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"Each of us must come to care about everyone else's children. We must recognize that the well being of our own children is intimately linked to the well being of all other people's children. After all, when one of our children needs life-saving surgery, someone else's child will perform it. When one of our children is harmed by violence, someone else's child will commit it. The good life for our own children can be secured only if it is also secured for all other people's children. But to work for the well being of all children is not just a practical matter-- it is also right!" - Lilian G. Katz, Phd.

Thursday, September 18, 2008

Hygeine

In 2002 Konal was diagnosed with Encopresis.  
Encopresis, from the Greek κοπρος (kopros, dung) is involuntary "fecal soiling" in children who have usually already been toilet trained. Children with encopresis often leak stool into their underwear.
There are many factors involved with this, and the Wikipedia article I linked to above is excellent, but I want to talk about the human factor with this.

At 14 years old, he is continuing to have fecal accidents.  He has them at school and at home, and frequently, others can tell he has had them.  He will refuse to acknowledge to accident, and because it has contacted the skin so long, he develops rashes and lesions that are extremely painful.

This becomes a feedback loop.  He refuses to change because it hurts, and it starts to hurt more because he refuses to change.  The treatment is behaviorally based, but the condition has become medical.  From the article:
The hardened stool continues to build up and stretches the colon or rectum to the point where the normal sensations associated with impending bowel movements do not occur. Eventually, softer stool leaks around the blockage and cannot be withheld by the anus, resulting in soiling. The child typically has no control over these leakage accidents, and may not be able to feel that they have occurred or are about to occur due to the loss of sensation in the rectum.
His gastroenterologist does regular Xrays of his colon, and it continues to be stretched out.  He has very little control over his bowel function.

And so we have routines in place.  We have code words, such as "go sit".  And I have laundry.  So. Much. Laundry.  I should buy stock in Febreeze and laundry soap.  It would do better than the banking stocks my mother has.  The issue becomes how do you respect a teenager's dignity while getting him to own the issue and become responsible for his own hygeine?

Writing about it here does not help the dignity issue at all, I am sure.  Some day he is going to read all I write about him and will either hate me or see things momentarily from my perspective.  We continue to work with him on it, but at this point, I am just tired of poop!