Older Children and Incontinence, a Family Story

November 29, 2015 by nohandsbutours 0 Comments

Our adoption journey started with two infant adoptions from South Korea, in 2008 and 2010. Our first was a healthy baby boy; our second, a daughter with limb differences. When we considered adding to our family again, we decided to adopt an older child and looked into the China special needs program. We pondered the medical needs checklist helplessly. We had good insurance, but what kinds of needs could we manage on a daily basis with a busy family of six? Could we provide years of possible surgeries and therapies? What kinds of special needs were more “convenient” than others?

At some point along this journey it occurred to us that no matter how inconvenient a special need might be for us, it was infinitely more difficult for a child without a family. We changed our outlook and began doing the research. In particular we felt pulled toward a child with physical special needs. Spina bifida topped our list as we searched photo listings for the child who would be our new daughter.

In June 2011, I found her. She was a 7 year old girl with repaired lipomyelomeningocele, tethered cord, and bowel/bladder incontinence. She lived in an orphanage, and had been there since being abandoned at a year old. A note left with her detailed the anguish her birth parents had felt at watching her untreated spina bifida derail her growth and development, necessitating decisions no parent should ever have to make. Photos of her showed large, sad brown eyes and a shy, fearful disposition. Orphanage notes said she preferred to play alone, and did not allow people to get close to her. Due to her incontinence she was not allowed to attend school, but instead stayed in the orphanage preschool.


As we filled out paperwork to adopt her, I started to prepare myself for the types of care I would need to provide for her when she got home. I learned a lot about how incontinence caused by spina bifida and anorectal malformations affects children socially and physically, when the causative conditions are untreated. For example, many children are classified by China as being regular and not having constipation, because they have a bowel movement each day. However, the vast majority of children with these untreated conditions suffer nerve damage affecting the ability of the intestines and colon to push stool through and to release it on a regular basis. Once the colon is full, stool will fall out, but the colon is stretched and any sensation is lost, making toilet training difficult or impossible. Children can benefit from bowel management programs which use laxatives, enemas, and dietary changes to produce a bowel movement each day and achieve social continence.

However, with overcrowded orphanages, poverty, and short-staffing, children in care in China are unlikely to have these opportunities. Instead, they face a lifetime of shame and separation, where foster families are unwilling to bring them home, schools reject them for the inconvenience and odor, and opportunity for education and social integration is nearly impossible.

As I prepared to travel in June 2012 to adopt our daughter, I considered the challenges that might be involved in managing the incontinence of an older child. Our daughter would have been used to a lifetime in a diaper, without a regular caregiver. Would she trust me? Would she be willing to let me try to help her?

Our adoption day was full of surprises. Our daughter walked confidently into the civil affairs office and sat in my lap. She was shy but sweet as she carefully touched my cheeks and searched my face for clues as to what kind of person I was. She eagerly gave her fingerprint to be adopted and in the weeks that followed, began to blossom!

As she settled in we started the medical workup to assess the range of her needs. It was determined that she could benefit from clear intermittent catheterization and bowel management. One thing that many parents find surprising is how little doctors know about the day-to-day management of these conditions. It’s one thing to learn about incontinence, but another to live it. Most of us find that doctors provide a good starting point for advice on how to manage, but because every child is different, and we ultimately find trial-and-error to work better for managing our kids’ needs.


For example, children with spina bifida experience many different symptoms related to incontinence. Some children are completely continent, or are continent but need to use the restroom on a regular basis, rather than using sensation to decide when to go. Some children may have the sensation of having to urinate, but cannot control it. Some have a neurogenic bladder, in which signals between the brain and the bladder are interrupted by spinal cord malformation, leading to a bladder that spasms constantly but cannot release or hold urine effectively. If the child is not catheterized regularly, damage results from the bladder’s pressure becoming too high and the urine can reflux into the kidneys, causing problems with kidney function. Finally, urinary tract infections are an issue where the bladder does not empty correctly, causing health concerns. Many of these children benefit from a medication such as Ditropan, which stops the bladder spasms, and catheterization, which completely empties the bladder.

Over the course of several months, I slowly introduced catheters and laxatives. Our daughter was nervous at first but agreed to try the protocol that was recommended. It wasn’t long until she was dry and wearing underwear, and we were using glycerin bulb laxatives and cone enemas to empty the colon each day. We use the “bucket approach,” which says that the colon is like a bucket. When a bucket is full, it spills over, but if you empty the bucket each day, you have another day to slowly fill it and empty it before it can spill over. This has worked successfully for several years.

