Toilet issues...bit long sorry!

[maybebaby23]

DD is 3.6 and has been dry during the day since just before her 2nd birthday-so quite a while. However she has never got used to pooing in the toilet or potty. She has always suffered with constipation since being tiny. She can go for days without pooing and then really struggles for a couple of days to do it. We have had her on lactulose on and off but have started to give it daily now. Because of the constipation i have up until now allowed her to poo in a nappy because if i don't she simply will not poo for over a week (tried this twice) and stop eating/looks unwell etc. She is very stubborn and im not sure how we are going to break this cycle. When i have refused to give her a nappy to do it, i have given lactulose every day and STILL she won't do it. No idea how she can hold it in but she does. She has never needed to do it anywhere out of our house so im not too concerned about the nappy issue at nursery (i know she would wait rather than poo at nursery which is not ideal but again, she is so stubborn!)

Do you think i should give it a while longer until she gets a little bit older before trying again to get her to poo on the toilet? She has done it a few times and got loads of praise and rewards for it but absolutely nothing can persuade her to do it if she doesn't want to. She just suffers in silence for days She has stopped eating again now so i know she must be so blocked up.

I also worry about giving the lactulose because maybe she's not constipated, just holding it in because she is afraid it will hurt? When she does poo in her nappy its not very hard or anything, she only does a bit at a time.

Oh what to do!! Thanks for reading.

[MunkyNuts]

This is really quite a common thing, you are not alone, there are quite a few threads on the fear of pooing if you do a search. As always I recommend a book called "Constipation, Withholding and Your Child" (I´m starting to sound like an agent for this book - I swear I get no commission!). Its written by Anthony Cohn who is an expert in children´s toileting problems. My DD had withholding problems. I personally would give her the nappy just so you get the poo out. I did this and eventually when she was in the middle of a poo whisked her off to the loo and sat her on it much to her annoyance, ignored her anger and shouting and praised her massively, whooping and cheering until she was pleased with herself and the treat she received. (Star charts help). In the meantime I would def keep up the lactulose as it softens the poo. If its not coming out you might want to up the dose. You will need to gauge how much she needs. Start with getting the poos so soft it´s impossible to hold them and then reduce the dose. I also used Prune juice mixed with Apple juice, and a teasp of powdered fibre in this. We were living in Spain at the time and found Eupeptina which is a powdered form of magnesium (for babies) which we put in her milk, I don´t know if there´s an equivalent in UK or if you can order it online - but this was really gentle and kept the stools soft. You will have to keep up the lactulose and/or other methods for quite a while (sev months) as it takes a long time to overcome the fear of pooing and unlearn the withholding response. One difficult poo can set everything back and you might need to up the doses again until the fear wanes. The only doing a bit of poo at a time thing in her nappy is because there will be a hard blocked poo and the soft new poo is squidging its way round it (sorry to be graphic!), this is overflow. I´d also try and get hold of books for children about poo (Everybody Poos, The Mole who knew that it was none of his business and others specifically written for children with withholding issues, there´s one about Mr Poo who wants to play with his friends - name anyone?). You will conquer this, it takes time and perseverance and maybe some ruined pants, I remember being very stressed by it but get it under control with laxatives and it will get easier until its no longer a problem.

[maybebaby23]

Fantastic thank you so much, will definately up the dose of lactulose to see if that shifts it. It does sound like overflow like you said. Will also pick up some prune juice and hopefully i can persuade her to drink some every day.

I am off to look on amazon for those books!! That was really helpful and reassuring thanks for taking the time to reply!

[MunkyNuts]

No worries, I´m only glad to help - I remember being so worried about it all with my DD and if you are systematic it does go away. I must say though that I still do take Lactulose with us on holiday bcos she´s still not keen on pooing on other loos - but at home she´s fine now, in fact quite proud and lets everyone know when she´s done a big poo! Good luck with it all.

[kreecherlivesupstairs]

Lactulose is just a stool softener though. Maybe she needs something to propel it - sennakot possibly. I think you should talk to your gp or pharmacist, I wouldn't advocate giving her something before hand.

