Soiling Solutions

These general results are admittedly impressionistic and based on 6 months follow-ups after initial purchase dates of the Clean Kid Manual and my consultations. Please continue on to the next section below and see actual parents' comments to the exclusive Clean Kid Manual forum which is offered on its purchase.

Here is what you can expect over the course of this program. One third can expect an almost miracle cure with children only requiring 3-7 applications of a suppository or enema before going to daily BM’s sometimes spontaneously, but most often in response to the standard sitting protocol described in the manual. It is almost as if they have been waiting for a bottom line and definitive program. Parents should expect that, even with a miracle cure, that their child will still require the “slow down” time and the carefully designed sitting schedule for a month or two at the very least. The next third will make satisfactory process and follow a more typical learning curve over the course of 1 or 2 months going first to the enema, thence to the glycerin suppository, and, finally, to ones own natural gastrocolic urges as sufficient. The last third may go longer and might possibly get “hung up” with the enema or the suppository being repeatedly required. Some may ultimately fail. I address the hang-ups and failures in the “Troubleshooting” section of this manual.

I cannot reliably estimate the number of relapses that may occur with this problem because of inadequate returns on follow up requests. I suspect a figure of around 50 percent. Relapses are disappointing, but THEY ARE NOT FAILURES! A relapse says first of all that our protocol succeeded and actually proves it will work again, probably even faster. Why relapses occur is complex, but easily understood. The “training” may have been terminated too early before the response was thoroughly conditioned or “over-learned” or the enlarged colon has not recovered sufficiently. Some children have very sensitive or wired GI tracts that respond to changes in routine—e.g., going camping with strange bathrooms or lots of excitement; getting out of school for the summer with lots of unstructured time; returning to school in the fall; adding extracurricular activities; divorce; family upset over some event, etc., etc. You may even observe difficulties in voiding regularly for yourself when you go on vacation or certain circumstances. Sympathize with your child and return to our treatment approach whenever it is needed.

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From: Jill
To: soilingsolutions@xxxxxxxxxx
Sent: Sept. 29, 2009
Subject: A Miracle Cure for an 11 y/o.

Dear Dr. Collins,

I am thrilled to report that our son Nxxx, who is nearly 11 years old, is now among your group of 1/3 of the cases who after following your program have a "miracle" cure. It is early to proclaim victory, but, so far so good for the last week and a half.

We found you on the web about 3 years ago and ordered your Clean Kid Manual III. Unfortunately, we did not follow the program seriously and therefore had no recovery.

Our son was terrified of receiving an enema. I kept hoping that my husband who is NOT consistently home (I am a stay-at-home mom) would be the one to "handle" this issue. Well, it never happened.

Our son's bar mitzvah is in two more years and I have felt so guilty and ashamed of his encopresis. To be totally honest with you, it wasn't until I was in a 12-step program for sugar addiction/complusive overeating for the past year that I felt strong enough and had enough discipline to tackle this problem. It went beautifully once I became determined to follow your protocal exactly, in a matter-of-fact manner, and with a positive attitude. I also bribed Nxxx with a new Lego set if he would take the initial enema. I actually showed him other people's bm's so he could see the diameter of them. I showed him how much narrower the diameter of the enema applicator is so he would realize that the anus is meant to open wide enough to accept it. Since that first enema, he has been producing sizable bm's on his own; no stains/tracks in his underwear; no bad smells. It is truly a miracle. He does not necessarily make one every day; even two, maybe three days can pass and then he makes on his own. He is, of course, very proud of himself and now for practically the first time he can have sleep-overs. (Please don't expect this kind of result, it is rare, but it does happen, keep reading and you will see more typcial responses. DrC.)

We are most grateful to you for your research and commitment to helping children with encopresis. We are among the lucky ones who "discovered" you on the web. I realize that we need to be diligent for the next year about having Nxxx sit on the toilet the same time every day. Perhaps in a year, we will be able to have a meal of "thanksgiving" to celebrate his recovery, G-d willing!!

Also, the picture of your cat going on the loo truly encourage and convinced me that your approach would work, believe it or not. And I HATE cats :)

Wishing you all the best and continued success in all your endeavors!

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October 30. 2009
A Typical Response by an SS Veteran with a New Mom on the SS Parents' Forum Who Wants to Start the Program, But Is Intimidated by Her Child's Intense Resistance. DrC.

Hi D,
I feel for you. We started the Clean Kid Protocol last Wednesday evening with our 5 year old daughter. Since we have started, she has not had one accident or soiling. I started telling her about the program a few days before we actually starting the sitting protocol and explained to her that Dr. Collins had helped alot of children just like her that have problems pooping and that it will all be worth it. I told her we are going to do this everyday and sometimes it will be uncomfortable, but that Mommy and Daddy love you and want the best for you, etc. My daughter is a very smart, yet strong willed child! We have had to do the suppositories just about every evening since we started, and even a few evenings had to go to the enema stage. She absolutely hated the enema, but we only used an enema once, and since have substituted the enema for a glycerin liquid suppository which is just as effective and more comfortable than an enema. But the last few nights she has only needed a suppository after the 2nd sit, and has gone to poo within 5 to 10 minutes of receiving the suppository. We keep a monthly chart with stickers on the bathroom wall and each time she poos she gets a sticker. Tonight she was a little resistant after the 2nd sit and said oh I don't want the suppository, and I just held firm and said L. you know this is working and you haven't had any accidents since we started the program, and then I said go lay on the bed, and it will be o.k. I always use a little K Y jelly before inserting the suppository and have her hold a stuffed animal or toy and talk about something fun or pleasant when I am inserting the suppository.

