My 4 year old will not poo in the toilet - please help!

[mrsm22]

Hi

I have posted a while ago about my 4 year old DS struggling with constipation and received some very helpful advice on here. However, we seem to be struggling again. To give some background, my DS has always been a very picky and difficult eater, and he will only eat very limited meals. For example, he will eat spaghetti bolognese, a jacket potato with cheese, plain boiled rice with gravy, Turkey meatballs in tomato sauce, a beef burger, chips. And those are the only meals he will eat each week, so usually I will make spaghetti bol a couple of times a week. I know those meals aren't bad but it's more breakfast and lunch times which are most difficult. He will not eat cereal or porridge of any kind. His breakfast each day is usually grapefruit and a yoghurt. We all like fresh red or pink grapefruit in our house so luckily he likes that, but I think it ruled be vetter if he'd eat some kind of cereal. Lunch times are hard as he will not eat a sandwich of any kind. He likes plain pasta shapes cooked, a dish of plain rice with gravy, sometimes a bit of cheese and tomato pizza. He loves yoghurts and fruit pots, he will eat apples and strawberries.
Sorry for all that info, but just to give an idea. I don't think his eating is brilliant and I think this may be the reason he suffers so often with constipation. Anyway, a few months ago he was badly badly constipated a do think it was 9 days he went without having a poo. He had awful stomachache and the doctor prescribed Movicol, which has been and still is wonderful for him. He had sachets for a couple of days when he was badly constipated and compacted and it did the trick. The Dr said to wean him slowly off the Movicol, but I haven't quite got there. I have reduced it down and down and he seems ok on half a sachet morning and night or just one full sachet before bed, but any less than that or stopping it completely and he just cannot poo.
I'm not especially concerned about him being on Movicol I it helps him, but the problem is that when he has been a couple of times badly compacted with hard poo that's been hard to pass, he got frightened to let his poo come out because of how much it hurt or how much he thought it would hurt that he stopped going on the toilet. Instead he would stand with his legs crossed trying not to let it out. And obviously eventually it would come out in his pants. I have struggled and struggled trying to get him to sit on the toilet and I try 20 mins after each meal to sit with him on the toilet, which he will do but he pushes and pushes and nothing comes out. Then a little later I'll find he's gone in his pants.
My DS starts school in under two weeks and I made it my aim to try and get this sorted out over the holidays but I am just not winning with DS and he's getting upset over it and I am too. Every day he poo's in his pants, and will not do it in the toilet. I have tried everything, reward charts, bribery, taking to him, treats and the promise of a brand new scooter at the end of this week if he manages to do one poo each day on the toilet. But no.. Been out with him and his younger sibling this afternoon to a park and playground and I could see him stood straining with that look on his face where I know he needs to poo but isn't letting it out. I feel ive tried everything. I am worried that at school he will poo his pants, and I don't know what will happen then. Will school send for me to change him? I obviously don't mind doing that but I wish for his sake that he could go more easily and that he'd sit on the toilet. I don't want him to be the boy at school who smells of poo when he's had an accident.
People say the eating more will come but making his lunch box when he starts school will be difficult.
I am planing a trip to the doctor's with DS this week but I'm not sure what they will suggest. I am wondering if he needs a referral to check his bowels are ok. Does anyone have any useful advice or has anyone got experience of this?
Apologies that this is such a long post and I would be grateful for any advice or shared experience.
Many thanks for reading.

It's such a difficult place to be in and it's a vicious cycle is'nt it? Poor DS and poor you!

I think from what you've said, that his issues have begun because his diet is so high in carbs and fat.....cereal won't be a lot better than his grapefruit....he needs more roughage and fibre.

I also had a picky child and eventually began hiding vegetables in things but it's hard going and of course, they're not as useful to the body once they're minced up in a sauce.

I would ask the GP for some dietary advice..to see how to get him eating in a more balanced fashion....and speak about his movicol....maybe it's not ideal to cut it back at the moment.

Have you involved him in cooking at all? I find this can help encourage a lot of kids.

Don't worry about the diet for now. It's not necessarily the cause of the constipation. It's such a common problem with children regardless of diet. Also, fibre/"roughage" is actually a big no no with chronic constipation. When you add lots of fibre to an already sluggish gut, it's going to set like concrete and make things a whole lot worse.

