At wit's end with 4yo's poo withholding.

[longestlurkerever]

Dd1 is 4.5. Poo has always been an issue. I thought we'd cracked it last summer but it's back again. She got very constipated before Christmas and started having accidents. I took her to the doctor and we've been making progress with lactulose and getting her to sit regularly but she's still deliberately withholding and I just don't know what to do. I have to beg her to try to poo as if she doesn't I know she'll have an accident at school but I can tell she's not trying and it ends with me angry and in tears and us being late every day. I don't think she's constipated any more, though I worry she will get it again if she stops the medication (another battleground).

She had two accidents at school last week and refused to be changed. School have said they can't wrestle her clothes off her so will have to call me in if she refuses to be changed. I'm supposed to go back to work soon, I feel like this is ruining our lives (dramatic, but all my energy goes on this, I want to be doing so much more with her).

It's the psychological aspects that worry me. She's normally so articulate but will not speak about this. She glazes over and blanks me out when I try to have a calm conversation with her (it's a bit scary) and if I get cross she's weirdly unbothered.

I have a meeting with her teacher and SENCO and a telephone appointment with a doctor this week. Is there anything I should be pushing for in terms of a referral? At the very least she seems to have issues around poo but I'm starting to worry that it's a symptom of something else. She's wilful and high spirited and gets hyper and unmanageable if tired but is confident, cheerful and very articulate as long as she gets 12+ hours of sleep, some exercise and some each day. Her diet is ok I think. She likes vegetables and loves fruit. she doesn't drink enough. This is another battleground.

Any tips?

[Haroldplaystheharmonica]

You poor thing, I completely know where you're coming from. This issue is just all consuming and it was all I could think off as I just felt worried about it all the time. I understand the 'glazing over' too, it's as if they don't get there is a problem or wasn't to discuss it in any way.

My eldest (11 now) has poo issues from when he was potty trained at 2.5 although it didn't really feel like an issue until he was at pre-school and I'd go to pick him up wondering how he'd been. At that stage, he would actually have a poo but not in the toilet so I'd sometimes collect him and he'd have done it in his pants. The staff were great and understood it was an issue and said they'd rather he had one (in his pants) than withhold it even more.

We went to the doctors which were useless as they just said it was a phase and him going once a week was normal (it wasn't as he was clearly ready for a poo after 3 or 4 days and would be uncomfortable and hide when we asked him to go). We also went to CAMHS who were very nice but didn't really tell us anything we didn't know or hadn't already tried. He's been on Movicol (great and worked but didn't really solve the problem) but I think one of our issues was the fact he doesn't eat or drink a lot. I'm sure this definitely contributed so all the problems.

We started making him sit on the toilet every night, about half an hour after his tea and honestly, he had (and still does have) a poo most evenings. This is great BUT at 4 or 5, there was not way he was even going to entertain sitting on the toilet to try and go so it's taken us a long time to get to this stage. When he was younger he was clearly impacted so sitting for 10 minutes wouldn't have produced a poo. Now he's going much more often, he obviously isn't constipated and so it comes much more easily.

So to cut a long story short and probably not what you want to hear, DS just came through it on his own but not for a long time. He was still having issues up until he was 9 or 10 but they were much fewer and only happened rarely although I still worried every time he went to a friends or a party.

Sorry for the lengthy post, feel free to ask me anything I might not have covered!

[WipsGlitter]

Very familiar!

I would go for movicol (or "move it all" as we call it) it makes them poo - the laculose is just a softner.

DS was similar, he still can go for days without pooing and when he does go it is MASSIVE. But generally no more accidents. He did get constipated over Christmas so i gave him three sachets of movicol and that did the trick.

We had tears (both of us), books about poo, making him sit on the loo - nothing really worked but it got better on his own.

[longestlurkerever]

Thanks both of you. It helps just to have someone understand how upsetting it can be. I've spoken to the Eric charity helpline today, who said I needed to take her out of school for a week and give her high dose movicol till she's pooing brown water. But when I spoke to the Dr he said this was going too far for now as she is going regularly, albeit not enough, and I should introduce movicol morning and night alongside the lactulose but she can go to school. Am inclined to try the latter first as taking her out if school will be a pain, but I'd rather do it now than later if it is going to be necessary. Any thoughts?