I want to encourage you to stick with it. I know how frustrating it all can be. My daughter has had soiling/poo problems for 2 years now, but has not had a poo accident or soiling since starting the SS protocol and I really believe that Dr. Collins protocol works and the standard "top down" approach that so many peds. and GI docs use like Miralax don't work in the long run....as my daughter has been on Miralax off and on for 2 years. She is still taking the Miralax, but we have started tapering it down to every other day, instead of daily.

Stick with it. Hang in there, and be firm and tell your son this program is to help him and that it has helped many others like him.

Many good wishes to you and your son. Come here for support. We are all here for you to vent, and to offer our support. We know it is not an easy fix, but that in the long run, it will all be worth it, and one day we can look back on this, and know that we stood firm because we want the best for our kids!

K.

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To: soilingsolutions@xxxxxxxxxxxxxx
Sent: Oct. 30. 2009

Another veteran responds. The parents really bond with one another with these shared trials and tribulations. DrC.

Hello D.,
Congrats to you for reading the manual and getting ready to start the program. My son was also 6 when we started. He turned 8 in August and has been accident free for over a year now. So many things I want to tell you, but I think the most important is, you're not alone and this forum is such a great place for parents to get the support and answers they need to help their children. I'm going to try and keep this very brief, althoug I feel I could write a book.

1) My son was exactly the same as yours. Same anger about the whole process. Same denial, same everything. I guess I would be too, if I couldn't control my body and got tired of getting in trouble. So you're not alone with how your son is acting.

2) Even though I know you have your doubts about this programs approach, you have nothing to loose. I promise you won't damage your child with suppositories or enemas if you follow the protocol correctly. I would suggest the liquid glycerin suppositories-they seem to be less intimidating than the full on enemas. But to get your son cleaned out which is a must, you probably will have to use the enemas which brings me to my next point.

3) I hope your husband or partner is on board with the program, because it makes it so much easier. It sounds cruel, but when we first started the program, my husband had to help me hold my son down to get the enema in. He hated it, he cried; no he screamed, but I didn't waiver. It took about two full weeks of enemas almost every night and believe it or not after about a week of my son seeing that this was the program and we performed it without any emotion or anger, he knew that after the 4th sit what was going to happen and he was accepting. But after we were finished with the enema, I would hold my son and tell him how much I loved him and I realized that it was uncomfortable, but that dad and I were trying to help him get better. I think after awhile of my son seeing that he no longer had accidents in his pants, he realized that what we were doing was working. Believe me though the enemas and suppositories didn't stop after two weeks, but it was about that long that I saw my son realize that he seemed to be getting better.

4) We didn't do a lot of talking about the program, because believe me he had heard about all these different programs that were suppose to make him better before. We simply said we are going to try a new program to help with your problem. This is the chart, this is how it's going to work. Dad and I are both on the same page. It has helped lots of children and we think this will help you. I would ask my son what questions he had and answer them as best I could. But I really did try to position this as "we are a team" program.

5) The last point, please give this program enough time to work and stick to it. My son suffered from encopresis for over 6 years. We had visited every specialist, G.I. doc, naturalist, psychiatrist, you name it Dr., with no results except more Miralax and Ex-Lax. Which as many parents on this forum know, I feel made my son's problem worse. (I will say that my son takes no medication now to help him go to the bathroom! We would never be medication free it weren't for this program). My son now goes each morning after breakfast. Oh, that's another thing, try to find the same time each day to do the program. We started at night, but we ended up changing to the morning because it worked better for us, especially after we got through the hard first part. But I think being consistent in the time of day helps the child know what to expect. The morning worked better for us, because I knew I could send him to school and not worry about having an unexpected present in his pants when he got home from school

So D., don't get pulled into a power struggle with your son. You are in charge and are truly trying to help him. Most likely, he will try every trick in the book, like my son did, to make you not follow through with the program. Don't get sucked in. Those tears can be powerful, but I promise if you stay strong, you will do your son more favors than by not performing the program.

Use this group for all the support you need, I did. We're all in this together!
Good luck D.
A.

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To: soilingsolutions@xxxxxxxxxxxxxxx
Sent: October 31, 2009
Another veteran responds to the same mother as immediately above who describes a very tough, strong-willed, child. See how much the mothers share with one another and how insightful and empathic they are. The SS Program is not easy and these mothers become comrades through their shared experiences. DrC.

Diane,
When anything becomes a power struggle you have to get yourself into a position that you win. Of course you know this, but it's hard with a strong willed child. My 9 year old was also very resistant when we started SS (he's totally on board now) and is still strong willed. I suggest you give everything as a choice. Let him choose between to options, both of which you consider appropriate, healthy and right.

For example, do you want to clean up your pants now, or later (if later he must stay in bathroom until he will and you may need to lock him in)? Do you want to put in the suppository yourself or shall I? Do you want to do the enema now or later (again potty jail if later). Do you want to cry in here by yourself or do you want to tell me calmly your concern and I'll stay? Do you want a blue or yellow gatoraide after you poo?

If you son hates enemas and remembers them from 3 then you're in good shape. It is much worse if they like enemas and suppositories. Believe me there are kids who say to parents, just do the suppositories instead of wanting to do it on their own. You want your child to hate enemas and suppositories! Hopefully when you star the protocol they have some terrible experiences with having to use them. Then you can say on sits one and two, now try to let it out (relaxation techniques work well here) so we won't have to go to the supp and enm.

Winning, or rather not letting your kid win is very important in parenting in general and not just SS. Perhaps you could consider it a blessing that you are having this conflict about sits and SS so that you and your son learn to work out this power struggle now at age 6. Learning how to give him safe choices and his learning to accept your authority will serve you well when you're discussing if he can borrow the car or spend the night with friends or go to high school parties.