[DesperateHousewifeToo]

I would also encourage her to drink lots more water. This is very important for soft poo and will help the lactulose do it's job.

Have a star chart for this perhaps, rather than one for pooing in the loo, at the moment. Does she drink much at school?

I wouldn't worry about getting her to go in the loo for the moment. Just concentrate on getting a daily soft, painless poo, even if it means a nappy. Lots of praise whenever she does one, no telling her ''poo, it smells'' or anything negative .

Once you have accomplished this, insist she goes into the bathroom to poo- even if she just stands in there. She'll hopefully get the idea that is where she is expected to be. Always pour the poo down the loo from the nappy. Get her to flush, lots of praise.

Some posters have a leaflet/book called ''Poo goes to Pooland'' or something similar. Maybe do a search and see if you cna get a copy emailed to you. I think it's about Poo going down the loo to join his friends in Pooland, or something .

Next step would be for her to sit on the loo in her nappy. I think some children find it hard/odd to sit down to poo when tey are used to doing it 'on the run' for years .

Then sit on a nappy on the loo, etc....

Keep up the praise with each step.

If you use a sticker chart, make sure they are achieveable steps so she does not get disillusioned.

Sorry, a bit garbled but hope some of it helps.

[maybebaby23]

Ahh some more great ideas, thanks a lot! Will show my DF this later.

DD gets even worse on holiday too, won't even do it in a nappy when we are away so we had to buy lactulose when we were away in June...

Thanks again, i feel much better about it now!

[maybebaby23]

kreecher thanks for your reply, i will be taking her to GP if these ideas dont work..im quite happy with lactulose for now as i know its gentle and have used it on and off for ages now. Bit wary of sennakot because i took it a while back and had awful cramps! Bit daft i know but i worry about making the situation worse for her.

[MunkyNuts]

Lactulose is a mild laxative as well as a softener, you may need to use a larger dose to get rid of any blockages - it does work if the right amount given. Water is important too as per DHWT. Lactulose draws water into the poo which makes it softer and more slippery. Poo goes to Pooland is the story I was trying to remember. Haven´t actually seen it but heard its quite effective. Your GP might prescribe Movicol, think its stronger than Lactulose but have no experience of this one altho I believe its commonly used.

[maybebaby23]

She does drink plenty of water, and loves her fruit too so weve got the diet thing sorted. will see how we get on. If not will ask GP about movicol. Thanks!

[MunkyNuts]

Great she likes water and fruit. Oh another thing, be wary of suppositories or enemas, some GPs recommend them and altho some children don´t mind them my DD was quite traumatised by her one experience of this. The Withholding book I keep raving on about says use anything that works but never use suppositories or enemas. His theory is that a child already sensitive about their bottom is going to have issues with them and it´ll make matters worse. Just something to bear in mind.

[maybebaby23]

Oh yes i agree with that. That would be it for DD i know it! Will be avoiding those at all costs! Thanks munkynuts x

[DesperateHousewifeToo]

How much water does she drink?

[Acinonyx]

Dd was constipated entirely due to deliberately holding on to her poo What a nightmare! We had her on movicol and lactulose daily for about 8 months, with occaisional senna if she still managed to go 4 days. I was told to keep up the doses so that she couldn't go more than 3 days, then get it down to 2, then 1. Basically - make sure she just can't hold it. Messy at first - butit gets better as you get the balance of laxatives right.

She's 4.3 now and has just started pooing more willingly and is 'only' on daily movicol. You may find that they need a stimulant for a while after they stop holding it deliberately because they have stretched a bit inside as the poos got bigger and it takes time to shrink back.

Dd din't refuse because it hurt - she just didn't like to poo and was determined not to. I would explain that it had to come out and she would just say 'No it doesn't!'. Very stubborn child. Can't think where she gets it from....