In 2013, I happened to come across the story of a young man who was aging out of China’s adoption program. An outgoing, smart, sweet 13-year-old boy, he had imperforate anus as one of a constellation of symptoms related to VACTERL association. His incontinence had led to his abandonment, and it had caused him to be kept out of school and foster care while he spent his life in an institution.

While reviewing his file I was touched by his hopeful smile, and his statements that he would like to be adopted. I cried reading about how, as a result of bowel incontinence, the students’ parents at his school had called for his expulsion. My husband and I considered what his life would look like if he stayed in China, without access to lifesaving medical care and the tools to achieve daily bowel continence. And then, we said YES.


I traveled to China and adopted him in March 2014, while my husband stayed with our other children. Those days in China were not easy, though my son and I can laugh about it now. He, too, walked willingly away with me toward his new life, and apart from being nervous and active, adjusted easily into his new life. We found that he was lactose intolerant, which negatively impacted efforts to achieve bowel management. However, with the use of a Miralax cleanout followed by daily high-volume enemas, he too found himself continent. Within just a month or two he had learned to measure the ingredients for his enema and to administer it himself. Today, both children manage their own incontinence and are proud of their ability to blend seamlessly into their peer groups, after a lifetime of segregation and humiliation.

There are some things I’d like to mention that I think are unique to achieving social continence in older children. For example, while we may be anxious to begin the journey toward “fixing” the child, it’s important to take the child’s lead. You may think that incontinence is the end of the world, but it is your new child’s “normal.” I was not prepared with either adoption for how comfortable my children were in diapers. I had imagined that both would be excited and eager to wear underwear and to manage their conditions. Instead, both found it easier to be in diapers, without having to stop to go to the bathroom or to learn new ways to stay clean. However, I always prioritized bonding and building trust over imposing invasive procedures. I made sure that both kids were ready and really understood what we were undertaking. They were willing to try the techniques I introduced, but weren’t overly excited about the goal. There are no words to describe either child on the first day of successful continence. My son was amazed that he, too, could wear underwear like everyone else. It was clear that he had lost hope of this ever happening… and he was thrilled by this development!

On the other hand, I also think that undergoing such sensitive and invasive bowel and bladder management built trust more quickly. I promised them that I would help them to stay clean and feel healthy, which no one in their lives had done before, and I followed through with my promise! We learned together and grew together. We laughed together over messy failures, and celebrated successes together. Catheterization forced us to focus solely on each other at regular points in the day, around everything else that was going on. They opened themselves up to vulnerability and saw that my husband and I didn’t reject them for their incontinence, or disapprove of their conditions, as so many people had.

As time went on and our relationship grew, they both shared some very humiliating stories of abuse and neglect which was cathartic for them. We have always made a point to honor those memories and to treat them gently, and to nurture the present, so they can overcome some of the trauma which resulted from their incontinence.


Related to this, I think it’s worthwhile for parents to really consider the social and emotional effects of incontinence as it relates to our children. There is no simple fix here, folks. For adoptive parents, it’s a medical condition to be managed. Honestly, it always surprised me how often people overlooked incontinent children for others whose needs I’d consider more involved, since it seemed a nonissue for us. But for the older child, it is the central focus of his or her life and the source of most of his or her negative experiences in life.

Children are acutely aware that they were abandoned because of their medical conditions. They have watched other children be adopted while they waited due to their special need. Many, if not most, children have been denied an appropriate education, field trips and excursions, foster care, and warm relationships and have been told in no uncertain terms that they smell, or that they failed to potty-train normally. They have been mocked about their conditions and it is the source of great shame.

In your home these memories will compound the typical challenges associated with older child adoption, which are to be expected as a child settles into life with a new family, siblings, language, food, educational system, expectations, and culture. You will need to gingerly approach social continence without putting your child on the defensive or making the child think you believe he or she needs to be “fixed” to be good enough. You will ask questions about bathroom behavior and your child will try to size up whether you are mocking them. Any accidents will be hidden in anticipation of discipline or scorn.

