Soiling Solutions

SOILING SOLUTIONS PAGE FOR PROFESSIONALS:

Notes from Robert W. Collins, PhD, the Author of the Clean Kid Manual and the Soiling Solutions website:

A PERSONAL NOTE TO PHYSICIANS: Psychologists adopted the work of a Pediatric Gastroenterologist who won the Fourth Nobel Prize for Physiology and Medicine in 1904 much more thoroughly than did your own profession! Dr Ivan Pavlov studied the front end of the GI tract for salivation and I’ve focused on the opposite end! I had earlier performed and published the first significant double blind, active placebo study of the bedwetting alarm which eventually led me to focus on the much more culturally and medically distressing condition of fecal incontinence. Your profession came to view the use of suppositories and enemas for encopresis for “clean out” purposes only. This bias was introduced out of the Boston Children’s Hospital by D. Levine with publications in 1976 and 1982 in Pediatrics and Pediatric Clinics of North America, respectively that referred to their use as “anal assault”. Subsequently, two-thirds to three-quarters of general pediatricians have significantly lowered their use of digital examinations for their patients!

A PERSONAL NOTE TO PSYCHOLOGISTS: The Soiling Solutions (SS) protocol relies heavily on reconnecting the stimuli associated with voiding (sitting on the toilet stool, interoceptive voiding cues, etc.) to trigger the voiding response mechanism. The holding response which is prepotent and characteristically first engaged when we experience voiding urges buys us time to get to the toilet. This is “natural”, but it can become so dominant that it blocks the voiding response which should take over. The suppository and enema “primers” (UCSs) in the SS assure successful voidings. Through a programmed conditioning process the enema primer gives way to the relatively inert glycerin suppository, and, finally, to the child’s own internal triggering cues. This then come under conscious control. The child’s massive “relief” with voiding and social reinforcement are usually sufficient operant reinforcers to sustain the voiding habit. Parents have found the book, “Sneaky Poo” to be very helpful in externalizing the issue toward the encopresis monster or “sneaky poo” rather than one another.