[Ashers40]

Both of my children were poo with-holders during and after potty training. I found it all very stressful. With DD2 I told her if she didn't start pooing I would take her to the doctors. Result - she started pooing regularly. DD1, amdifferent story, and overall a much more complex child. She was regularly constipated, wouldn't go for days. Would leak liquid and dirty her knickers and then eventually do a massive poo that was painful. She also suffered tummy aches all the time. Eventually took her to a paediatrician who of course put her on laxatives. This was when she was about 6. She eventually accepted the cause and effect, i.e you withhold the poo, the poo gets bigger, it can't stay there forever, you get a tummy ache and then eventually do a poo that hurts, which makes you afraid to poo.... So she agreed she would do a poo every day at the same time, after her bath (feeling relaxed) and before bed. The paediatrician said so many years of withholding had affected her ability to feel the urge to poo and it could take years to get back to normal. As long as she did a poo every day then it was ok. She is now 10. She still pretty much does still poo every evening before bed, but occasionally she will do one at a different time, I.e when she feels the need so I think it's a slowly improving situation and I don't worry about it as long as she is going regularly. Good luck. I think you need to continue with the laxatives for quite a well, longer than you might expect, until the psychological issues with pooing eventually disappear.

[Misty9]

I came on to start a very similar thread op! Ds is 4.4 and we've had issues with pooing since potty training about a year ago, but now I'm pretty sure he's withholding and impacted. We've got movicol morning and evening but he's managing to hold it in at nursery even with that!

Today he stood in the playroom while I made my lunch and shat himself. It was everywhere. Down his legs and completely liquid. We just don't know what to do really. He only attends nursery one full day and two mornings, but starts school this year... our house has a permanent aroma of shit

I don't handle it well at all, something of which I'm not proud, but I feel so helpless. Maybe we shouldn't be berating him for pooing his pants as it's preferable to not pooing at all? I don't know. Have got the book from ERIC but feeling at a loss.

[longestlurkerever]

Aw, Misty, sorry you're in the same boat. After the doctor explained how they lose the sensation of needing to go (they get desensitised as it's always present) so really can't help it I stopped getting angry at accidents but still get really angry when she won't try or won't take her medicine. I know it's counterproductive but it's so frustrating. We could be doing so many nice things but instead all our mornings and evenings are taken up with me nagging her to take medicine and poo. She's so stubborn. I'm wondering if a psychologist would help?

[Playitagainsam]

I absolutely know how it can feel like this can dominate your life. With our DD, now 3.5, our life was dictated to by whether she had gone for a poo that day. She started withholding at 2, and it's still a problem now. Doctors have little or no knowledge on how to deal with it, IMHO, even though it seems a fairly common problem. I took my DD to see Dr Anthony Cohn (based in Herts & N London) - he's written a book on withholding that you can get on Amazon and does consultations. He really understands the psychological issues around it all and could probably give you reassurance/advice on the glazing over thing. The best thing we ever did with our DD was to give her enough Movicol so that she had no choice but to go every day - in her case, this meant 3 sachets! Any less than that and she could still hold on. And then you have to keep giving it to them until you're absolutely sure they've stopped holding on - sometimes even for a while after. It's a reflex/habit that develops and becomes very difficult to break, the only way to break it is to make them have to go each day, and to make sure it is never painful for them. This will just set you and them back. It may surprise you how much Movicol they need, and it is always more than the recommended dose, but the right dose is the one at which they can poo easily once a day. It is very, very hard not to get upset with them about it, I have done it myself, but honestly it makes it worse. The only time we've made progress with her is when we just stopped talking about it - we occasionally encouraged her but otherwise ignored it. Negative attention is still attention.
Anyway, if I can help at all do feel free to message me, although it's only my experience of it all - if you can get to Herts/N London then seeing Dr Cohn could really help too. Just google him and you'll find his contact info. There's also another good book that I found out about on here, let me dig out the name.
I totally understand that it can be relentlessly miserable to deal with - some of my worst parenting moments/fails have been around the whole subject of poo!!!

[longestlurkerever]

Thank you. I am in North London so will look up Dr Cohn

[Misty9]

Thanks both. I am a psychologist...! But it's so different when it's your own. The thing which baffles us is that prior to this latest spate of diarrhoea/accidents he did go more or less every day. So was he constipated then? He also eats and drinks minimal quantities, his younger sister regularly out-eats him!

We're doing a star chart as there's a playmobil toy he's really coveting until he gets it probably with a star for each day he ends in clean pants. But we're changing it to a star for every poo on the toilet I think, and one deducted for accidents... but maybe we shouldn't?

[longestlurkerever]

My dd goes more or less every day too, at least while she's on the lactulose, but maybe not fully emptying her bowel each time.

I think it depends on how often he's earning a star. The Eric advisor told me to up the ante on rewards as if she felt she wasn't getting anywhere then it'd stop having an impact.

[SlinkyB]

So sorry to read your plight OP. My ds is almost 5 and still withholds quite a bit (lies on his stomach on the sofa going paler and paler, rather than just going to the loo). I ask him every day to please just go and sit on the loo, especially when I know he needs to go. I find it all so odd, just can't understand why he does it.

