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Pediatrics/Bowel issues in a child

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Hi Dr. Olson,
I am writing regarding my 5 1/2 year old son.  He seems to have a preoccupation with feces.  I thought maybe it was due to constipation, but at this point I am as a loss.  My son seems to go regularly and stool is not hard or loose, but we keep finding him removing stool with his fingers, particularly when he is in the shower or in his room trying to go to sleep.  I am not sure if there is an actual medical issue (which I have no reason to suspect) or if it is an attention issue.  He does have a new brother (6 months old), but this behavior has been going on for over a year now.  There are weeks to months where he is fine, and then out of the blue he starts disimpacting himself.  I cannot see any patterns with his behavior, there have been no other major life changes, and he is otherwise healthy and displays no signs of constipation.  We have tried giving him Miralax, talking with him, threatening him with punishments, ignoring the behavior, taking away his favorite things/activities.  He denies that he is doing it, although it is clear that it's happening.  He is upset with punishment temporarily, but he gets over it very quickly.  I mentioned this to our pediatrician at his 5 year appointment, but she didn't really have any comments or suggestions.  At this point I am at the end of my rope.  I am not sure if there is an underlying behavior problem that is to blame, or if it is a medical condition, or if it is just part of the development of boys.  As a nurse, I don't see anything alarming going on with him medically.  I also hate to make a doctors appointment if there is nothing wrong.  Do you have any ideas why he would do this, and perhaps things I should be looking out for that could be the cause?  I feel like it falls into a gray area and I am not even sure who to take him to, but I feel like he is too old for this to still be going on.  Thank you so much for your time.

Answer
Hi, Karri,

Sorry for the delay in answering this question!

This doesn't seem to me to be a medical issue, especially if the stool is not consistently hard.  Can he pass a normal BM without distress?  If he can, then to me this is a behavioral issue and may be some type of OCD behavior.  

If this was my patient, I would be sure that the medical aspects of this have been eliminated and then see a pediatric behavioral specialist in your area.  This type of person can do some counseling of him and you and should be able to readily take care of this.

Good luck, Dr. Olson

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David Olson, MD

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I would be happy to attempt to answer any questions about general pediatric topics, either medical issues or behavioral issues. This would include all the various questions one receives in a busy pediatric practice. I`m a board certified pediatrician in northern Michigan and have been in practice for over 15 years. I enjoy the teaching role I have in our practice and would enjoy the opportunity to help others with their pediatric problems.

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