I don't mean that I've enjoyed this struggle with my son over SS. He and I both hated it, especially during the first month!!! But now I can see that I learned lots of important parenting skills (giving choices, not allowing him to get away with things, learning to solve problems with him by brain storming, leaning when to talk to him about things we're both angry about.....). And I learned a lot of it from Dr. Collins and the parents on this support group. We're not glad our kids are enco. But I for one am glad that this awful problem has taught me and my son a couple things about ourselves and parenting in addition to fixing his poo problem.

E.

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Date: Nov 16, 2009

Here is another Dad who reports on a particularly difficult course of treatment for a considerable period of time. He kept wonderful records.

Hi everyone,
Just another happy milestone to report. My son (7) started the program 22 months ago (50 enemas in first 10 weeks!), has had some ups and downs but has been doing really well lately - 10 weeks since last suppository. He's been on an every other day and even every 3rd day protocol. Today he said sometimes his day at school was not the best because he realized it was his "sit" day. So we asked if he'd like to not have to do "sits" anymore (but just tell us when he pooped) and he said yes and we agreed.

It's possible that knowing he has a "sit" coming encourages him to go when he does, but we're taking this leap. The next step would be actually not recording the size and quality of his every poop someday. Can you ever imagine that?
-Steve

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Date: Nov 16, 2009.

Here is a mom with a short course of treatment with very promising early results. Results vary widely on length of treatment, relapses, etc., but they all make very good progress and no one returns to the "maintenance therapy" approaches with oral softeners, Miralax, etc. The children adapt well to the program and they all accept going back to it after they have experienced success and no dirty clothes and dirty looks. DrC.

Hi, we have just started the SS program more than 3 years of FRUSTRATION!!
We were not getting the right answers for our problem. Our pediatrician at the time when he was probably about 11 months told told us don't worry about what comes out, worry about what goes in. (We know have a new doctor!) We were still having problems getting him to go. The longest he had held it for was 11 days, but it was nothing for him to go 7 days without going. He was put on Colace about a year and a half ago and that did work for a while until his body became immune to it and he started holding again. When he would finally release his BM it was always in his underwear and NEVER in the toilet. I don't know if he had issues with the toilet but he would never want to go there. This September he started school and he had a few accidents there so we had meeting with the school trying to explain what this problem is and there were completely unaware that this existed, but fortunately were willing to work with us. My sister found soiling solutions web site and thank goodness she did.
We have been doing the program since October 28... we had to use the enema the first five days, on the eighth day he went on the second sit without anything (no suppository) and yesterday he went on his first sit. He is also going on the toilet!
We were at our wits end....we didn't know what we were going to do and how we were going to be able to help him but this book is the answer to probably sooooooo many children's problem. We are beside ourselves. He had so much more energy (didn't think that was possible!) I cannot say enought about this program and will recommend this book to anyone who has the same problems. We will continously monitor him but I think he is going to be great.
Thank you Dr. Collins
P.

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Date: Nov 16, 2009

Notice that a lot of this traffic all occured on the same day! Here is a mom who reported back to her PedGI doc about her SS experience with records and all. Note how suspicious the doc remained. Many think our parents just have "fluke" results. Their "maintenance therapy" in my opinion is just that, "maintain the encopresis". They don't understand retraining the urge-toilet-voiding response sequence and overcoming the holding reflex. This despite their all accepting that children are "trained" for continence earlier in the course of normal development!!! Dah-h-h-h! DrC.

Hello everyone,

I took L. to the GI Doc. for a 3 month follow up visit. We had only seen her once in August and she recommended clean out with Miralax over 4 days which we did, and then sits after each meal, and miralax daily. I took the Clean Kid Manual and the SS treatment hour sheet with me, plus calendars of the last 3 months of sits, etc. She asked initially how we've been doing, and I said she is doing great and we started a new sitting protocol/program Oct. 21 and since then she hasn't had hardly any accidents....and I showed her the manual and asked if she had ever heard about it, and she nodded her head, yes, she had. And her response, is well if its working for her that is great.....and I said well, it is definitely better than just giving the miralax by itself.....and she said, well alot of kids have problems with the suppositories, etc......and I said, well she wasn't too thrilled with them, but she is doing SO much better, and is re-learning the colo-rectal urge to go which she wasn't doing with just the Miralax alone......She said well, it sounds like it is working for her, but I wouldn't cut out the Miralax entirely......and I said I have cut her back to 1/2 capful a day, and that seems to be working o.k. with the SS......and I told her that I would be adding the fruiteze and evidentially I would try and taper off the miralax.......anyway, the point is she said, well we are here if you need us, but I don't think we need to schedule anymore followups, it seems you are on the right track!!!!!!!!!!! Gee, Doc.....u think so, huh????? I could have saved myself a visit! But at least I got to advocate for SS and she indeed could see by the charting/calendars that it was working!

Thanks again, Dr. Collins for caring about kids with Encopresis and for your time/effort with the Clean Kid Manual, SS protocol. Without you we all would still be struggling with the medical Doctors top down method of miralax, miralax, and more accidents/dirty panties, etc....... Thanks a million for caring about our kids and us parents, too......Your program is a God send!

Oh, and L. said she pooped in the toilet today at schoool and they were at recess on the playground and she felt the urge to go (Thank God!), and her teacher let her go to the bathroom! Ya hoo!!!!!!!!!!!!!!!!!!!!!!! She said it wasn't very big, so we continued the SS sitting protocol tonight, and she did produce a small amount on her own, but needed the suppository to get the 1/2 cup! Just had to share!

