Q: I have begun to notice when I do the wash that there are occasional smears of bowel movement on my 9-year-old's underwear. Why is this happening now? Does he have a disease? Will he get one? What should I do about this?
A: Your son may not be taking the time to wipe thoroughly after going to the toilet. Many children do not consider use of toilet paper a high priority. They certainly do not consider wiping more than once. Some fear they will get feces on their hands.
The fact that you have not detected the problem with your nose, but only at the time you do laundry, suggests it's not big. Try pointing it out to your son gently and privately. He probably does not inspect his own underwear. Suggest that he wipe more thoroughly. You may even want to imply that you will be happy to let him do his own laundry if he doesn't shape up. See what happens.
If you notice a large amount of feces, if every pair of underwear is marked even after you talk with him or if your son begins to smell like feces, visit your doctor. Sometimes a child avoids going to the toilet for any number of reasons -- passing stool might be uncomfortable, the school bathroom is dirty or not private or paperless, or it interrupts other valued activities.
If this avoidance develops into a pattern, the rectum can become so stretched out and full of stool that the child loses the sensations that go with needing to defecate. Stool spills out without notice, a sign that a huge reservoir of hard stool remains in the intestine. If this has happened to your son, you will need your doctor's help and a great deal of patience. You will need also to remember not to blame your son.
Dr. Wilson is director of general pediatrics at the Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.