Wits End with DS Poo Withholding. Any tips?

[Drogonssmile]

5 year old DS has now gone for a week without a poo. Prior to that over the space of two weeks he had 4 soiling accidents i e full poo in his pants once he couldn't hold it in any more.

I'm at my wits end.

Over the last week he's been on lactulose and calfig. I have a GP appointment for him on Tuesday to get some paediatric Movicol. At least I hope they'll prescribe it.

He's avoiding baths because it makes him want to go. He's very clingy. He's eating and drinking as usual and seems relatively happy until we mention poo

He said he's scared of it hurting so I know he's been constipated, it's hurt and now he won't go at all. We're now on day 7.

School have been warned and have been brilliant with support but it's not been needed yet. They are on standby though if the worst should happen.

Does anyone have any advice? I've tried sympathising, cheerleading, shouting, bribing, cajoling, reassuring and this morning just crying out of sheer frustration and worry for him. Please help!?

You've probably already done it but could you ask him just to sit on the toilet with a tablet to play with / watch. Tell him he doesn't 'have' to poo but you'd like him to sit and relax for 20 minutes there.

Movicol. Movicol. Movicol. Massive dose to treat the impaction then pretty high dose to keep it soft and coming. May be he has a few accidents until you get the dosage right. Keeping him on it also makes the poo soft so it won't hurt and gives any tears tube to heal.

GP should advise about getting him into a good poo routine too. And definitely use a stool to raise his knees.

We were also told to continue with the movicol for as long as they've been constipated, definitely weeks to try and heal and get over the fear

Movicol!!! And some medicated cream for his bottom. If he's withholding, the stools are large and he likely has tears, and it hurts every time he goes. His stools need to be soft, if not borderline runny, to both prevent him from withholding, and to stop him from feeling scared about it hurting.

Third vote for Movicol. My son suffered with impaction/constipation/soiling from months old until around 10 years old. Didn't start getting proper treatment until he was about 5 after I had to basically refuse to leave the hospital without something useful. We got weekly nurse home visits where they assessed him often and tracked his input of laxative/output etc. We are talking litres of laxative laden water, and ALOT of output. We had to take weeks off work/school, but my son was left for so long without the correct medical help that his problem was massive. It actually affected his growth for several years as he wasn't getting all his nutrients etc.

Assuming this is not just a one off dose of constipation; (if it is, then ignore the following) - you really need to fight his corner to get this taken seriously. Health professionals advised me it takes almost as long to fix as the problem is left for i.e. my son was 5 until we started proper treatment to cure this, and it definitely did take around 5 years for him to become fully independent i.e. not having to pack change of underwear, me not having to ask him every day if he'd been to the toilet etc.

One thing that has always stuck with me is about a year down the line after him being properly treated I asked him how he was feeling and he confusedly communicated that his stomach wasn't sore anymore - the wee soul had actually gone more or less his whole life in pain and didn't realise that wasn't normal. Broke my heart

I'd just like to add, that if he's constipated, to please consider lactose intolerance. My DD was under paediatric care for many years, and it was considered 'under control' and he was on low level laxatives. Turns out he suffers from constipation due to the lactose intolerance - went lactose free and he is constipation free. The specialists never did work it out for us, it was pure chance that I tried going lactose free for my DS.

Wow thanks for all the responses and advice. @bringthethunder what a nightmare,
poor little mite, I'm glad it's sorted for you now. I'm prepared for it to be a long process.

Unfortunately I think it's been going on for a while undetected and I feel so guilty about it. He just tended to do massive poos but thinking about it, he was probably only going once or twice a week and with him being elsewhere such as school or grandparents I didn't realise he was only pooing at home. It's only since the soiling started that I realised

Posted too soon. So can't wait to get some Movicol and I will not leave the GP without it. We have a quiet weekend coming up so will start on Friday ASAP and hope the worst is over by Monday morning so he can go to school.

I'll take all your advice and suggestions on board and try them out too. I really feel like I've failed him by not noticing this sooner

Poor love, it doesn't help that his 2.5yo brother is showing off all over the place doing poos on the potty and we're giving him loads of praise. Poor DS1 looks so sad.

@Drogonssmile nothing to feel bad about, I've been in your shoes. I just thought it was a fear of going thing and he needed the cheerleader treatment also. It wasn't until I spoke to someone who's child had went through the same thing and was still suffering from the effects of it well into their late teens that I really grabbed the bull by the horns.

