Help me break a vicious circle of painful poo/witholding

[parched]

DS is 2.6 and is writhing in agony every time he does a poo. It all started 4 weeks ago when he was ill and didn't eat for a few days. After he was better he did an enormous poo which I think hurt him and we're now in a vicious cycle of him holding the poo in because he thinks it will hurt. He's been having Lactulose for the past 3 weeks and his poos are soft, so he's not constipated.

When he gets the urge he tenses up, writhes around, starts crying (today he's been almost screaming) and finally passes a tiny poo. When I change his nappy I can see that he hasn't completely emptied his bowels and half an hour later we go through the same thing again. I've been trying to explain that if he does a big poo he'll feel better, but he's just relieving the immediate pressure.

I'm getting really stressed and it's horrible to see him in pain. I don't know whether to take him to our GP (who is usually very dismissive) since it seems to be a behavioural thing rather than medical. Is this a phase that will pass or should I be seeking professional help?

[nilbyname]

What about trying to potty train now in the fair weather. Potties everywhere, nappy off, no pressure??

Has he watched you do a poo? Make him laugh as he hears the "plop"? Have you sort of role played doing poops with teddies and dollies?

Sorry that your DS is going through this, and I don't have better advice.

[BobbiFleckman]

this started for us around potty training. we had a year of hell, all I can remember about DD for her 3rd year is the pain she was in, withholding. The third doctor we made it to cured all very simply and quickly.
GPs will tend to prescribe horror powder called Movicol. Unless your child is constipated, it's probably not the right thing however it is the newest wonder drug for constipation and is the only one for which clinical trials have been carried out (apparently). The good old fashioned remedies have been used but not formally trialled. The side effects of Movicol are monstrous and far more distressing than the withholding.

To cut an extremely long story short, Doctor Number Three (who is very old school, in his seventies and has 6 children of his own and is a close personal friend of the doc who set up the ERIC charity) prescribed good old fashioned Senna / Senokot. He advised us to totally ignore what's written on the packaging (& not tell the pharmacist that it was for a small child when buying the mega bottles of it!) and to start at 5ml / day and then titrate upwards daily by 1ml (we administered via syringe for accuracy / avoiding the vile taste as far as possible). I think we built up to 20ml / day before we had absolutely regular daily poos (you could set your watch by it). At whatever stage you reach teh regular daily poo, you titrate downwards by 1ml / day - stop at any stage and keep going at that level until you get the daily poo. The whole process did take about 6 months BUT - there are no hideous side effects like the Movicol powder. We gave it to DD first thing in the morning and it produced something at about 4pm / 5pm - it says on the package that it shoudl be taken at night but given how early small children go to bed, it would have them up at 3 /4a.m needing to poo.

The big difference between Movicol & senna is that with movicol it liquidises the poo and so they eventually can't stop themselves from going (& you don't need that if it's soft anyway), but senna gives teh bowel a good old squeeze and they therefore learn the signal that they need to go.

The ERIC charity website had some good hints on how to teach a child to poo and how to make it easier on the potty / loo - not sure if it dealt with nappies at all.

You're dealing with the problem very, very quickly so you won't have nearly such a long haul with it. Good luck!

[diedandgonetodevon]

Poor boy. Maybe take him to see a more sympathetic GP? There is nothing worse than being fobbed off when you know there is a problem.
The witholding may well be a phase but he is going to need help to get through it. If he keeps holding it in it becomes impacted and then the poos and leaking are really quite awful.
DS (3) suffered from this but is now on Movicol from the GP and I cannot describe how much better it has become.

[BobbiFleckman]

actually the wonderfully named diedandgonetodevon has reminded me that we had to do a massive Movicol clear out before starting on the senna treatmetn to get rid of all the impacted poo, and a final Picolax extravaganza (which she still managed to withhold on). The whole impaction thing is vile which is why it's so good that you're on the case and dealing with this in 4 weeks before it gets too bad.

[juneau]

Just found this thread. We're two months into a horrible, summer-ruining bout of witholding and we're finally getting specialist help, because I'm at the end of my tether. DS1 is currently on day 12 without a poo. Two sachets of Picolax have so far failed to produce anything but a bit of smearing in his pants. He's been on Lactulose and/or Movicol for large chunks of the summer and it does work to clear constipation. The faecal incontinence that comes after is just awful though and as he's about to start school I really don't think it's the answer. We have tried Senna - albeit cautiously - so the answer above is very interesting. At this point I'll try anything

[NomNomingiaDePlum]

have you tried glycerol suppositories to clear the hard bit? nasty but effective

[brettgirl2]

I reckon try and encourage him to use the toilet to break the cycle. My daughter was terrible at with holding in nappies but it stopped completely once out of them.

[juneau]

We've had no success with suppositories and DS finds them really unpleasant, so that was one of several things that just didn't work. This is a serious problem, unfortunately. We've just a session of 'Poo Goes to Pooland' though as I like the way the troublesome poo in the story is to blame, rather than the child. DS has been feeling lately like he's to blame and that just doesn't help.

[butterfingerz]

Try Floradix Magnesium liquid (available via Amazon for about £6). Magnesium is a natural laxative as well as an essential mineral required by the body like calcium. So some people take it as a health supplement but if you take too much it will make you go. It's a very safe thing to take as the body does require it anyway, it's very hard to overdo it unless you megadose and have poorly functioning kidneys.

Anyway, the adult dosage for the magnesium liquid is 20ml so you could safely give him a half dose and it'll do it's magic several hrs later. It doesn't make the poo runny, just stimulates the bowel to move.

[juneau]

Thanks for the recommendation butterfingerz - I'll have a look at that. We finally had some movements yesterday after the Picolax.

[NeedToSleepZZZ]

Ds is 19months and had severe constipation/ withholding problems since he was weaned and we are currently seeing the paed and have a referral to a bowel specialist in October. Ds has senna at night and movicol in the morning, it does lead to very runny poo but the idea is to get ds used to pooing without pain, he's too young to really explain much to but I have tried and he's seen OH and me on the toilet and changed his teddy's nappy etc.

I just wanted to say that it might be a good idea to get your ds checked for any fissures that may have come from the big poo he did after being unwell. They can lead to this behaviour because it really does hurt to poo when you have a tear in your bum! Ds had one and we used germolene (the one with local anaesthetic in it) on his bottom to numb it. Other than that, I feel your pain, it does seem more common in boys. If the bowel specialist has any other tips I'm willing to share if it's still a problem then.

[NeedToSleepZZZ]

Oh, and if no fissures then try using aveno cream on his bottom to ease any soreness and help the poo come out.