K.

Next, we have a much wiser Mom who is now signing off of the list and moving on. There are about 300 parents on this list as i make this note. DrC.

To all SS families and Dr. C:
This is my last post before unsubscribing, but wanting to share 1 more time before I did. I just want to thank Dr. C for saving my family. So many people in the world take such a thing as going to the bathroom and even potty training as something so simple and cut/dry. But as we all know, it's something that when it doesn't work that way, it can just damage relationships, cause such frustration and poor behavior that leads to so many other problems... and just down right rule your lives and ruin your world somedays. It has changed so many things for us. My son started SS when he was 4 and had many accidents a day and we had tried everything, been to a GI and everything. And it did take us probably a good year or more to really get down going to the bathroom by himself w/ no accidents and no prompting. And even now, occasionally he'll get himself off track and we have to kind of start over, but once we do, it never takes long to get back on track. The tools SS gave us was the most beneficial. My heart, thoughts and prayers go out to all families who experience these issues. I hope everyone that does this program makes it their mission to educate those who don't "get it" and who choose to deny that their kids have a problem or that it needs more than just miralax to fix it so that kids can be treated instead of punished and shamed for something we know they can truly not help on their own. And so that kids no longer have to go through school having this humiliating problem hanging over their heads causing poor self-esteem that may last a lifetime. I can't imagine how things would have gone for us if we had NOT found this program, and don't want to either. Again, thanks Dr C so much for dedicating yourself to all these families and kids and to the topic that most people don't even think twice about. I may get on again in the future just to check in or if we do backslide. But best of luck to you all!

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Date: November 23, 2009

This is from a mother in Singapore who found me online and the SS parents' forum inputs absolutely critical to making a breakthrough with her son. It also reveals the heroism of SS parents in taking tough and necessary actions for their children. This also reveals that my program is not for the faint-hearted, though this mom had an unusually resistant (and scared to poop) child when he had urges and a BM was imminent. You can see how dramatic the changes can be. You can hardly imagine this child responding other than for my SS protocol. DrC.

I have a 3 1/2yr old son who has been withholding for a yr. And he would be stiff as a plank when we tried to put him on the toilet , kicking a screaming ( you can read the post i sent on the website about 3days ago- Question on suppository and how to get my child to sit).
Anyways, I started the SS programme yesterday. But for 3days before that, we tried to entice him to sit on the toilet, with art and craft and books. Just as a prep (our behavioral Psychologist wanted us to make the toilet a happy place for him and to get him to sit 2-4 times a day for 20mins each. I think she will be horrified that we forced sat him with the SS programme ). And it worked, as he was happy to sit and paint for 10mins on the toilet bowl BUT ONLY when he had no urge and with pants and nappy on. Once he had the urge, it was back to standing and cringing with the legs behind him again.
On the 3rd day however, I manage to get him to sit without pants.
So on the 4th day, we started the programme.
It was a traumatic fight for a good 45mins. For the first 2 sits, both my husband and I pinned him down. And in between sits, he layed on the floor, kicking the door and screaming ,' I want my nappy". During the process, I had many doubts and thought that I could have taken a step back and slapped myself in the face, that my son would be totally put off the toilet once and for all.But Dr Collins is right, you have to be the boss and let the child know that he /she has to sit and there was no other way around it. The moment, you relent, the ball is in his court (as I have relented many times in the past. Because I was afraid the more i pinned him to the toilet the more he would withhold)
I told him, the doc said he needed to sit , if he kept pooping in nappy, his rash will keep coming back and he would get sick. He would scream - Don't listen to the doctor. Inserting the suppository and enema was with much diffculty of cos.
But he calmed down during the 4th sit. It's like breaking a horse. He finally resigned to the fact that , like it or not, this was how things are done now.
I also kept reiterating to him that he is 3.5 now. That nappies are only for bedtimes ( and he has been repeating that to me today!!!)
The process took about 1hour 30mins, he pooped 30mins after enema.
So today is Day 2. It's like he is a different child! He went to sit without kicking a fuss. The suppository, there was a bit of crying ( but nothing like before). The enema, was tougher as he kept crying it hurt and stiffened to a plank.
The process took 1hour 15mins today. He pooped 2x, 10mins after the enema.
And he seems relaxed at the toilet bowl now. And he agreed with me - It is much cleaner if we poop on the toilet, the poop doesn't get stuck on his butt.
Before, I had a child who wouldn;t hear of sitting on the toilet. And today, it's like he has grown up overnight.
It is still early days as i think he has to relearn how to push the poop out instead of holding it. And he is still withholding, cos i caught him after lunch trying to hunch over. But, for once, in the whole year, I feel like there is light at the end of the tunnel.
It is amazing to me that he is actually sitting when he is pooping, instead of screaming and sliding off the toilet.
I really do hope that in a couple of mths, my son will be able to sort himself out.
Thanks Dr Collins for writing such an informative manual. And for making us take charge of the issue.

Best regards, C.

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S from France on 12/15/2007

I also want to echo what has been written here. I was at my wit's end when I found SS and it changed our lives.A., who is now 9, hasn't had more than 2 or 3 accidents since we started the program in April and all of those right at the beginning. I consider him totally cured and it is ALL thanks to the SS program.
I am staying on the list in order to give out helpful advice when I can... if any questions coincide with our experiences.
Thank you Dr Collins! You are our hero!

Orders for the manual are now coming in from around the world. This mother like many stay around for a while to help the newbies. The internet has been a fantastic communications tool and makes my program more attainable for all and relatively inexpensive even without insurance. DrC.

