In February 2022, Sierra was pregnant with her second child and was determined for Phoenixto be potty-trained before his sibling entered the world. Having exhausted her at-home options, she reached out to her son’s pediatrician. The pediatrician prescribed a laxative to clear him out. The daily regimen of the laxative for four weeks, once a day, did nothing – his bowel movements were still quite large and caused him a lot of pain. “I was so frustrated,” Sierra said. “Nothing worked, and I didn’t feel like I was being heard.”
It was clear that it was an incredibly stressful and embarrassing situation for Phoenix – not just a potty-training issue: There was a psychological factor. By June 2022, Sierra really started to panic – she was getting closer and closer to her due date, and Phoenix was scheduled to start preschool in August.
“Phoenix was making himself constipated so he wouldn’t go,” she said. “It was a painful poop every time. The longer you wait, the bigger and harder it would be – part of using the MiraLAX was to show him pooping isn’t painful. But even if there was medication, he would still try to fight it.”
Phoenix’s pediatrician referred him to a social psychologist. This consultant charged high fees, and Sierra found the advice to be unhelpful. They adjusted his diet, got a sticker chart, and made a schedule for pooping, which cost their family quite a bit of time and money.
Hope from Shriners Children’s Northern California’s Colorectal Program
With Phoenix’s preschool start date drawing near, Sierra contacted the school’s principal to see if they should withdraw from the program, as he did not meet their requirements.
“I thought I didn’t potty train him properly, and had failed as a parent,” Sierra said. “I had a 4-week-old baby and felt so isolated and alone. The scariest part of parenting is not knowing what to do as your child’s advocate and protector.”
It wasn’t until they had their first appointment at Shriners Children’s that all the issues they were facing were validated.
Shriners Children’s Northern California is home to the only comprehensive pediatric colorectal and gastrointestinal program in the Shriners Children’s healthcare system, and the only program of its kind in California. The Pediatric Colorectal Center is one of only 18 hospitals in the nation that offers this highly-specialized pediatric care, and our dedicated multidisciplinary team is committed to providing world-class treatment and support for children with complex intestinal and anus deformities. We utilize advanced technologies to ensure optimal surgical approaches and deliver excellent outcomes, all while empowering patients and their families on the path to greater independence and confidence.
“I felt like we were almost boring; they’d seen it before!” Sierra said.
After his first appointment at Shriners Children’s when he was 3, Phoenix was taken off his current laxative and put on two faster-acting laxatives. He had fewer accidents, but still was having them. It was at this point that the colorectal team decided that he would benefit from an internal sphincter botulinum toxin injection.
“Botox helps relax the internal sphincter to allow easier passage of stool,” said Payam Saadai, M.D., pediatric surgeon and director of the pediatric colorectal center at Shriners Children's Northern California. “This can help us get over the hump of stool-withholding behaviors that are common in young children with constipation, and it allows us to transition to noninvasive solutions such as dietary modifications or medicines.”
This procedure made it so that when Phoenix felt pressure, he had no choice but to release. Though this was a good thing, his family was warned that more accidents were a possibility before it got better.
“They did such a great job bringing him into the pre-operation waiting room,” Sierra said. “He was given toys, dressed in a gown and drank liquid Versed with flavoring. Normally, he wouldn’t be comfortable leaving mom and dad, but he has no memory of the procedure – he still loves coming into Shriners Children’s.”
After the procedure, the colorectal team prescribed enemas. Phoenix didn’t like the enemas, which helped him realize that he preferred to release his stool naturally.
