Dr Catherine
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8-15 years

Hi S., Leakage can be the result of a number of factors. Absorbent pants commonly leak due to improper fit; check that they are not too small or too large and that they fit snuggly round her upper thigh. The extra pant should really have little impact on the overall fit and is a really good idea, as you want her to feel confident and not walk around with a permanent fear of being discovered by her peers. The best way to hide smell is to ensure your daughter is changed regularly. I am surprised to find that she is leaking if in fact she is being changed every hour when she is at school. Perhaps in the short-term this needs to occur more frequently. You can also use nice perfumes or oils on her clothes to help disguise any smells, although this will only mask minor odours. You do not mention in your question whether her daytime wetting has been linked to developmental delay. Faecal incontinence, like what you describe, can also be the result of a medical condition such as chronic constipation. If left untreated, constipation can result in leaking of faecal matter that can very smelly and dark in colour. The signs and symptoms of constipation include: poor appetite, lack of energy, irregular bowel movements, excessive and foul smelling flatulence, irregular stool texture, withholding of stools, daytime soiling or overflow, nighttime incontinence, abdominal pain or discomfort, and irritability. Do you find her toileting patterns to be the same when she is at home as when she is at school? If not, it may be in response to the school context. Is she able to recognize signs that she needs to go (or has gone) to the toilet? If she can, then the best way to manage the leakage is to work toward helping her to use the toilet. Rewards systems typically work best among children with developmental disorders. Discuss with her what she needs to do and how she would like to be rewarded. The more she feels included in the process the better she will feel about the situation. Rewards may be given for a range of behaviours (not just when he has a bowel movement) including sitting on the toilet for 10 to 15 minutes after each meal, eating healthy food, or drinking regularly throughout the day. All the best and please do not hesitate to contact me again if you have additional questions. Regards, Dr Cathrine