Eventually, you will realize at some point that the hurt is so very deep, and the child’s self-esteem has been damaged so severely, as you slowly pull apart the layers of your child’s personality. You will realize that incontinence has affected the child so much more than physically, and that so many seemingly unrelated experiences your child has had really stem from the medical condition that put your child in the situation.

You will slowly conclude that long after your child achieves social incontinence, he or she will still remain an “incontinent” or “disabled” child inside, with the stigma and shame, and that it will be up to your lead and your child’s resilience to change this. It will be up to you to patiently rebuild the child’s self-esteem, while showing him that his identity is so much more than what happens in the restroom.


And one day, after many other exhausting and difficult days, you will realize that it’s been a while since you comforted a crying child after an accident, or found a hidden pair of stinky underwear, or treated a urinary tract infection, or had a conversation about poop at dinner, and you will realize how far you have all traveled, together. Your child will realize that her worth is bigger than her trips to the bathroom. Incontinence will be just another feature of your child’s life, like his eye color or his favorite color, rather than sorrow that is written upon his soul.

Your future, together, is now.

– guest post by Tracy

Orphan Sunday: An Answer to Prayer

November 29, 2015 by nohandsbutours 0 Comments

Thanksgiving was just a few days ago, and I find myself reflecting on all that I am grateful for this year. I filled my belly with turkey, Mama’s dressing, corn pudding, and pies while sitting around a table with some of the people I love most. I celebrated the presence of my new son and his first Thanksgiving home. I was even able to sneak away for some Black Friday shopping without tears from either of us. This year everyone in my family is healthy and home, and for that, I rejoice!

This time two years ago, we were surviving a difficult transition home with our third son, whom we had adopted from China. Regardless of how challenging life was at that time, I still was so grateful that we had been obedient to God’s calling to bring our son home. With so much emotion and passion, I continued urging others to defend the fatherless. I prayed that families would open their homes to the least of these. I held meetings with church leaders to talk about the plight of the orphan and shared ways to get involved in the crisis domestically and internationally. I poured my heart into blog posts in hopes that more people would choose to get involved. Over the past few years, my desire to empower, encourage, and enlist others to serve the least of these has remained a huge desire of my heart.

As Thanksgiving ends and launches us toward the Christmas season, it also signals the end of National Adoption Awareness Month. On November 8, 2015, churches across the world recognized Orphan Sunday to encourage people to step into the lives of vulnerable children everywhere. After 3 years of praying for such an opportunity, the church we recently began attending allowed us to host its first Orphan Sunday event. I cannot express how excited I was to put this event together.

Although I believe adoption gives vulnerable children the most hope for a future in this world, the heartbreaking reality is that the majority of orphans will never be adopted. Additionally, not all people are able to adopt a child, so I wanted to make sure our event provided ways to defend the fatherless in addition to adoption. I made a list of 7 different agencies and organizations and invited them to participate in our event. Each agency would be given booth space to share information before and after the main program, and during the actual program, they would each have 5 minutes to share how their organization works to serve vulnerable children. I was so encouraged by the excitement that each representative shared as we discussed the details of the evening. To speak with like-minded people who share your passion can sometimes feel like a rare treasure!

In addition to inviting the 7 agencies to the event, we chose powerful worship music and videos and strategically placed them throughout the program to keep people engaged. God can present Himself and His Will so beautifully during those moments. Hunger is an unfortunate reality for so many orphans around the world. Both of our children from China have experienced insecurity and fear about food. In order to make the issue of hunger more personal to people attending our event, we decided to incorporate the Orphan’s Table into our program, as well.


While I was coordinating details of the evening, my friend Christy, who is employed at our church, was facilitating everything on the inside. Christy worked hard to make the evening such a success. She used some of the print materials at the Orphan Sunday Website to create an info card, which was available in our church’s lobby area. She also communicated and coordinated the need for church-wide announcements about the program. The Orphan Sunday event was posted in the bulletin for several weeks leading up to our event. We were also so fortunate to have multiple pastors give pulpit announcements the three weekends leading up to the event. To hear our pastors calling our congregation to stand up for vulnerable children brought tears to my eyes.

On the morning of Orphan Sunday, I couldn’t help but smile when the church service begin with the 2015 Orphan Sunday video. The Lord was answering so many of my prayers, and the evening program hadn’t even started yet. It was incredible.

