Relief and Resilience: Shriners Children’s Colorectal Program Supports Phoenix

For new parents, the first year of their child’s life is full of beautiful, challenging and brand-new moments.

One of those beautiful and challenging moments is the joy of potty training, as there is a learning curve for every child and can be a challenging time for first-time parents.

When Sierra started the process with her son, Phoenix, she had no reference for what was “normal” when it came to potty training.

“By the time he was just over 2, he was potty-trained for pee, but not for poop,” Sierra said. “He suffered from constipation and would have big, painful poops.”

This became routine, to the point that Phoenix would run and cower because he didn’t want to go to the restroom – the constipation caused a buildup, and his bowel movements would be large, hard and painful.

Sierra was determined to find a solution. Phoenix was enrolled to start at a preschool that required students to be fully potty-trained with two or fewer accidents a day to attend. 

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.

Progress Changes Everything

Following the procedure, Phoenix’s relationship with bowel movements was like night and day compared to the year before. “He’s so used to taking his Senna, he’ll remind me to go get his medication,” said Sierra.

The colorectal team is also readily available to them for questions and concerns, which is helpful for Sierra, who resides in the Bay Area, almost a two-hour drive from Shriners Children’s in Sacramento. They have regular virtual contact and come to the hospital for in-person appointments as needed.

“They would send over X-ray and prescription requests to our local providers,” said Sierra. “It’s a big relief to be able to get everything taken care of in the same day.”

Validation and care from the Shriners Children’s team also meant that Sierra was able to send him to preschool with a note that his accidents were due to a medical issue, not a potty-training problem.

Living Life with No Restraints

Today, Phoenix can now go to the restroom and lets Sierra know when he needs help. He still takes his medication and periodically weans off them to see how he does. Sierra is no longer worried about his future in school, or about any embarrassment. “I can’t even convey what it meant to have the team sit down with me the first appointment,” she said. “I wish I could tell myself a year ago that everything is going to be okay.”

Phoenix still has some accidents, but has a good nature about them: “Poo poo used to be scary, but it’s not anymore!”

Sierra always thought the colorectal program would need a more “significant” case, but came to realize that there is a spectrum of care that’s covered. Because of the nature of colorectal and GI functions, many parents and patients are embarrassed or ashamed to talk about it- a stigma that Sierra wants to break.

“Everybody poops!” she said. “We see Dr. Hasaan and Dr. Saadai regularly, and getting into the colorectal program was such an easy process, even as a self-referral.”

Today, Phoenix is a wildly curious 4-year-old who loves learning about the world around him. Every time he has a question about something, Sierra said they find a documentary to watch so they can learn more. One of his biggest obsessions is the TV show The Magic School Bus. Coincidentally, the episode about poop is his favorite. “He was telling me all about how poop breaks down, where it goes; the whole process,” Sierra said. “He has a much more positive view about poop and learning more about it.”

Phoenix’s curiosity and big heart have given him big ambitions in life – he wants to be both an animal doctor and a “people doctor” so he can “help everyone!” For Halloween, he plans on dressing as a doctor and having his little brother, Raven, dress as an animal.

Phoenix’s story is a testament to the comprehensive care and support provided by the Shriners Children's Northern California’s colorectal program team members. With the right treatment, Phoenix transformed from a child fearful of painful bowel movements to one who embraces learning about the process with curiosity and confidence. Thanks to the compassionate care of Maheen Hasaan, M.D., Dr. Saadai and the entire colorectal team, Phoenix can now focus on his bright future, leaving the fear of bowel movements behind him. His curiosity and ambition know no bounds, and with Shriners Children’s by his side, Phoenix can do anything.