8 year old child that does not have ADHD or any biological dysfunction states the sensation to defecate is not felt. Additionally, constipation does not exist. Child was traumatized from age 5-6 years of age.
Sexual trauma? More details regarding actual trauma and other neurodevelopmental events would be needed in order to begin to develop potential explanations. Do you know other info? Thanks.
Ken, sexual abuse confirmed, penetration unknown. Child suffered a variety of physical abuse including being pounded on the top of head and kicked from behind (while on all fours) a distance of 10'-15'. TBI is highly probable. Abuse occurred 1-1/2 - 2 years ago, and physician did not examine child properly. Child does not exhibit fecal incontinence during daytime hours, only in the evenings.
Khaled Saad, thank you for the detailed information. Like you, I have read studies like those you mentioned. Are you familiar with any treatments, therapies, or medications evidenced to alleviate fecal incontinence in children? Thank you!
We need to know that he has had a respectful thorough medical workup to determine what physical injury could have occurred from physical injury due to penetration, being kicked from behind on all fours(spinal injury? other injury to the pelvic region, etc.). What neurobehavioral or neuropsychological symptoms of TBI are evident? And keep in mind there is research evidence for adults that trauma victims(PTSD) report symptoms very similar to mTBI survivors. I would want to be quite sure we rule out physical medical causes for this problem before we explore psychological behavioral explanations like some sort of regressive defensive response. Also basic issues like no shaming, no punishment, be matter of fact concerned and helpful apply as far as interaction with this child go. Is he distressed that this is happening? Does he want it to stop?
One very straightforward approach is to wake him at regular intervals like every 2 hrs. to attempt to have a bowel movement in the toilet. You would do this with his agreement assuming he wants this problem to end. You do it as suggested above - kind, caring, matter of fact manner with encouragement and no threats or punishment.
Tough situation you are describing with multiple factors potentially in play which means intervention may be multi pronged and incremental approach.
Khaled Saad,
Thank you for your recommendations! I will advocate for this patient to seek professional help in learning exercises and consider other therapies to restore muscle strength. This is exactly what I was searching for. Thanks much!
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