Finally, Sunday evening, the time came to see the fruit of everyone’s efforts. I almost could not believe my eyes that evening as I met representatives from each agency and watched them set up their booths. When I looked to the left, I saw my friend and her uncle preparing all of the food for the Orphan’s Table portion of the program. It was a huge undertaking, and I am still smiling with such gratitude! Our Children’s Pastor, his wife, and their small group offered to provide free childcare that evening, which was extremely generous. We were confident that more families would attend our event if childcare was provided, and there were 60 children registered for childcare. To see people I love come alongside us to support our passion and execute the Orphan Sunday event was such a gift. Before I knew it, people began arriving, taking their children to childcare, and visiting the booths to talk with representatives from the various agencies. Everything was coming together so beautifully!


Just before the event began, my husband, Ryan, started ushering people to the chapel. We provided everyone with a program and paper on which to take notes. I couldn’t believe all of the people who came pouring into the chapel. It was exciting to see many of our closest friends, my dad and step-mom (who surprised us and drove 2 ½ hours to be there), Ryan’s parents, our senior pastor, fellow adoptive moms with whom I had only corresponded online, old coworkers, and several people from our previous church attending the event. Ryan went to his post at soundboard, and he began coordinating all of our audio/visual components for the evening.

Two wonderfully talented people from our church played guitar and sang Holy Spirit to begin the main program, and then Ryan started the 2014 Orphan Sunday video. Next, it was my turn to speak, and although I expected to be super nervous, I found myself more excited than anything. Seeing all of those people gathered together on a Sunday evening – and missing the Colt’s game nonetheless – brought my heart so much joy! After I finished speaking, my friend, Christy, led everyone in a prayer, and we began the Orphan’s Table. While everyone ate their small portion of food, our musicians played and sang Called Me Higher. I loved the way the songs, video, and introduction worked together to set the stage for the rest of our evening.

As soon as they finished singing, a representative from Lifeline Children’s Services shared information about adoption and their (un)adopted program. Next, a representative from Central India Christian Mission shared a powerful video about a child whose life changed by God through CICM. She also discussed opportunities to sponsor and/or adopt children served by this ministry in India. Ryan played a Francis Chan video clip to demonstrate the parallel between our spiritual adoption and earthly adoption.

The next portion of the evening provided people with various ways to get involved with vulnerable children in our local community. Our county’s Department of Children’s Services (DCS) shared information about Foster Care. Then, Safe Families provided information about the need for safe, loving homes while parents voluntarily restore stability in their lives. Next, Court Appointed Special Advocates (CASA) shared about the need for children who have experienced abuse and/or neglect to have someone to represent their best interests during judicial proceedings.

To introduce the next part of the program, Ryan showed another video about global orphan care opportunities. A representative from The Boaz Project shared about their organization’s work serving orphans in India and Russia and provided ways for people to get involved. Last, representatives from Horizon International provided attendees with information about how their organization serves orphans affected by the HIV/AIDS epidemic in Africa and offered several ways for people to get involved. As soon as they finished, Ryan then played one final, powerful video called Depraved Indifference by Eric Ludy. Despite seeing it at least 10 times, I still cry every single time.

Hearing representatives from each organization speak about the great needs in our community and around the world was heartbreaking. Those people are on the front lines, witnessing vulnerable children on a daily basis. At the same time, my heart was encouraged to see so many people willing to learn more about opportunities to defend the fatherless. I closed out the program with some final words and a prayer. Tears of heartache and hope fell that evening. The musicians played one final song, No Turning Back, which had such an impact throughout our first adoption journey. Everyone was dismissed to visit the booths and gather more information from the representatives before going home. It was incredible to talk with people about how God was moving in their hearts that night. I loved seeing so many people asking questions and learning more about the organizations. Visiting with some very special adoptive families and meeting the children I have prayed home was so powerful.

Throughout the entire evening, I found myself amazed at what God had done that evening in bringing us all together. He sovereignly opened doors for us to share His heart for the fatherless and had planted us in a field that was ripe to hear His heart. As we move forward, it is my deepest hope that God answers the prayers of many children through the people who attended the Orphan Sunday event. I am confident that He planted many seeds that evening. I have received many email messages from people excited to take next steps or wanting more information. We are having dinner with a couple next week to talk more about adoption. As much as I would love to continue adopting more children, I believe with all my heart that this is how I need to serve the fatherless for now. I want to be a voice for vulnerable children, encouraging, empowering, and enlisting others to step into their lives.