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Received on 12/15/2007

We had our first big milestone yesterday! My 7 yo daughter is on the program. We've been doing it now for almost 2 weeks. She hasn't had an accident in 9 days, but up until yesterday she has needed at least the suppository to go and usually we went all the way to the enema. Yesterday she went during the 2nd sit, all on her own!!! Woohoo!!! I was definitely doing the happy dance! And I am so proud of her in how she has handled all of this. She tends to be very fearful of anything even remotely invasive, and yet she hasn't fought me on this even once. Sometimes she needs a minute or two to "get ready", but she has been compliant from the beginning. Today we are going out to buy some new pretty panties, and this weekend we are going to go do something to celebrate...just the two of us (with 6 kids, that is a real treat!).

Thanks, Dr. C!! And thanks to all of you who stay even when you are "cured" to help those of us just getting started. It helps so much!

This exclusive CKM parents forum can be quite active. If only pediatricians would look at these spontaneous exchanges at the archives! They could not help but be persuaded about the power of the SS program. If your pediatrician or gastro doc is interested I can give them access to the archives--they probably cannot afford the time to be on the actual forum because the traffic can get to be quite heavy between the parents. DrC.

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Received on 12/21/2007.
Subject: Your manual is terrific!
Hello Dr. Collins!

I'm not sure if you remember me but I called you over a month ago to order your manual for an 8 year old client I am seeing with encopresis. I'm a LCSW in xxxxx and had been seeing my client for almost 2 months before calling you. I just wanted you to know that I think your manual is great! My client made more progress in one week with your manual than the 2 months with the behavioral interventions I recommended. The family and the little boy are so happy and appreciative that they asked me to tell you that you have changed their lives. I have told my colleagues about your website and manual and have strongly recommended that they purchase a copy for their own practice. My client's pediatrician asked for your website and contact information.

I have ended treatment with the client and I can't thank you enough.

Happy Holidays!!

JC, LCSW

Parents have been the major conduit for spreading my protocol. Talks at conferences or my writing have not had much impact. Now word is getting out to the professionals who actually employ my protocol and I hope that they will also have an impact. DrC.

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T&J Sent: Dec 29, 2007 2:11 PM
Subject: Success story

Our son is 9 years old and had never achieved "bowel control". We took him to our family doctor, to a pediatric gastroenterologist about an hour away, and finally to a specialist in a big city hospital 4 hours from here. All they could do was run a bunch of tests, tell us that he was chronically constipated, and put him on Miralax for long periods of time. Of course, the Miralax kept him going, but it didn't help his ability to stay clean, it just made matters worse. One of the specialists finally said that the only solution for him was to do surgery which would involve putting a stent into his colon so that we could give him direct medication and could clean out his system every night. There was no way we were going to do that to an active 9-year-old boy! So we just kept on praying that God would show us some other solution to this problem.

A few months ago, after we received the final word from the doctors, a friend found your website. We were amazed to learn that our child was not alone! We were also intrigued by the idea that his problem wasn't lack of control, but too much of a good thing. We got your materials, read up, bought the supplies, and attempted to start with our son. He refused to have anything to do with it. He didn't want to talk to us or have us do anything to help him. He thought that his problem could not be solved and he was too discouraged to try anything new. WE told him that other kids his age had the same poblem and they had been able to overcome it, but he didn't really believe us. We followed your advice and didn't try to force him, although I doubted that he would ever come to us and say he was ready. But we kept on praying and waiting.

After a few weeks he had an embarrassing incident at school and came to me in tears saying he wanted to do something about "his problem". So we started "Clean Kid". The very first time he sat on the toilet he was able to go. It has been 2 weeks and he hasn't soiled himself a single time! We've never had to go past the first sit with him. Because of that, he has been able to do this almost entirely by himself. All we do is tell him that it's time to sit quietly, then send him to the bathroom. He's proud of being able to do this by himself. We can hardly believe the change! What an incredible Christmas present for all of us! You have my permission to put this testimonial on your website if you would like to. Just let me know so I can look it up. Sincerely, J H.

This report is important because it illustrates how extreme a medical intervention can become for what is basically a functional disorder when the dominant "top down" or oral approachs do not work after repeated trials. This case illustrates how effective a manual-guided, "cookbook approach" can be where all the proper treatment elements are carefully explained, read and reread, and other parents are available in an email forum for support and advice. Most parents will not need a paid consult with me. This outcome was of the "miracle" variety, but only because it was in the context of the total protocol which the parents (and, in this case, the child as well) were fully committed to carrying it out while knowing what was required with the "bottoms up" approach. Again, the SS protocol does not depend on a punishment or "threat" paradigm (that would not work), rather it conditions the urge signals and proper release mechanisms for successful voiding on the child's own newly developed competence for daily BMs. Suppositories and enemas when properly used and timed establishes the appropriate times and conditions for successful BM's. Soiling also stops much earlier when the SS protocol is used. The parents will have to remain very alert for any signs of relapse and be prepared to go "all the way" if that should become necessary. But, now the parents recognize the possibility of that necessity and are prepared and encouraged to do just that. DrC.

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Received on 01/22/2008
Note from a child!

Hello everyone.

I dont use this e-mail very often,but i decided to share my support! I'm the only kid who uses this service because i suffered through this complication for 12 long years, yes i went through the Miralax, which i thought was helping but only made it worse in the end! My parents turned to Dr. Collins book which turned into a sucess for me! Now,i'm not completley"cleaned out" but im pretty close,I'm now in 7th grade,and even in 6th grade i had these problems,this year has been amazingly new and easier for me,I no longer must make frequent stops at the bathroom nor walk around with that horrible smell !I'm also a runner,i ran a marathon last year before i began the steps,it was hard to run 13 miles with grose underwear and an awful smell!This year i am training for it again at the moment and i have found it amazingly easier!Please always turn to me for any support i can help you with!
Thank-you,
K.