Don't reduce the Movicol either. In fact you probably need to increase it. You need to make the poo soft so he can't withhold it, and also break the association with toileting and pain. That will take a long time.

Absolutely ask for a referral to a paediatric gastroenterologist. They can look into what may be causing the constipation, advise on long term strategies and help tackle the withholding too.

Thank you ever so much both VioletBam and Jinxmonsoon.
VioletBam- It's true what you say about hiding vegetables in things. When I make spaghetti bolognese, I put carrotts onions and mushrooms in it and DS will eat the whole meal. Also chopped toms are in there. However, if it's another meal and he sees carrotts sliced up he will not touch them. He does like brocoli. I do get him involved in cooking, he helps me make meals and watches me chop and peel veggies and he puts them in pans etc. I find it very hard thinking of meals to make every week as he's so reluctant to try anything new and is set on a few certain meals. It would be good to try something new if I could think of a good meal he might be willing to try.
Jinx- I took DS to the doctors this morning and I was very honest with the gp about the difficulties especially with getting him to sit on the toilet. I asked for a referral and the Dr agreed to write off for one today. Fingers crossed I will get some help. He's had no problem 'going' today but sadly each time it's been in his pants. I can't think of how to try and persuade him to sit on the toilet but I'm going to try in the morning after his breakfast. I suppose half the problem is that you don't know exactly when he's going to need to go and the timing needs to be right, so that I take him up to the toilet at just the right time so that it drops in for him without hurting or too much difficulty for him. If he sees its not that painful actually then he may be more willing to sit and try each day.

Google Poo Goes To Pooland. It's a story you can download free as a pdf written by a child psychologist to help children who are struggling with poo. My 3yo wouldn't go in the toilet until we'd read that a few times and still mainly goes in his nighttime nappy first thing in the morning, but did stop just doing it in his pants. Worth a try.

Have you seen the 'poo goes to poo land's app by Tyne and wear (I think) NHS? I downloaded it for DD this summer as I was getting desperate to get her to poo in the toilet. It took a few weeks to sink in but she's actually just cracked it in the past few days. (She has digestive issues etc and would also withold poo until she could do it in a nappy)

At the referral you will almost certainly be told to up the Movicol! And yes fibre is not the answer - it just creates a concretey web that's even harder to pass. Just do it with the Movicol and let him get on with life.

He needs to have ages and ages and ages when pooing is not painful and sitting on the loo is routine and fun (poo or no poo).

His bowel is likely normal but now saggy because it's stretched from all the time it's been constipated. So it will take a long time for it to return to normal and know how to do a nice controlled formed poo again without the aid of any Movicol and with him completely in charge of it as the bowel has to shrink back to normal size and he has to stop being frightened and relearn what to do.

It's a very very long haul and you may find he is on some Movicol for months or years. It's not about how much veg he eats

Would a high potty help, so he was sitting with feet on the floor and knees bent in a more squat-like position, IYSWIM? We had one of these for DD until she was over 4, just for poos, because she felt too unstable on the toilet even with a step.

I also use a hand blender to hide chickpeas in pasta/meatball type dishes - whatever is in chickpeas, seems to help!

I think PPs have given brilliant advice about other help, and I hope it all gets easier soon.

I'm wondering whether pooing on the toilet isn't the problem per se, but that it's more a case of him trying (but failing) to withhold all the time and that's why he's soiling himself.

Of course, one option is to take the toilet out of the equation entirely. Would he use a potty or is he too big for one?

My DD had a problem with public toilets and just wouldn't use one, so we used to take a potty out with us even though she was four. And she wouldn't even use the potty inside a toilet sometimes, just in case I accidentally set off a hand dryer (that happened once ) so we'd have to go to a baby change room or something. God, it was awful and embarrassing. Kids are weird and stubborn. Thankfully, she grew out of it.