[oneofakind]

ds 3.8 has been going through this - he went straight to peeing in a loo - never used a potty but became increasingly constipated as refused to poo on the toilet. we had seen a hv and he was prescribed lactulose to soften stools. hv advised loosening nappies every week or so and then sitting on toilet in nappy and then pulling it away on one side etc. all the while with a step up to the toilet so legs not dangling and an inner seat for the child to sit on.
good advice but unfortunately it didnt work for us as he didnt like the loose nappy, so two weeks ago I went with ds to buy a potty (thomas sit down lift out one - he picked it and bloomin expensive it was!). I kind of felt we were regressing but he liked it and since then he sits himself down in the bathroom for each poo and empties it himself (with supervision) down the toilet, lots of praise etc. He is now going regularly 4 times a week which was not the case before.

last night I persuaded him to step up onto the toilet and sit on the inner seat and put the potty in the toilet and he poohed!! he was so pleased with himself and so were we. hopefully we will continue with this and then try without the potty. sorry so convoluted and prob. too much info but you are not alone! good luck

[maybebaby23]

Ah great thanks for that! I didn't think of her stretching inside so prob needing stimulants! Thanks will bear that in mind.

Thanks for sharing your experience oneofakind. I will try the loose nappy thing too. I never thought of letting her empty the potty either! (how rubbish am i!) Im sure she would be delighted to do that knowing DD lol! Will see how it goes tomorrow!

She ran to the potty earlier as she said it was coming..she sat and tried but nothing came I suspect she is not really trying though..poor thing. Still we are getting somewhere seeing as she decided to go to the potty i suppose. But having been here before i know it doesn't mean she will do it again tomorrow! Just when she feels like it lol! She has had 2 5ml doses of lactulose again today, will prob have to increase it tomorrow.

Thanks for all your help and support! I will update!

[DesperateHousewifeToo]

This leaflet from the ERIC website is useful, even though it about soiling specifically.

ERIC also have a hlepline which is, apparently, very good.

[maybebaby23]

thanks for that, will have a read through!

DD pooed on the toilet yesterday!!!! She just ran to the loo by herself! Made a huge fuss of her, she was very proud.

I keep having to throw away heavily soiled knickers though..she must have a big blockage in there oh well onwards and upwards! Thanks everyone!

[MunkyNuts]

Fantastic!! That´s really good progress if she ran to the loo by herself, brilliant! Once that blockage is out and if you keep up the lactulose that knicker staining will stop, (maybe just put her in white ones that can be bleached after?). Keep us posted as to how it all goes. Good luck!

[DesperateHousewifeToo]

I always just chuck ds' pants out if really bad.

Decided life is too short and pants too cheap to have to deal with them any other way!

Glad your dd has made progress. Hope the blockage clears easily and quickly.

Once you think it has cleared, you'll have to keep up the lactulose and water to get the bowel back into a regular pattern.

I always feel it's 'two steps forward and one step back' in terms of progress with these things.

[maybebaby23]

Thanks guys I just spoke to DF and now we are worried about how this blockage will clear! Even though she is having lactulose it will still be big (and hurt?) won't it? I hope that doesn't set her back. She has soiled pants again now after nursery but says she doesn't need to go..hmm will see this afternoon. Will update! Thanks!

[maybebaby23]

She has jut done it again!!!! Yay!! I think its the hilarious sight of me running around the landing screaming and cheering that is making her really try who cares, im just so glad things are moving! I hope no-one is eating while reading these updates lol

[maybebaby23]

And again she is definately just holding it all in because she just announces that she is going, and actually does it no problem I decided to make out that i dont believe she can do it. so DD being DD has to go and prove me wrong Fantastic. I hope this is clearing the bockage now so we can get her going every day without the staining.

[MunkyNuts]

Oh you´re definitely getting somewhere , I like the reverse psychology stuff not believing she can do it. Has anything big come out yet or is it still small squidgy stuff? - I now hope no-one is eating!

[maybebaby23]

haha so do i Yes there has been 2 big ones then lots of little ones, they are not so squidgy now they look normal. I feel so relieved for her she must feel so much better. Lets hope it's not a one off, this has been an ongoing problem for ages so i can't believe that it has been fixed as easily as this..thanks for replying i hope im not doing anyones head in about this your support and advice has really helped im so pleased

[DesperateHousewifeToo]

Fantastic!

Lots of praise, singing and dancing is good

Telling her not to worry about her pants - ''it doesn't matter'' is also really important too.

We seemed to move forward a lot once ds got this message.

Good luck