Key things;
if he has lot of impaction (xray gives the best indication; you can see how backed up they are) then be prepared to be on a high dose of laxative for first 4-6 weeks and it stays high but gets lowred steadily over months/years. At the beginning it is drinking glasses and glasses of the stuff and after a day or so, it will be pouring* out of him. It can be distressing for all involved but is a necessary evil. Like I say, we had ot take time off work/nursey as the changes were just so frequent. I was concerned about dehydration etc but it really is necessary if they are seriously impacted and the nurse told me I had to persevere. Plus you'd be amazed how quickly they go back to retaining/impaction if you take even a day off of the medicine.

• Set up a toilet routine. Set times of day. After a bath is a good time as they are more relaxed. It's not so much about them physically going to the toilet, just the routine of sitting on it, not being afraid and celebrating any toilet activity to take away any fear they may have.

*Try not to be stressed. I used to be sat on the toilet floor holding wee legs and literally sobbing because I was so distressed/frustrated right alongside him. It doesn't help.

*Look at his stomach at certain points of the day. My son was distended at certain times and I would indicate to him that when his tummy went that way, he should try sitting on the loo.

*Its a long slog. It's not something that will be fixed in a couple of weeks assuming your son is anything like mine , but I don't assume everyone is the same. But be prepared for a battle. So worth it though when they are no longer in pain.

*star charts/rewards did help in the early years for us. Not just for physical bowel movements but for fulfilling his "toilet time" with no tantrums/screaming matches. I would give him a book or my phone to play with s he was distracted while doing toilet time.

*If its been going on for a while, it becomes just as much a psychological thing as physical as they are afraid of going so fight it and the cycle just continues viciously. That's where the toilet time/rewards/trying to remain calm really helps.

Thanks so much @bringthethunder you've given me a lot to think about and try out. I'll let you know how we get on.

My DD suffered for ages from this age 4. She said poos were scary...they hurt her.
One day we were in a toilet with her friend who did a poo....it didn't hurt her...the penny dropped for her. She was more relaxed after that and started pooing.

Movicol is the best option. My daughter suffered constipation for years. Then accidents constantly. I was really stressed out and at my wits end. A big dose to clear everything out and then a daily dose when they're near to a loo for a few hours, or before bed. I got my daughter to sit on the loo at regular points and chat to her, I didnt make a fuss if she went or didnt. Lots of water too. Gentle tummy rubs helped too, good luck

Been there and done that with DS2 at the same age and was also at my wits end. Movicol was a godsend!

Everything above, a step for his feet to put his knees in the "go" position, stomach rubs using clockwise circles, get him taking as much fluid as you can now in preparation for the Movicol (which is excellent. Lactulose is rubbish), globs of Vaseline over and around his anus to protect the skin there when he does start shifting. My health visitor had me tickling DD's anus with a damp cotton bud only outside, never insert which made her go sometimes, maybe he would let you? And the usual diluted orange juice, prunes, etc etc. Plus bicycle legs, which technically he is a bit old for, but up and down the path on his bike pedalling like buggery will massage his insides as well.

Constipation in children is horrific. I used to have to cwtch DD with her back to my chest and dangle her over the bath or a mat bent slightly over giving her stomach muscles a good scrub with my knuckles until her muscles contracted. It was very distressing for us both, but after she went she finally became her happy little self again (while I cried into my pillow at night with the guilt of putting her through it).

And if you see poo it's the best thing ever.

@Drogonssmile

When you get the movicol then start as soon as you get it. You need to build it up for disimpaction treatment. And it is loose (water) few days after the blockage goes. It won't be cleared and normal over the weekend Im afraid. We just went throught it at easter break it took us 4 days and I upped it quickly as we have done it before so knew how to manage (im a nurse so dont recommend doing this) just wanting to know its not quick fix as such.

Thanks again for all your input everyone.
Well he's just done the most enormous poo and nearly blocked the toilet I am under no illusion that this is the end of it and need to keep a very close eye on him. He was starting to get very lethargic after school and wouldn't eat his dinner. He just wanted to lie down.

DH shut himself in the toilet with DS1 and had a chat with him (he was better for this because less emotional than me about it) after about 15 mins suddenly DS1 said "right I'm going to do it" and did. Massive praise, hugs, high fives etc. The neighbours must think we're mad because the back doors are all open!

My question now is, although I'm very relieved the imminent poo is out the way, is it likely there would be more? Am I still best getting the Movicol and getting it to watery consistency or is that going too far? I don't want to get to this situation again. Maybe it hadn't been an issue for as long as I feared. I just don't know. And not even sure the GP will prescribe Movicol now.