JinxMonsoon - All of the responses I havd had so far have been really helpful but your suggestion here about taking the toilet out of the equation has really made me think. And I think that's an excellent idea. No idea if it will work with my DS but he obviously doesn't want to even try to go on the toilet, but the fact that I'm constantly changing him into clean pants and having to wash his pants out all day (I don't really mind this), but it would be much easier and I think a step in the right direction if he'd try go in his potty. Basically I need to take it back to basics, he's perfectly toilet trained in the wee department but he needs re-training in the other way. I still have his red racing car potty and he will still fit perfectly on it. My younger child is just about ready to be potty trained and I plan to do that when DS starts school.
So the plan.. I have downloaded Poo Goes to Pooland, ready to show DS tomorrow. I think he will like that. Then do I have a little discussion with him in the morning and say that I'd like to bring the potty back out for him to try and poo into? That way he will see that we then put it down the loo, still sending poo to Pooland. I really think this would be good progressing he can and will do it, and it would be an improvement on the situation for him. It would be good to go to that referral saying we have made some steps forward. Thank you for coming up with this idea Jinx. I really hope it works!

Yep, back to basics! The way I see it, anything is better than pooing in pants, so if the toilet is too big and scary for whatever reason, stop trying for a bit. It won't last forever.

Just going back to what a pp started on, make sure his little legs are not dangling. It puts pressure on the bowel and effectively "locks off" being able to pass matter.

Think right angles or slightly higher. Get his feet right up on a high secure step or blocks.

Sit on the toilet not for poos but for screen time. Remove screen time from the day to day.

Make the toilet a positive association. If he goes he goes, if he doesn't then he got an episode of whatever from YouTube!

It will come. Keep him well hydrated.
Does he like milk? Milkshake? Yes he needs roughage but fats will help a little too.

With regard to school, we have several children with the same issue - one in Year 4. So it's not unusual.

Give him a bag with a change of pants and trousers and be prepared to have it come home every day (it probably won't). Talk to his teacher and explain the situation and what works best for him.

If he can clean himself up after a pop (or an accident), that will make a big difference. Bear in mind that if he needs an adult to clean him up, it will need two of them and that's not always possible so if you'd prefer to come in and do it yourself, let the teacher know. I'm sure it won't come to that.

• poo not pop!

Well I have some good news and I am really delighted! After a fantastic suggestion from JimxMonsoon last night, this morning I showed DS 'Poo Goes to Pooland' on my phone and he loved it. He found it very funny, especially Poo's voice. Anyhow, I talked with him about bringing back the potty and he said yes. So I went and got the potty and we had it downstairs and after breakfast he had a poo in his pants. I wasn't happy, it wasn't looking good BUT then about ten mins after his lunch today he told me that he needed a poo and he sat on the potty. After about ten mins he did a poo on the potty! He was really pleased with himself and I was so pleased. He took it upstairs and sent it down the toilet to Pooland! This afternoon at about 3pm he came inside from playing in the garden and while taking off his shoes said that he needed another poo. A second poo on the potty.
I know it's not the toilet but I think it's fantastic progress and a step in the right direction. He's been told of he keeps it up for a whole week, going on the potty every day that he can have the scooter he wants.
I want to say thank you to everyone who has responded as it has been great advice and tips from everyone but a big thank you to JinxMonsoon. I can't believe I never thought of bringing back the potty, I never thought.. How stupid of me. If only I'd tried this sooner. The hard bit is obviously going to be keeping him going on it every day and getting him into the routine. We have 7 days before starting school on Weds 7th.
I'm a bit worried about school as he won't be able to use the potty there obviously and I don't want him going backwards. Hopefully as he will have his breakfast early on a morning, he might do a poo each day before school and he doesn't always go after lunch. Does anyone know how long going on the potty before I can try suggest the toilet? I don't think he likes the toilet as its high up. We don't have a stool or steps, but I could get one (can't think of the correct name).

I was also going to suggest the potty again, and I am delighted that it has worked. I wouldn't hurry to change back to the toilet - let him get used to not going in his pants first. If that is weeks or even a couple of months away, don't stress. I assume you have one of the inserts for the toilet seat? I found that was a blessing, because the kids weren't scared they would fall in if sitting for a while. Goggle steps for toilet training and there are various sturdy options that might make him feel more secure. I spotted one that had sides, which seems a good idea.

Just have patience and with everything you are doing, I am sure you will get there in the long run.