Immediately following is a later response to a parent who responded to K's email. Note that these exchanges are very spontaneous and quick over the exclusive CKM Forum and more will surely follow, but I will truncate it all here. DrC.

Thank-you J! I'm happy to encourage anyone,i struggled and hated this program at first, but now im so happy i used it! K.

I believe that it is significant that NR is a pediatric nurse and had to face so much frustration from within her own field. However, I have recently received an order from another nurse at a University Medical Center who's Pediatric Section is encouraging her to use the SS Protocol. Nurses jokingly refer to encopresis as the "Nurses Curse" because they so frequently find other nurses with the same issue! DrC.

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Received: Tuesday, January 29, 2008 7:13:02 PM
Subject: Another success with additional benefits.

Dr. Collins,

I recently read the testimonial of NR and thought I would share our results. I came upon your website through a friend of a friend that had ordered and successfully used your manual. I read your website and testimonials and felt hope for the first time. I even contacted you with some questions before I ordered the manual and you (not a secretary or receptionist) answered all of my questions! I ordered the Clean Kid Manual and read through it before I started. Our son had been suffereing with encopresis undiagnosed since he was 8 months old. I had him tested and to the doctors more times than I can remember. Once I found out about your program I did inform my pediatrician and she was very supportive and also offered me behavioral psychologist's # for additional help.

We started in October 2007 and now we are to the point where our sons tells us when he needs to go and enjoys privacy while going and calls us when he is done! If you would have told me a year ago that this would have happened I would not have believed you. It took us about a month with supppositories and luckily never had to use the enema. Our son did show a lot of resistance and proved to us that it was a control issue. We did begin using a fiber supplement(Benefiber worked best for us) and increased fluids (orange juice). This combination helped keep him regular even though he is still a picky eater. I do have to say that of the foods he does eat he eats way more than he ever did and is willing to try new foods.

The friend that called me to tell me about her friend that had gone through this and used your manual can not believe the difference in our son. Even her husband has commented on the change in demeanor in our son. He is sooooo much more outgoing, playful, and social.

For all of these comments our family will be gratefull to you forever. NR was right when she said God puts every person here for a reason and we are so blessed to have found you! Thank You.....Thank You......Thank You! For anyone that is considering starting the Clean Kid Manual I would say that if you follow CKM you will be amazed!

Thank You & God Bless You!

CF & Family

The child here was 3 years old at the beginning of treatment and I am now more comfortable with intervention at this early age as other parents have reported similar success at this age. This mother also commented on my availability which generally remains true to this day since I have left an office-based practice to devote full time to this website and extending the CKM protocol. The positive changes in behavior that CF noted in her son following treatment is fairly typical and continues to lay to rest earlier, silly, psychoanalytic based charges that my interventions were shallow and not treating a true deep underlying psychological cause. Note that the pediatrician here was open to the CKM protocol. I seek to work with physicians as much as possible and offer free consultations to them. DrC.

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Received: 02/06/2008
Subject: Oldbie to Newbie!

Hi T.--Trust me when I say that you are no longer lost. Trust this process and follow it to the letter for at least a few months. Once you have made it past the initial hump of starting the program, you will find that you have more progress than you ever thought possible. Our family is definitely not a miracle cure, but since we started with this program our major problems have all been over. Hardly any accidents in the past four years and none occurring in embarrassing situations and any that have occurred have been fairly minor. No accidents in the past six months. Our journey is far too long to go into in detail and boring unless it specifically applies to your case, so I will spare you. Bottom line is give this program a try, you will not be sorry. I don’t think a slow transit colon is a reason not to try this program. If really in doubt, I would verify with Dr. Collins. We suspect that our son has slow transit colon. He has not been officially diagnosed, but my mother in law says that she has it so it would make sense if he inherited it from her and we have other indications that make us suspect it may be so. We, too have been to three pediatricians, a Ped GI and a urologist, but none have led us in the right direction. We found no real progress until we found the SS program. Also, it was the only program that made sense to me when I was doing the research.

If you are not comfortable bringing this program to your doctor, then I would encourage you to go ahead with it any way. We did not bring it to our doctor’s until later and none of them were interested in the details anyway. Talk about nobody taking ownership of this. It has been all us all the way. I diagnosed my son with encopresis even. Thank goodness for the internet! So many of us on this forum have had the same experience as you. We have all gone to doctors looking for advice and most of us have found no real help that is how we ended up with Dr. C’s program. And so many of us have found success.

As far as school, if you still think you can salvage your daughter’s experience at school, then there is still hope for you if you start this program right away. If you have to, I would encourage you to take her out of school for a week just to get a head start on it. Or even take her out for a long weekend to get started and trust that she will be OK when she goes back to school. Things were so bad for our son before we found this program that we pulled him out of Kindergarten. He had gone for six weeks and unbeknownst to us he was having accidents at school with poop falling out of his pants and on to the carpet (at half day preschool he had no problem making it through class without trouble). The teacher wasn’t even able to figure out which child it was and announced it at back to school night. I was devastated for our child. We tried to work with her and I was coming to school two times a day to take him to the restroom with a two year old in tow! Needless to say it ruled our day and our two year old had no life. We could do nothing all day as there was hardly enough time to run to the market, let alone squeeze in a nap. At a pediatrician appt, our doctor told me just to pull him out and give him some time. He said it was silly for me to have to go to school so often and it wasn’t good for our little one either. I was so relieved. He was right on with that advice, but still had no solution for the accidents. While I had my son at home I did lots of research and found Dr. C’s program. We were able to start the program during that year off of school. We started him the following year in Kindergarten again and it was smooth sailing. He had a great year. I have never regretted it for a day!