The good news is DS said it didn't hurt and he was beaming from ear to ear so hopefully it's been a positive experience that'll he will want to repeat. The little love even said "I did it to stop you worrying mummy"

Sorry for waffling I'm just so relieved! As I said to my mum when I texted her to tell her, I never thought I'd cry happy tears over a poo

Thanks for your continued advice. I know we aren't out of the woods yet

We’ve had a few issues (although nothing as bad as above, poor PP!). Dr still prescribed Movicol as we explained it was an ongoing problem and Dr view was that it was better to sort things before it became a massive problem. I echo the need for a routine...we always have poo before bathtime. It’s no longer a massive battle if DS1 can’t go but we still ask him every night (3 years later).

FWIW... as part of my job taking science activities into schools, I do the digestive system. I always talk about diarrhoea & constipation. I always say that it's far more common than anyone thinks for children to get constipated like this. I tell them that they should not suffer in silence and they are not alone! I reassure them that there are things to take to make it all soft again. If I've helped just one child feel that it's not just them, or helped just one feel braver about asking a parent for help, then I'll be happy.

If it was a huge poo and it didn't hurt then I wouldn't be too concerned. I probably wouldn't go down the Movicol route and I'd keep a very close eye on how often he goes from now on. Get your DH to have a good chat again and really point out the danger of letting himself get to an impacted stage. I know he's only 5 but he should understand that he could end up in hospital if he doesn't go. We had similar with our daughter and ended up doing the Movicol but she never let herself get to that stage again out of sheer fright!

Thanks all, he's absolutely over the moon. He's still jumping around with a grin on his face and no sign of being tired I've not seen him this happy for a long long time. He must have been so uncomfortable. I'll have a word with the GP still and maybe see if they'll prescribe some Movicol as a preventative measure. In the meantime DH is on poo chat duty and we'll be keeping a close eye on his movements.

Please do go And get Movicol. One big poo is NOT the end. Most gps are not good at chronic constipation, you may need to google your local childrens constipation clinic which will be run by nurses specialist in this. This is a long game.

Long term/ chronic constipation- which is what you have if you've got to soiling stage is NOT rectified by one big poo. The bowel will have stretched over time ( think a ladies stocking/ tights stretched afyer lots of wear) and it needs time to heal and go back to size and regain tone. So you need things loose and soft. If you leave it, he will poo fine short term whilst filling up the stretched bowel with poo again and getter ng constipated again.

It takes years. My dc was similar to yours and still on movicol 4 yrs later. Low dose now as you can't just stop you have to slowly gradually reduce

Please, please, get some movicol/laxido, at a decent dose. Or he'll rapidly back to square one.

OP, you've had some great advice here so I haven't got much more to add except that I can honestly say that the issues with poo with DS1 has been the hardest thing I've had to deal with as a parent. However he's now 15 and those awful days are but a distant memory!

He didn't really crack proper poos until the last year of primary when something must have clicked with him and he'd start sitting on the toilet every evening just to see if he needed to go. He didn't always have a poo but got praise for having a go. At 15, he still doesn't go every day (more like every 3rd day) but obviously just has a slower bowel than others.

I would say that you're right to tackle this now as it can take a long time for a stretched bowel to shrink back to how it should be. Good luck, hopefully your road with this isn't as long as ours was 😯

And yes, I know the elation you get from seeing a huge poo in the toilet! Unless you've gone through this, you just don't understand how it affects your child and the whole of the family.

On the psychological side, you need to embrace toilet humour for a while - the noises and smells are nothing to be ashamed of and a sign it's all working properly. When DD was potty training, DH used to congratulate her on a huge poo and they'd mark the noise out of ten. It was grim to listen to sometimes but it seemed to jolly her along.

I'd keep some analgesic cream handy for tears or discomfort too. Not sure which brands are appropriate for young children but a pharmacist will know. I have pelvic issues that cause tears and fissures and I carry Lanacaine around with me constantly.

I promise I definitely will fight for the Movicol. There is no way I'm leaving him to get back to that stage again. I will start up a routine daily and make sure he's taking regular medication to get a good balance.

He already drinks plenty of water but I think he could do with a lot more fibre particularly in the form of veg in his diet.

I used to work in paediatrics where there was a constipation clinic so know where I can be referred if things look like they might be beyond my capabilities.

Thank you all so much for sharing your experiences. It really helps to know I'm not alone! It's a horrendous condition isn't it?

We had very similar with dad. The longest she went was 15 days! She now has1 sachet of movicol a day and is fine now. She isn’t scared anymore and usually goes every other day, sometimes once a day. Hope you get it sorted out. It’s a horrible situation to be in.