A reader writes:  My son is eleven years old and he still sometimes (like 3 times a week) soils his underwear a little. I talked to my son about it and he can’t really seem to tell me if it happens before or after he poops.

            We never shame or punish him for it. Each week, when I separate the laundry to be washed, we pull out the problem underwear and he hand washes them before they go into the wash. All this is done without anger on his part or mine.  We just make it “the way it is” because my partner and I want him to take responsibility for himself.

            Well, this has been going on for about 3 – 4 years now and the problem is not lessening. The other thing we do to try and help him correct this problem is to have him sit in the bathroom for 10 minutes after dinner and after lunch on the days that he is home. This actually has helped to lessen the problem but it still happens sometimes.

            I am not sure if this is an ADHD problem. He has been diagnosed and is on meds for ADHD and the meds have greatly improved his life and focus.  I think that this might be an ADHD problem because I suspect it has to do with either l) not noticing cues from his body when it is time for him to use the bathroom or 2) not being patient enough (he is always in a hurry to get to the next activity) to clean himself after he does go to the bathroom.  Please advise.

 
I chose this letter to respond to because it demonstrates so many important principles for raising a child to be a responsible, independent, and competent adult. This boy is learning to take care of things because they need to be taken care of, not because he fears punishment.

Punishment rarely teaches anyone anything but to fear the punisher.  People who are punished may behave as the punisher wishes, but it doesn’t mean that they have internalized the lesson or that they see the sense in it. This Mom isn’t responding to her son’s behavior by hitting, screaming, shaming, issuing “time outs”, or making threats.  Instead, she is calmly setting a consequence (washing out his underwear) that helps him deal with the problem (soiling).  Dealing may be inconvenient but it makes sense.  He is learning to take care of himself.  Because she is taking a matter-of-fact position that people who soil need to do their wash, the problem doesn’t get entangled in a contest of wills, nor does it become a vehicle for defiance.

Good consequences:

This Mom is doing a great job. So why is there still a problem?

She already has two good guesses: Often kids with ADHD do take longer to learn body cues than other children. And these same kids are often in too much of a hurry to get on to the next activity to take care with finishing whatever they are currently doing.  Asking him to sit for 10 minutes seems to help, perhaps lending support for both guesses. Sitting helps him focus on what his body is doing and slows down the whole bathrooming process.

But I also have another guess that has more to do with anatomy. The sphincter muscles of the anus do not slam closed like a door, cutting off the feces like a guillotine.  Rather they close with a twist.  This is why feces have a little point on one end. (Sorry folks. Parenting gets real basic sometimes.)  Sometimes these muscles aren’t quite as developed as they should be. When this is the case, a little fecal material may remain on the anus after a bowel movement or (if he has hurried his movement and not really quite finished) it may leak out - which then stains the underwear.  As far as I know, there isn’t any medical intervention for this.  The solution is to accept that this really is “just the way it is” and to take the extra time for self cleaning.  As this boy is 11 years old, he can certainly understand that this is a minor problem that he has already been managing competently for a number of years and that he may continue to have to manage it for some time. It’s an inconvenience but it’s not a tragedy and it certainly isn’t something that will change because somebody gets mad about it.

My suggestion to this mother is that she share this information with her son and then remove herself as much as possible from the situation. Her son is now 11. He knows that he does better when he takes his time and he knows how to take care of his underwear.  She can validate any feelings he has that this is a “bummer” (humor almost always helps) and help him accept that this is a sometimes unpleasant but still manageable part of his life.

By the way, I suggest the same approach for bedwetting.   There is no sense in yelling, spanking, lecturing, or humiliating.  After an adult does all these things, the bed is still wet and the child is terrified and shamed.  Much better to simply (and calmly) help the child learn how to strip the sheets off the bed and put them into the washing machine. (A child over age 6 can usually learn to add the soap and turn the dials too.)  As the child gets old enough, he or she can also be asked to put the clean sheets back on the bed.

Most kids who wet aren’t doing it on purpose.  Either their bladders aren’t yet large enough to hold all the urine that is produced during their sleep or their body cues aren’t developed enough to wake them up from a sound sleep when they need to void. It often helps to carry such a child to the toilet just before the adults go to bed so that he or she can void part way through the night.

Dr. Marie advises:

For bedwetting and soiling. . .