Anyone have experience of SENNA in poo witholders?

[HiggsBoson]

Hello :)

Could do with others' perspective on this.

DD (2.7) has been potty training for 4 months and has been dry from day 1, but will avoid pooing at all costs.

We've been referred to a 'poo doctor' who prescribed increasing doses of senna to disable DD's poo witholding ability.

It's not really working :( We are up to 25ml per day and she can still hold on to the feckers!

Every day is blighted by DD screaming, dancing and holding on, waiting around for her to poo and generally being on edge and ultimately dealing with VERY messy & runny senna - induced poos. Grim.

The poo doc keeps saying increase, but I'm not sure this is working for us. We're also getting the patronising 'blow bubbles on the toilet' advice, but we are WAY beyond that.

I have tried EVERYTHING :(

Anyone else have experience of this?

[Brandnewbrighttomorrow]

The only thing we found that helped was this book by Anthony Cohn we don't use any medication but get our DD to sit on the toilet every other night basically until she goes. This hasn't resolved the withholding but it does prevent her from getting constipated or having accidents.

We tried movicol, lactulose, prune juice etc but none made any difference. This book made me look at what was causing the problem (the withholding) not just treating the symptom (constipation). It also gave me an insight into what was causing my DD to withhold and gave us common language to discuss it.

This is an area in my experience that gp's are particularly bad at dealing with. The last gp I spoke to about it laughed at me and said she was just doing it to get my attention - that may be part of it but it was spectacularly unhelpful.

[BikeRunSki]

I could have written your post last year OP! On phone, on hols, can't link, but search under my nn for Oct 2011.

[HiggsBoson]

Thanks guys! Will check out your posts BikeRunSki.

I have that book Brandnew, but it doesn't seem to have helped much. I can only get DD to sit on the toilet for very short periods - she gets massively stressed if she needs a poo and won't even entertain it :(

[HerbWoman]

Can I ask what preparation of senna you are giving her - can you post the ingredients here? 25ml does sound a lot but it depends on the preparation. It might only contain a small amount of senna I suppose.

[HerbWoman]

Oh, and was your DD having any problems with pooing before potty training?

[HiggsBoson]

Hello Herb :)

We are giving her Senokot. I doubt it's the strongest preparation available.

It's confusing as she is definitely still able to withold, but when she goes (everyday usually now - after lots of fuss!) it's messy to say the least. The senna must be doing something, but on it's own it doesn't seem to be enough.

DD wasn't having probs before potty training, no. I feel that her probs are behavioural and much more complex than the poo doc is giving us credit for. FFS we've tried the bribes, charts, pooland, books, sitting on the potty, blowing bubbles, watching her friends doing it, etc., etc.

Maybe I need to be more patient!

[HerbWoman]

Ah - 25ml of Senokot syrup is quite different to 25ml of a herbal tincture, but is still 5 times the max on the bottle for that age. If it is making them very runny then it has certainly done what you would expect senna to do so I don't see the point in increasing it, and if they are that runny I would question the wisdom of keeping it at that dosage at all.

If there were no problems before potty training then it obviously isn't a diet/water intake issue, but a stress issue. I would probably try backing right off and handing control to your DD - put a nappy back on, say she can still wee in the potty and you can help get the nappy on and off but tell her that it's OK not to bother about the potty for poos until she wants to. Then don't mention for a couple of weeks. I know that sounds as though you would be going backwards rather than forwards, but it helped when I was potty training my dd and she was having accidents everywhere because it took the pressure right off her. Bribes and charts just added to the pressure.

Senna can also cause stomach pains and there are no herbs in the syrup to deal with that so she could also drink some chamomile, fennel or peppermint tea to ease those. Herbalists would commonly use warming herbs like fennel to prevent griping with herbs like senna. Chamomile would also help to relieve the tension.

[madwomanintheattic]

At 2.7 you probably need to stop trying for a few months and both chill out.

Medicalising the issue at this point probably isn't helping your stress levels or her to relax. (and I am faintly weirded out by a doctor suggesting meds at this stage, if I'm honest)

Put her back in pull ups and nappies, and take the pressure off. Try again in November when you have both recovered from this traumatic period.

And in the meantime, let her know it doesn't matter.

[HiggsBoson]

EXACTLY my thoughts Herb!

I've had lengthy telephone conversations with the poo doc on a few occasions about this.

