voiding helps to establish a reliable sit and release response, but it must be done properly in a sequence involving free sits, a mild suppository prompt, and, if necessary, a powerful enema prompt. The mildest and weakest prompt is the child’s own internal cues, which my program assures will become adequate over repeated daily evacuations so that the child is on his own.

Why does the Clean Kid Manual cost more than the material cost alone?

I have had two parents write in recently with concerns that I am overcharging for my manuals because those charges surely exceed the material costs of the manuals alone!

One is a mother of a 12-year-old daughter, and the other is a mother of a 5-year-old daughter. Both have been strong, responsible advocates for their children by personal research and obtaining medical advice in the course of trying to solve the problem of chronic holding, which causes many cases of chronic encopresis.

My Soiling Solutions® (SS) protocol which is detailed with theory and step-by-step instructions is set forth in the Clean Kid Manual© (CKM) which sells for $109 (+$10 for postage and handling = $119) in a hardbound edition or $99 in the digital version. Both combined are available at $149 (postage included). The bound copies have a money back warranty if not satisfied with a return within 120 days of purchase.

I will avoid detailing what I regard as the essential successful distinguishing properties of the SS protocol and just address the issue of costs for this Q&A. The unique features of the SS protocol are amply set forth on the website.

Dr. Collins’ Answer:

First, these parents appear to have no understanding or appreciation of intellectual property and the investment and time spent in the authorship, revisions, and necessary promotion of the Clean Kid Manual.

Second, the reliance on suppositories and enemas presents a considerable barrier to purchase because of parental and children’s fears, which means that the Clean Kid Manual will likely never be a high-volume seller, which would allow selling at a lower price for the same level of return or profit.

Third, the Clean Kid Manual is necessarily associated with access to online forums that I moderate, requiring an ongoing commitment of time and research. Some outstanding professional leaders contribute their pro-bono time to my forums because of our collaboration.

Fourth, I have a personal mission to advocate for the proper treatment of encopresis and reaching out to physicians to train and educate them about the Soiling Solutions® (SS) protocol and more effective approaches. This requires more travel and collaboration with outstanding leaders in the field. This requires my money, time, and effort.

Fifth, I do provide free exam copies to physicians who request one Clean Kid Manual for each practice or clinic to share to implement the Soiling Solutions approach with proper knowledge.

Sixth, my manual also has two chapters on daytime and nighttime bladder incontinence, because these problems often go hand in hand with encopresis and I was instrumental in validating the bedwetting alarm, which is now recognized as the leading, most effective treatment for bedwetting, even over medication.

Seventh, for comparisons of costs go to www.doctordaum.com and www.ucanpooptoo.com, the latter of which is a commercial site that rose out of research at the University of Virginia Medical School. Plus, the cost of my program is much lower when you consider your current out of pocket costs such as: copays, travel, diapers, etc. without any success!

Finally, I am so sorry that this problem exists. When I hear complaints like these two mothers presented about the cost of my manuals and program, I can understand that they are mostly speaking out of frustration and a sense of the terrible isolation that this condition presents.

Soiling Solutions Parent Responses:

Postby kblank

I remember being hesitant about the cost, mainly because I just didn’t know that much about it and whether or not it would be worth it.

But certainly anyone who has the level of expertise that Dr. Collins has on this subject can expect to be compensated for their services, the same as any other service provider, be it physician, therapist, counselor, etc. It is what he does for a living, and I am quite sure that even at this price, he is practically giving away all his expertise, given the amount of time he has spent and is spending trying to help these kids and their parents.

We spent about 10 minutes with a pediatric gastroenterologist who charged us $250 for the privilege and was no help at all – not one bit!

For us, the CKM was worth 10 times its weight in gold! Thank you Dr. C!

Postby Phoebsmom

Agreed! The Internet is a scary place, but after waiting two months and still no appointments available to see the specialists, I was ready to take my daughter’s health into my own hands! After calculating in the costs for co-pays, gas, time off work, and prescriptions, the cost of the manual is equivalent to 2 maybe 3 doctor visits. We are already having more success in two weeks then with her doctor over the last two years. It’s all perspective. I get it’s scary with all kinds of people selling all kinds of things on the Internet. That’s why I searched for independent reviews and on other medical sites before purchasing the manual and to be honest, I could not find one bad thing about this site or Dr. C’s protocol! To me, that says a lot as people are always ready to post the negative! Please think about all of those considerations, as we are two weeks in and accident free.

Postby Pip

Mum from down under land (Australia). I agree with the cost, although I haven’t started yet. $100+ was worth it. I have spent thousands over the years on consultations and still have an 8-year-old with a problem and now a 4-year-old too. I bought the manual, got personal advice from Dr C. and support from other Mums. Can’t put a price on that. Thanks for setting up the forum – it has given me hope from a miserable and very smelly place.

Postby bayougrannie

I agree – it has to be out of frustration that these moms are projecting towards the cost of the manual. Intellectual property is not understood in this society anymore. Everything for free. As Dr. C has pointed out, research and time devoted does cost money.

The Soiling Solutions® program has afforded my grandson the ability to attend pre-K (Big Boy school). He is so proud of himself. There is not enough money in the world to see his self-confidence soar, watch his growth take off and reaching out to new foods.

Thanks Dr C.

Postby mustbepatient

I was also hesitant about the cost.

Here in England, everything related to children’s health is free, so we don’t have the comparison of the costs of doctors visits or buying medication. And I confess, I did look on it as ‘buying a book’ as you might do on Amazon – but it was a lot more expensive than your average paperback.

The thing that made me hesitate the most was the Internet factor. The Internet is full of freaks looking to prey on stupid people. Desperation makes you want to believe everything you read, but you really don’t want to be sending money to some random quack and then kicking yourself and feeling even more helpless than you did before.

Fortunately, before this forum went live, Dr. C was still running his web based question and answer service, so I was able to email him. He took the time to write back and what he said convinced me enough to take a chance on being taken for a fool. And I’m incredibly glad I did. Everything that’s written in the manual makes sense. The community help on giving enemas was a lifeline – both in practical terms and in providing a setting where giving an enema wasn’t a big a deal which in turn gave me quite a confidence boost.

It’s been well worth it. I’d buy it again in a heartbeat.

Postby Mrspee123

Worth every penny! Yes there are unscrupulous people out there on the Internet, selling quack remedies but most if you Google and research them for a bit, they come up as as a scam with bad reviews.

I hope he does earn something out of his efforts because he deserves it. I have spent thousands of hours and money trying to cure my lovely son of this debilitating disease all with no joy whatsoever. With Dr. Collins’ program, we are in control of it now and not the other way around.

Thank you very much for taking the time and commitment to research these diseases. We love you, you are a diamond.