Ds2 has just turned two and I'm dreading potty training in regards to poo, as don't want him to be the same. Sadly though, I've noticed that the past few (12?) months he will only poo at home, so looks like he'll go the same way.

Does anyone have any tips to avoid it? I try to praise him when he poos and be all like "ah yay, have you done a poo poo for Mummy? Good boy!" (Cringe) as have heard they pick up on negativity from a young age. I've always asked DH and MIL not to be disgusted when he's pooed or they're changing dirty nappies, as don't want him to think it's something to be ashamed of. They forget most of the time though (luckily I do most nappy changes).

Good luck with Dr Crohn OP, hope your little girl is soon better and you don't have to take her out of school for a week.

[Haroldplaystheharmonica]

Just quickly popping back on... when we saw the CAMHS doctor, he advised us to reward DS for everything poo-related. So a star for sitting on the toilet (for any length of time) and a bigger star for actually doing a poo. This way, there wasn't any negativity regarding it all although it was hard to be bright and breezy when like a PP said, your days activities was determined whether they've had a poo or not.

[longestlurkerever]

Thanks. That does make sense, although she will sit on the potty for ages without fuss. She just doesn't do anything!

Any tips for getting the meds down her with minimal fuss? Is agonising at the moment.

[Misty9]

Well ds has done TWO poos this evening!! One with promoting and one without. He said he thinks it might be helping that he's getting stars for pooing on the toilet now... this could bankrupt us as he's getting a pound per star towards his coveted toy...!

The real test will be Thursday at nursery but we said if he poos at home every evening then he might not need to go during the day as much. So we will encourage him to go to the toilet after dinner every evening. He never poos when we make him sit on the loo (though often wees) so there's not much else we can do really other than bribe him

How are you doing op?

[longestlurkerever]

Excellent! Well, she has pooed. And has taken her medicine, though achieving the latter may have taken a year off my life. she didn't earn her reward as that's for "no fuss" but she's disappointed about that and has vowed to earn it tomorrow. We shall see. Weirdly she had a wet accident at school today, which she's not had for months, so am puzzled about that, but am treating it as an unrelated blip for now. I have downloaded Dr Cohn's book for some bedtime reading and may pursue a referral. He appears to have an nhs and a private practice. Did you see him privately playitagainsam? I have a weird type of health insurance that might cover a private consultation if I can get my gp to refer me.

[longestlurkerever]

Oh and I spoke to school who say not to worry, they will deal with any accidents as long as she lets them. I am a but worried about the other children noticing and making fun though. Fx with the meds it won't be a regular occurrence

[SlinkyB]

We used to put a jelly bean in the bottom of a shot glass, then pour the lactulose dose in. Ds would have to do it down in one to get the jelly bean! Not sure if this is glamourising shot-taking though

[Misty9]

I forgot to say, we had a nightmare with ds taking his movicol the first couple of times, until I mixed it with strawberry cordial. Now he asks for it!

[longestlurkerever]

Thanks! Will get some jelly beans and look out for some strawberry cordial. Have read Dr Cohn's book. I think we're doing most of what he suggests already but will keep it up. The bit about being worried our attention will lapse if she sorts this struck a chord as she does have a new sibling as well as having started school

[Playitagainsam]

Yeah we saw him privately. It's worth trying your health insurance though, we would have done if the problems hadn't started before we got the policy.

[Playitagainsam]

Oh and we also put our DD's Movicol in a bottle of fruit juice first thing in the morning and she doesn't notice it - any relatively strong flavoured drink should do it!

[Playitagainsam]

Sorry for all the posts, I just found the name of the other book which I found helpful - 'Stool Withholding - what to do when your child won't poo!' by Sophia Ferguson. Urgh it's terrifying what passes as a good read these days.

[longestlurkerever]

Please don't apologise, it's all very helpful! Have some summer fruit drops to go in the movicol and we've moved on to plain flavour from the,rather dubious chocolate. Hopefully this combo will be more of a hit. Not planning a daily poo update but so far so good!

[SlinkyB]

Good luck with the new flavours/method. Just out of interest, and because I'm lazy and cba to read the book, does Dr Cohn suggest this can all be avoided somehow? Like the attention thing? My ds2 has just turned two and I'd love to avoid him having poo issues down the line. Thanks!

[longestlurkerever]

Well nit avoided entirely but nipped in the bud. Laxatives as soon as there's any sign of constipation or withholding - plenty of fluids and aiming for a soft poo each day. I am going to work on the fluids with baby dd2 as I think this is where we went wrong, compounded by having no idea that soft poo accidents could be a sign of constipation