Last time we spoke I said that although DD is very loose, she is still holding and still going any time of the day or night as opposed to at a set time each day - her answer was to keep increasing the dose until she HAS to poo every morning - up to as much as 40 or 50 ml . We are miserable :(

She is lovely, but I do wonder if this is best for us, as she seems to think it is a physical rather than behavioural problem and is forever forgetting that we don't use pull-ups, haven't had impaction/fissures etc.

I am definitely trying the don't talk about it route now as DD KNOWS what's going on here and doesn't need to be told that 'big girls poo on the potty' yet again!

My two big worries are:

Nappies back on: DD is in knickers in the day and, this is going to sound really pathetic, but most of DD's toddler friends potty trained for poos overnight and I'm worried about the public humiliation of having a 2 year old in nappies (I know some rather competitive mums!).

Going against medical advice: I'm a bit worried the poo doc will get the arsehole if I don't follow through with the advice (oops! Pardon the pun )

I am so hoping the penny will drop with DD soon!

[HiggsBoson]

Thanks madwoman DD would be mightily hacked off at being back in nappies though. She likes to wear her knickers.

I have tried putting her back in nappies and saying it doesn't matter, but she still witholds regardless if what's on her bum iyswim.

Am I being naive then? Or are other mums bullshitting?

Amongst the other mums I know 2.7 is considered very late and in fact many are saying their under 2s are fully potty trained. Loads of pressure to be clean and dry very early - plus I have the whole 'you were pt at 18 minths' guff from my mother and MIL.

[TheCountessOlenska]

Oh God, ignore horrible competitive mums! I know loads of people who haven't started potty training till nearly 3. I did it when DD was 2.3 but only because doing nappies was giving me the boak (morning sickness) - I really can't see the problem in older toddlers in nappies, I mean they're obviously going to get there eventually!

And DD wasn't overnight by any means - in fact we had a poo accident yesterday at soft play and she's been potty training for a good few months now!

Good luck with your DD, 2.7 is only a little thing really - she'll get there!

[madwomanintheattic]

Increasing the dosage until withholding is impossible is a recommended technique, but for much older children.

Much older.

I have no idea why your doctor advised this method in such a young child.

All kids will develop when they are ready. It's about your child, no one else's. I might be very matter of fact with dd, and explain (there are a gazillion books out there about different levels of development for kids that would be age appropriate) that it doesn't matter that she can't control her poo right now, but that she will, soon. But that in the interim it means she has to wear a pull up.

Believe me, I know she won't like it. But she doesn't have the control to wear knickers, if she is having unpredictable bowel movements. You really don't want to spend the next few months clearing up after her, never knowing when she's going to explode, in knickers.

It's really really common. Whatever the other mum's say!

(we had a friend whose son had perfect control of his bowel movements. Except that he chose not to do them in his pants or on the potty/ toilet, but in a quiet corner, usually behind a neighbour's sofa....)

But you just need to be really matter of fact about it, no pleading or coercion, just 'this is how it is, and it doesn't matter'.

Any pressure right now will convince her that is something way big and scary, not a perfectly normal part of being 2.7.

[HiggsBoson]

Oh dear :( The idea of going back to napies terrifies me!

Her bowel movement's aren't unpredictable as such. We know they're coming for hours by the whimpering, whining and shouts of 'need a poo'. She KNOWS when a poo is coming alright, but has a massive stress issue with using toe potty/toilet to deposit it.

I've even had her sat on the potty squirming about and moaning about needing a poo etc., but she never actually does it :(

[MousyMouse]

what about nappies only for a poo for a while? would that be less stressfull for her?

[madwomanintheattic]

You just need to go back to the matter of fact. If she is whining and saying 'I need a poo' you can ask her if she wants to use the potty. But no pressure at all, and I'd be pretty much ignoring it. She sounds as though she absolutely has the understanding and ability to gain control, and it is just the anxiety holding her back, so you can just say 'that's okay darling, do you want to use the potty?' and if she says no, then say, 'ok, but then we get a nappy on. Poo goes in the nappy or in the potty.' and then carry on without comment. It really doesn't matter if she chooses not to go to the potty. You could even just ask 'where would you like to do it?' whilst absent mindedly chopping carrots or whatever - don't make it a big thing at all.

Fear of pooing on the potty is so common at this age. Did you try letting her use the toilet? Some kids don't bother with a potty at all. It would be physically more difficult for her, without a step at the right height to facilitate the bowel movement (which is why potties are better for short legs lol) but if she is used to you sitting on the toilet, some kids find it less threatening.