Just wanted to share a bit of our story with you. I don’t want you to feel alone. My best advice is to follow the program to the letter and be patient. I would also encourage you to read through the archives of this list (link should be at the bottom of all of the emails) - there is a tremendous amount of valuable information there. Good luck and know that you and your child will be OK! Good luck and feel free to ask for help when you need it. This list is great for that!

M.

This is a typical response by the more experienced parents reaching out to those just starting the program. Also, note that this parent had a much more difficult course for her child than many, but in spite of that she experienced early benefits from the very beginning of treatment. I don't want to give false impressions that the process is easy. This mother's experience makes that very clear. I sometimes think that parents have to reach a point of frustration where acceptance of the SS program becomes possible. But do they have to go through these kinds of trials and tribulations before even learning of the SS protocol? DrC.

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Received 02/06/2008
Subject: Later the same day, another Oldbie to the Newbie above, what a group! DrC..

T,
You are definitely in the right place! Like the others said, trust the program, follow it to a "T." You will definitely see results, and, yes, maybe even a miracle. My son is a 2-year veteran of the program, and I am so thankful that we found it when he was almost 5. After a year on the program, I no longer required supps. unless he goes more than 3 days without a BM. That usually only happens when we travel. Everyone is different, but my son stopped needing the supps/enemas about 8 months into the program. My son stopped soiling/having accidents the week we started the program, so I know it works. He started full-day kindergarten the following September and has had no issues, although I did tell his Kindergarten teacher his history in case he got excited and told everyone about having a really good BM! So two years after starting the program, I still remind my son to do the sit after dinner, but usually he does the "karate chop poop" as Dr. C. likes to call it, on the first sit.

I would say that most of the children here had/or have a slow transit time on their colon due to the holding issue. After a time of ignoring the signals from the brain, the connection gets lost. The brain/bowel connection has to be reestablished. That's what this program is all about, because just making the stool mushy with medicines doesn't help the child, it only makes it worse. We gave up the Miralax cold turkey the day we started the program. I told his pediatrician we were using the program about 3 months into it, and he was very supportive of the protocol, didn't have any problems with it. I also gave him Dr. C.'s card so he could get a manual himself. I only hope it has helped him treat his other patients differently.

Best wishes to you and your daughter. There are a lot of wonderful people here on the forum if you have questions.

A.

Note that this is another mother who had to do a more extended application of the protocol, but she is so happy and has a wonderful sense of humor. DrC.

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Received: 02/06/2008 (yes, a busy day on the forum, and there were many more!)
Subject: Allergies and getting husband on board!

S.
My daughter had terrible fits the first few days of the program. She would scream, yell, hit, kick and spit when we got to the enema. After she was done, all was fine and she'd apologize and be very affectionate. She did complain after school for a while, but that only happens occasionally now.

Don't make the mistake of altering the protocol, you will regret it. I think with the enlarged colon, the most important thing is not letting stool sit any extra time for a larger success later. It needs to regain it's elasticity, and being full is counter-productive to that goal. Pooping every day is essential to re-train his colon.

My husband wasn't convinced when I started this program. His theory was that we should stop everything, leave our daughter alone, and eventually she would have to go. After three days in the hospital for a clean out, he reluctantly sat quietly while I started the program. He had to hold her for the enema the first day, and then washed his hands of the program. Since starting SS, she hasn't soiled (I don't even carry extra clothes anymore), her bad behavior is 95% gone, and she is so much happier. When I had to leave town for three days, my husband didn't follow the program. I came home to a huge set back, including an urgent care visit, because after five days back on the program she hadn't produced much poop. Once she was cleaned out, it was like starting all over. Now my husband is on board. He even gave her a suppository last week, and she reported back that he did a great job.

We had our daughter tested for food allergies last month. I decided to wait a few months after she had a rectal bx for all the same reasons you have. She is allergic to wheat. I think going wheat free is making a difference. We have done SS since August, and even when she had a normal size poop it usually looked like a bunch of small clumps molded together. Now they mostly look normal, her stomach is soft, hasn't been hard and distended, and she says it is easier to poop. I feel horrible that she has had these problems since she was 2yrs old and no one ever suggested checking for a food allergy. After she was tested and negative for celiac, the idea of this being related to diet was ruled out. Getting tested can be difficult, but it is quick and once it's over so is the discomfort. If there are a lot of reactions, he might be itchy for a while, but not in pain. I think the skin prick is more accurate f or allergies than a blood test. If I had known a wheat allergy could cause intestinal problems, I would have had her tested before ever going to a GI.

We still need SS, but hope to have quicker success now that she is wheat-free.

Good luck,
J.

Again, this demonstrates that the SS protocol may not be easy up front, but so many rewards follow from very early on that the parents follow through to success. Also, the SS protocol helps to reveal complications which may just be hidden in all of the confusion of the standard "top down" approaches. I continue to be amazed at the strength of mothers in conducting the protocol, it is so valuable if the husband is on board even if they don't want to get their hands dirty! DrC.

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Received: 03/03/2008
Subject: Newbie thanking the Oldbies and observations about pre-SS experiences.

Hello All - Just wanted to say thanks for all the wonderful posts in response to our little set back - had a good day today - praying for another good day tomorrow.