Sounds like you're making good progress Get the special toilet steps from Amazon-I can't remember what they're called. We had terrible withholding issues with ds and the he went in a pull up for nearly a year after being potty trained. We used the advice from the ERIC website to move him from pull ups to the toilet and used the steps to help him grow in confidence. He now happily poos on normal toilets and at grandparents houses etc though he does still need reminding to go on occasion if he's doing too many things and doesn't want to get distracted. School will be understanding, just talk to the teacher

Brilliant result

If I were you, I'd leave off mentioning the toilet for a few weeks at the very least, just to break whatever negative associations he has with it. As long as he's not withholding or going in his pants, that's a big step in the right direction.

Then ask him if he like to start pooing on the toilet. Maybe a reward chart for each successful visit.

You never know, he may be OK on the toilet at school as they are smaller and lower than the toilets at home.

Our infant toilets are smaller and lower down, plus we have stepping stools

LittleCandle - Thank you for also suggesting going back to the potty again. And thank you, I am so delighted. I have been really stressed about this, I thought he'd be going in his pants forever. I don't have a toilet insert. Does that stay in permanently and where can I get one? I definitely need steps too.
MrsSlocombesPussy - I hope you're right, I was thinking the loo's might be smaller. It would be great if he just went when he's at school and that being at school sort of sorted out the problem but I'm sure that is probably too much to wish for and I know it's going to take time.
SuburbanRhonda - thank you, that is comforting to hear that the loo's are small and have stools. Hopefully they will be like that at DS's school.
Thank you again to everyone on here who has taken the time to help me with this. We are by know means there but I know it's baby steps and as JinxMonsoon said, as long as he's not withholding or going in his pants, he is definitely moving in the right direction.
I should probably try choose and get some toilet steps and a toilet insert soon as poss so that I'm organised and ready for when DS is hopefully ready again to try the toilet. If anyone has any really good suggestions for the toiket steps please feel free to advise.
My worry with school is what he will do if he needs a poo and he will know there is no potty to go on. It would be a shame if he's using the potty at home and then goes in his pants at school. Hopefully it won't come to that. Should I have a talk to him the day before school and just mention that there won't be a potty at school to use but that the toilets are nice and small just like a potty, or is that daft?

Teacher54321 - Sorry that you went through similar with your DS, it's so reassuring to hear that your DS is now doing so well and will even go to the toilet at Grandparents houses. I'd love to be at that stage now. I will look at the ERIC website too.

www.amazon.co.uk/gp/aw/d/B000VY1WPC/ref=mp_s_a_1_17_a_it?ie=UTF8&qid=1472676838&sr=8-17&keywords=toilet+step

Is similar to the seat we got

for a long time he had the routine that he'd only go after his bath at bedtime. Now he either takes himself off during the day or if I can see that he needs one then I just send him to the loo and bribe him with a chocolate button to go. If he's not done one during the day then I encourage him to try after his bath and he usually does. He was on movicol for a few months as well and it made a massive difference. I always keep some in the house just in case!

Fingers and toes crossed that the potty will make a big difference. Sending you all the luck. This was honestly the hardest bit of parenting, I cried so much about it and even considered paying to see a consultant privately. He cracked wees on day two and has never had a wee accident since.

teacher54321 - thanks for the Amazon link! I think the Movicol is actually a Godsend. We previously tried Lactulose about a year ago and it was awful. What you said about this being the hardest aspect of parenting, it struck a chord with me and so far I'd have to say the same. This weekend just gone I cried a lot about it as it dawned on me how close he is now to starting school and I felt like I was losing a battle with DS. He's very self-willed and if he doesn't want to do something it can be so hard. Also, I barely had to potty train DS with wee's, he got it from moment one, we never had any wee accidents and he never sat down to wee in the potty either. He was very quick with that and clever. The poo training was harder. It's stressful and it's upsetting because we just want the best for them and not for them to struggle or suffer with things like this. So day one of the potty over and two successful poo's! Let's see what day two brings and thanks to you all.

How was today? Was thinking of you and crossing my fingers!

teacher54321 - that's really nice that you were thinking of us. Well today was strange because we didn't get even one poo, not in the potty or in his pants. He just didn't go. I don't know if it's because he had 3 poo's yesterday that he just didn't need to go but the good thing is that he has sat 3 or 4 times throughout the day on the potty but nothing has happened. I sort of feel a bit disappointed that he hasn't gone but I should just be thrilled he hasn't gone in his pants. He has eaten not too bad today for him. I think he definitely still needs two Movicol each day, one morning and one at night.