But whatever you decide, for a few months she has to be able to grasp that it doesn't matter. Pressure right off.

I'm still in shock that the doc prescribed laxatives with no constipation in a 2.7.

With ds1 (much much older than 2.7) the paed recommended sitting on the toilet ten minutes after dinner, having had a warm drink. Just for ten minutes, and then off, even if nothing happened. I wouldn't recommend this in a tiny either, as you want them to be listening to their body and recognizing the signs that they need to 'go'. Ds1 has had extensive toileting issues.

[HiggsBoson]

It's a good suggestion Mousy, but one I've already tried :(

I'll offer the nappy, put it on and then she STILL witholds, even if you can see she's in agony with it. It seems to make no difference at al whether her bum is clad in knickers or a nappy.

The only person it makes any difference to is me, as of course pooey knickers are more unpleasant/awkward to deal with and can cause leaks onto clothes, so putting her back in nappies would be purely a move for my convenience.

[HiggsBoson]

We have toilet seats and steps for the big loo, but no banana :(

DD has never been constipated as such,but we were initially referred because she was going 2-3 days between poos.

I think you are probably right madwoman - it's a case of playing it cool and chilling out. Not talking about it or trying to persuade - then she can take control on her own terms.

Makes total sense :)

[madwomanintheattic]

Re the 'control' issue - I think it is absolutely key. You need to stop thinking about the nappy as a retrograde step for your convenience... It isn't. It is absolutely tied up in the control issue - she does not have enough control not to poo in knickers, ergo, to put her in knickers is plain daft (whether every other kid on the block wears them or not). it isn't anything to do with convenience for you, it's because she isn't ready.

So, until she develops that control, you need to be the one in control. She might even find some sense of control in that - in that she doesn't need to be anxious because you have removed the control from her. She's so very small.

Obviously, she needs to know that you will be in control, until she is ready to do the big girl thing herself - and there's no big deal about hurrying that, as long as she knows that she has the option to use the potty or loo if she feels like it. And if she's dry, then do get her to carry on using the potty to pee, and lots of reward. But no value judgement about the poo issue etc etc.

Kids are so very different. Who knows what goes on in their heads?

[StrawberrytallCAKE]

Wow senna for a 2 year old seems a bit crazy!? When I've had to use senna in the past it was so painful, hours of cramps before anything else.

My dd went through the exact same thing at the same age, she wouldn't even go in her nappy. I used to have to read her stories to get her to calm down and relax but it could take hours. Our dr prescribed movicol which is more gentle and when she had relaxed about doing a poo in her nappy we tried potty training. It took a long time but she has no issues now, I believe it's quite common and the more stressed you are the worse it will be for her.

[HiggsBoson]

Thanks - really appreciate your help.

It's wierd - if she's wearing a nappy and needs a wee, she will want to take it off and use the potty as opposed to just going in the nappy, so yeah - that could work. I assume with pull-ups I just cut them off if she fills them with #2?

My mummy 'friends' are going to love this

[HiggsBoson]

I'm sure you're right about the stress Strawberry and I am a serious stress-head!

I've heard some horror stories about Movicol though, so I'm not sure about that. It's all very confusing

[HiggsBoson]

Oh yeah, and I cloth-nappied her until she was 2.4, so that old chestnut about it being easier to PT from washables ain't quite true

[madwomanintheattic]

Different stuff suits different kids, tbh. But anyone who prescribes senna to a 2 yo must be due for retirement, or at least hasn't had much recent exposure to toddlers and potty training!

We haven't used movicol or senna, but have been prescribed lactulose, and elsewhere, lansoyl. Much older, though. Much older.

Meh, who cares what your mummy friends think? The fact that everyone maintains this ridiculous aura of silence around potty training issues is exactly what makes you think your kid is abnormal and stresses everyone out. More people should discuss it. It's only bowels. and she's 2. No need for any shame.

[Brandnewbrighttomorrow]

Oh, I didn't register your little one's age when I read the op. Agree I would back off completely, go back to pull up nappies so she can still wee on the potty / toilet as she wishes but I don't think meds are the answer for poo withholding issues at such a young age.

Both of my elder dc's were well over three before we started potty training, it only took two days for my eldest, a little longer for my son (easily distracted) I know it varies from child to child but four months for potty training suggests that she just isn't ready yet.

[HiggsBoson]

You all make perfect sense, but then this is MN, what did I expect

What do I do about the senna though? Surely we can't just stop it? Poo doc won't be happy!