I hope many of you reading this post will encourage your churches and/or community to engage in the plight of the orphan. I gave you as many details as possible for you to consider as you plan your own events to bring awareness to the plight of the orphan. Regardless of whether God is opening doors for you to host your own event or you are feeling resistance from those around you, never give up because “he who began a good work in you will carry it on to completion until the day of Christ Jesus” (Philippians 1:6). Stand boldly as you speak with love and keep fighting the good fight! I am cheering for you.


Waiting Twins: Chad and Tad

November 28, 2015 by nohandsbutours 0 Comments

Chad and Tad are twin brothers who are 3.5 years old. They were found as infants and determined to be premature and of low birthweight. After a few months of careful care provided by their orphanage, they grew and matured enough to be sent to foster care. The two brothers have lived in separate foster homes since this time. Both boys are now considered healthy and similar to their peers of the same as far as their health and physical development.


Chad answers questions about his name, age, and asking where people such as his foster father are. He can count from 1-20. He is able to follow instructions, recite poems, sing, dance. He has friends he likes to play with and knows their names. He is affectionate with foster mom and makes good eye contact. Chad’s foster mom has cared for 10 children and thinks he is almost on par with peers. Chad is described as a “naughty” child, doing things such as stealing the tv remote to watch his favorite cartoons. Chad has no special needs listed.


Tad’s special need is suspected autism. He was moved to an experienced foster family about a year ago and during that time his foster mother feels he has made good progress. However she reports that Tad does not feed himself or follow directions to carry out simple tasks. He exhibits repetitive behaviors and is nonverbal. Recent video shows Tad exhibiting behaviors which suggest that his autism might be more mild to moderate. On video you can see him interacting with individuals, giving social smiles, exhibiting fine motor skills, and crossing his midline during play all while in a noisy environment. Tad shows great potential improvement for a family who can provide him with the many resources and therapies available for children with autism.


Chad and Tad are currently designated to Lifeline Children’s Services, please contact them for more information.

Looking Beyond the Label

November 28, 2015 by nohandsbutours 0 Comments


Gastrointestinal Issues. These two words changed our world and lives forever on December 2, 2012. My husband and I had poured over the list of special needs provided by the Waiting Child Program at our adoption agency and chosen those we felt we could handle emotionally, physically, and financially. Gastrointestinal issues was a special need …Read More

My Wounding

November 27, 2015 by nohandsbutours 25 Comments


“I not only have my secrets, I am my secrets. And you are yours. Our secrets are human secrets, and our trusting each other enough to share them with each other has much to do with the secret of what it means to be human.” – Frederick Buechner Be gentle with me, dear reader. Please …Read More

Telling the Story: Theirs, Mine and His

November 26, 2015 by nohandsbutours 0 Comments

Templeton 2

I realize now that when we first brought our children home, I had an undefined, but deeply felt and well-meant desire. However, I have also realized that my desire was not exactly what God had in mind. Let me explain. I wanted our adopted children to be so loved, so secure, so encompassed in the …Read More

find my family: Jude

November 26, 2015 by nohandsbutours 0 Comments


Jude turned four years old in October and is diagnosed as having lower limb weakness. He came into care at the approximate age of two. His nannies report that he has big beautiful eyes and is very handsome. When his file was prepared in October of 2014, he could stand up and walk while holding …Read More

Meet the Contributors: Nicole

November 25, 2015 by nohandsbutours 3 Comments

Continuing today with our series in which we share a short Q and A with one of our contributors to give y’all, our faithful readers, a little more behind-the-scenes insight into the amazing group of writers assembled here. And it will also give each of our contributors a chance to share their heart in a …Read More

find my family: Naomi

November 24, 2015 by nohandsbutours 1 Comments


Naomi is a precious two year old little girl who is listed with Lifeline. Her special need is cerebral palsy. Naomi is a beautiful little girl! She responds to others asking for her belongings and waves goodbye to others. She is a good sleeper and likes playing with toys. Naomi’s file reports that she is …Read More

Nothing Else Mattered: FAQs About Anal Atresia

November 24, 2015 by nohandsbutours 1 Comments

We saw her face. We fell in love. Nothing else mattered. My husband and I simply wanted to be parents and we knew in our hearts that our children were in China; we just had to go get them. Like most parents to be, we hoped and prayed that our children would be healthy. Our …Read More

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