As far as the doc thing goes - we are on our 3rd GI doc - with no progress with him - hence the turn to SS - more progress in the past month on SS, despite out small set back this past week, than 3 years with under reactive, parent blaming GI docs and we go the "number 1 Children's Hospital in the world" or so they think they are. We haven't gone back to GI since finding SS. I haven't yet shared this protocol with our pediatrician yet either - starting to feel braver though.

The amount of advice and support here is incredible. I don't often respond as I don't feel I have things under control enough here yet to offer advice but I am reading everything! Thank goodness those of you with more experience on the program have stayed active on the list. Please continue to do so. Your insights and advice are so needed.

T

Note also the reluctance to share the SS intervention with their physicians because of the fear of a negative reaction. They want and need their physicians. And I prefer that their physicians be available to them. I hope to ease this situation somewhat with education and a "Letter to the Doctor" inserted in the manual and contained on the home page of my SS website. DrC.

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From: tsh
Sent: Friday, May 02, 2008 5:14 AM
To: soilingsolutions@XXXXXXXX.XXX
Subject: Re: Growth Spurts?

I have a suggestion for your second question. My son was 7 and small (barely 40 lbs) when we started SS. I used the adult size suppositories and the adult size enema (although we only used half...personal choice) and he produced the required 1/2 cup, sometimes more, every time. No adverse side effects. But I did notice one very significant change. After 6 months on the program my son suddenly gained 10 pounds and grew 3 1/2 inches. My personal thought is that his encopresis somehow stunted his growth and he has been growing like a weed ever since! I have no clinical proof that his lack of growth was caused by, or a side effect of Encopresis but to me it is just too big of a coincidence to ignore. tsh.

A Response from a parent: Ditto - I too have no clinical proof, but my son is filling out and has grown significantly after doing well on the program for 4 months. Thank you Dr. C. for us parents and the kids!! K.

Hm-m-m-m, a good research hypothesis here? DrC.

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A record from 04/27/2007 to 05/12/2008 on one family who just desired to personally update me on a couple of occasions. DrC.

04/27/2007--Our pre-school son has had stool issues since before the age of one. He hides, withholds, cries, you name it. We have tried everything we can think of, including contacting a local childrens mental health agency for support and ideas. We thought that would be the last step but unfortunately they are giving us the same Sit him on the toilet with a toy and then give him a sticker type advice weve already tried for in excess of a year, to no avail. This is a different idea and it sounds like it could actually help sooner rather than later. His soiling is straining our family, upsetting him, and limiting the activities he can get involved in, including potentially keeping him out of kindergarten, which would devastate him. We just want to get this dealt with because it becomes more ingrained with the passage of time. Hope you can help us.

04/29/2007--Has 3.5 y/o and cautioned him regarding my prefering age 4 and over, but noted the CKM forum and others have succeeded well with younger children. RWC.

05/22/2007--Dr. Collins -
We just wanted to say thank you; our 3.5 year old son has been on the protocol for two weeks and two days, and he was one of those "miracle cure" kids you talked about in the book. We had to go through all the steps on the first day, but then we saw steady progress each day and on the fourth day, he was able to have a bowel movement on the toilet on his own. By the end of the first week, he was generally successful on the very first sit, and yesterday he actually pooped during a routine pee break in the morning. He's been happily sporting underwear for two weeks now and is thrilled. We don''t have to time his sits anymore. We haven't tried giving him grace days as he's still quite little and he's incorporated his post-dinner poop into his daily routine and actually asks for it. It only takes about five minutes, and we're thinking we'll just let it sink in for him.

As I'm sure you've heard from many other parents, the years we struggled with this issue were hellish. Our families gave us a lot of useless advice, our friends were uncomfortable to see him screaming and crying whenever he had to poop, the daycare questioned what we were actually doing to our son, and we were starting to wonder what we did to him as well. He was starting to miss out on things he wanted to do, and our compassion and patience had worn down to a growing resentment for every holiday or party or vacation that was essentially spoiled. In my view, the protocol was difficult but not nearly as difficult as living with the problem. Our son is just so proud to have mastered this skill.

Thanks for having the courage and the willingness to put something like this together - I can't imagine it's a popular view. When I was about nine, I went through a similar issue. I remember how it felt, and I know that the solution doesn't lie in rationalization or a simple desire to change. While our son is a bit below the recommended age, I believe we caught it at the right time, and I'm looking forward to getting past this part of our lives.

Thanks again. We'll report again later.
S. H.

05/22/2007--Thanks for your thoughtful note, it is one of my favorite rewards for sticking with this. I am quite willing to take on the entire pediatric profession as being too passive and dismissive of this problem, but noone is willing to give me the opportunity! DrC.

05/11/2008--Dr. Collins,
We just wanted to let you know that it's now been a full year since we used your program with our son. He made amazing progress, and by the end of July he had mastered the art of going to the bathroom without prompting, whenever and wherever. He seems to have little memory of things being any other way than they are now.
We haven't had a single accident, regression or problem. He's finishing his first year of school, and it would have been a shame if he had been forced to miss out. The results are wonderful - thanks very much.
S & A H.

05/12/2008--Congratulations and thanks for the update. DrC.

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The general tenor of the above anecdotes from parents are quite representative of the exchanges I see everyday on our exclusive, free email forum for purchasers of the Clean Kid Manual. This exclusive email forum for parents has proved to be incredibly valuable in their sharing insights and support for one another. It also serves as a kind of natural "clinical lab" for me in observing the difficulties and breakthroughs that parents encounter with my protocol and their physicians. These observations will figure into a future edition of my manual.

I will likely truncate this page at this point as there is a good representation of exchanges over the CKM represented above. DrC-May, 2008