Q: We need your professional help. Our 12 year old son continues to “soil” in his underwear almost daily and sometimes more than once daily – during school, after school and at night when he is sleeping. Our local doctor has prescribed medication to “loosen” his bowels but that only makes matters worse. When he is home on weekends he will go to the bathroom, sometimes as many as 20 times a day and when he does the smell is overpowering. I am surprised the school has not sent him home due to the fact that other kids or his teacher can smell him. When we go out to eat at a restaurant it is embarrassing because the smell is so bad. He does not have many friends and has quit doing sports due to this problem. His mother is at the end of her rope with him and does not know what to do at this point. He is an excellent student and has no other problems at home. We would appreciate your input. Thank you very much.
A: As I am sure you are aware, there is no standard for the number of times a person has to move his or her bowels in a day; however, it appears your son’s habit appears a bit excessive and unmanageable. As such, there are a number of conditions that might require investigation. We will touch on them briefly.
Crohn’s disease is inflammation of the lining of the digestive tract that can result in abdominal pain and diarrhea. Signs range from mild to severe, may go into remission or exacerbate and can include diarrhea, cramping, abdominal pain, blood in the stool, and more. In severe cases, malnutrition may occur. Treatment may consist of anti-inflammatory drugs and short-term corticosteroids. There are times when ulcers can extend through the intestinal wall and create a fistula, an abnormal connection between different areas of the intestine. When a fistula develops, food may bypass areas of the intestine necessary for absorption. An external fistula can result in continuous drainage of the contents of the bowel to form an abscess. This condition must be addressed.
Celiac disease is a reaction to consuming gluten found in wheat, rye and barley. If he has this disease, every time he eats gluten the small intestine responds with bloating and diarrhea. The irritation in someone his age can cause abdominal pain, particularly following a meal. The cure, if we can call it that, is to eliminate all gluten from his diet.
Hyperthyroidism is a condition in which the thyroid gland produces too much thyroxine, accelerating the body’s metabolism. Nervousness, irritability, irregular heartbeat, diarrhea and weight loss can occur. The condition is treated with medication and some instances with radioactive iodine which will slow the production of thyroid hormones. Diagnosis can be made through lab testing.
Ulcerative colitis is chronic inflammation of the bowel that commonly affects the lining of the large intestine and rectum. It results in diarrhea that fails to respond to over-the-counter drugs, causes abdominal pain, blood in the stool and more. There is no cure for this disorder but a physician may test a stool sample for viruses and parasites, order an X-ray, CT scan, barium enema, flexible sigmoidoscopy, or colonoscopy for confirmation of the diagnosis. The condition is treated with oral medication to help reduce the inflammation, corticosteroids and one of several drugs available on the market today.
Irritable bowel syndrome affects the large intestine, causing diarrhea, constipation, abdominal pain, bloating, gas, and more. It does not cause inflammation and may be controlled through stress management and a proper diet.
The foul smell he emits may be from an underlying condition or bacterial action. Bacteria produces hydrogen sulfide that resembles rotten eggs, ammonia, or sulfur, so his diet may be partially to blame. If the odor is a constant, it may be difficult to determine exactly where to begin. Consider adding more fresh fruits and vegetables to his diet. Eliminate junk foods, refined sugar, sweets, fried or greasy foods, drinks with caffeine, and excessive amounts of meat. Certain foods respond differently for all of us, so experiment based on his current diet.
I could continue, but the bottom line is that your son should be seen now by a top-notch gastroenterologist at a nearby teaching hospital. I can understand your wife’s dismay at the situation but if you consider your son’s disability and embarrassment, it really isn’t easy for him, either. Have a frank talk with him regarding seeing a therapist to lessen his stress level until he can get to the bottom of the situation.
