Stool witholding and movicol

[FirstTimeMama21]

PLEASE HELP 😭

I started potty training my daughter in February. She used the potty to go for a wee almost straight away but had a few accidents with stools. She was upset by this. We did our best to comfort her, let her know it was ok a that it wasn't a big deal. She then started to withhold her stools causing her to become constipated and this problem is still going on now.

I spoke to the GP who said I should contact my HV. HV said to go back to the GP for movicol. She has been on movicol for around two months- 1 sachet a day which is a CHALLENGE to get her take over two or more 'sittings'.

The movicol has worked to soften the stools but the problem is, she's still able to hold it in if she doesn't want to go. She only 'likes' to do it at home, often when she goes to bed but even if we are at home she will still try to hold it. We have been away recently and she was able to hold it for 8 days.

This is really impacting her everyday life now as when she needs to go, she doesn't want to do anything other than sit on the sofa underneath a blanket. Her diet is fine and hasn't changed since we started potty training so I know that's not the issue (although I have still tried to increase fibre and water).

I have tried explaining all of this to the doctor today but he has just said to increase the amount of movicol. I have tried this already and she got diarrhea and then became even more unwilling to go.

She's starting school in a couple of weeks. I feel like a failure. I am desperate for help.

I would suggest getting in touch with the charity ERIC they have a website with their helpline number on. They’re really good. I would also say the GP is right you will have to increase the movicol. How often is she going now? She might be impacted, the diarrhea might have been making its way around the hard stool that’s stuck and has stretched her rectum. I hide my DC’s Movicol in milk, so I mix it with water, then add it to milk in her usual cup and don’t tell her it’s in there. My nephew will drink it if it’s mixed with vimto. It’s just a matter of finding the right thing for her to hide it in.
ERIC really are good though and your area may have a bladder and bowel team of children’s nurses who you may be able to self refer to, or ask the GP to refer you.

If it’s hurt in the past she will be very reluctant to go now. She is old enough to explain that the longer she withholds the more uncomfortable it will be. How’s her sleep?

You aren’t a failure!

My son had issues with constipation from around 3 months old. As he grew, he would disappear into corners and squirm, essentially trying to hold back his poo. End result was a lot of soiling and immeasurable amounts of visits to the school to change him. Ultimately, I needed to fight to get it taken seriously. Ultimately, it was compaction which has resulted in a fear of having a BM (bowel movement). Its ridiculously common and once I found the path to the right kind of help, it was great.

The jist is; as children they experience constipation which results I some pain when having a BM. The result of this is that they try to "hold in" the poo, causing compaction and a vicious cycle of pain. So, it really forms into a combination of physical & psychological issue.

My son was given high doses of Movicol for long periods of time. I'm talking years. He had a nurse that would visit our home every week, to check on progress and discuss reward charts and the such like to encourage BMs and to try ease thee psychological issues.

A massive tool was to impart routines and "toilet time". Even if a BM wasn't successful, praise for them for having trusted the process and spent the time sitting on the toilet/potty. Trying to lessen the fear of the toilet, essentially. So, in the morning after breakfast, perhaps 10/15 mins of toilet time. Again in the evening, or whatever pattern works for your family. After a bath is a particularly good time to try as they tend to be more relaxed. Gosh, even IN the bath, if it works for them. The crucial thing is to have the BM's to lessen the impaction. Its a hard journey to get out of the cycle but it really is necessary.

I was advised that it generally takes about as long to "fix" as they have had the problem. My son was around 5 when I finally accessed the right kind of help, and it took about 3 years for him to no longer need to be managed in some form (soiling issues, Movicol intake, checking whether he had been to toilet etc) for his BM's.

It was an incredibly stressful thing for me a single parent; I recall sitting on the bathroom floor crying and pleading with him to just do a poo (watching your child in pain and scared is awful). The numerous excuses to get out of work to change him at school...Jeez I really could go on.

I'm somewhat of an old pro at this stuff by now so feel free to et me know if I can give any more info.

(Im in Scotland, btw - incase NHS/medical processes vary).

I would mention that the Movicol is crucial. It seems like they are simply changing from constipation to Diarrhoea but really, the compaction takes a long time to shift. My son had an xray at one point and his bowels were literally compacted the full way up his body; the pain he must have been in is unimaginable.

There was a point, with nurse guidance, that I had to keep my son off school for a full 2 weeks because the soiling/ apparent diarrhoea was so bas. I was essentially just getting back to work from having changed him to needing to return. It was a big step in helping him. They need a flush out of their system. The impaction needs to ease so that the soiling can lessen (soiling occurs because they are essentially so full, they leak). Once the soiling stops, it means the impaction is easing off and the "pipes" can start being flushed.

A major part of the healing from this is that they need to learn the indicators for a normal BM. They lose a lot of muscle function of the sphincter. They can't easily tell when they need to go, or what the correct sensation is to bear down etc. This is the part that can take as long to fix as they have had the condition. They are teaching their body something totally new, that feels very alien and uncomfortable to them.

Trust the Movicol but don't rest on your laurels. I pushed for a hospital referral and once I got on to the paediatric consultant and could stress how much pain/discomfort it caused, it was a big help. I then had to harass the consultant secretary for more follow ups; this is what eventually led to us being assigned a nurse for regular visits - this was the absolute turning point as it was reviewed weekly tracked effectively and you just don't feel as alone!

Other key advice: get the school on board. I had a meeting with the HT and explained the situation fully. I was concerned he would be bullied, or that he may smell etc. We came up with a plan that the teacher could look out for the squirming and sent him to the toilet. There was a code word for when I needed to be called. In time the school had a wee supply of pants and he could be excused to change himself (as he was a little older). The school was a big part of relieving stress and helping my son pretty much going under the radar with his classmates.

Download the app poo goes to poo land. It's gross but useful! It's an interactive story about a poo who wants to go down the loo to be with his family. Lovely stuff... It helped my Dd who was very like this!

Sounds like you need to experiment with the dose.
For us dulcosoft was a lifesaver but I have to pay for it. Like movicol but tasteless.

I'm trying troo also - recommend on movicol mummies Facebook group. Head over there for a look, there is loads of collective experience. Eric also as mentioned above.

I would see if your area has a paediatric continence nurse who can draw up a plan with you and a care plan for school. The school nurses might be able to help if not.

I had a terrible time with DS1 and it was just so stressful. We got there eventually but with hindsight I would have asked for more help.
It might be she isn't every fully clearing and needs properly disimpacting but you need medical advice so it's done correctly.

Pediatrician gave us sennacot syrup for dd as he said she wouldn't be able to withhold then... It did work, as others have sIf treatment needs to be for a long time, was from age 3-about 9 for our dd. Glycerin suppositories also v effective within 30min and available from pharmacy.

I’ll come back when I’ve got more time but in brief

• you’re not a failure, it’s unbelievably common
• you need Gp to prescribe a stimulant like senna
• join Movicol mummies on Facebook - incredibly supportive and knowledgeable group

Oh op I've been there too. We are just turning a corner with it and I am amazed at the impact it has had on my little boy.

Agree with what's been said upthread - Google "the poo nurses" and they have videos which explain how the movicol works. Basically it softens poo, but if your child has been withholding for a long time the older poo will be drier and take a long time to shift.

Your child may need disimpaction - where you increase the movicol gradually over a few days and stay at a high dose until your child's poo is watery. Then you can begin a maintenance dose to keep things soft.

During lockdown one we were able to really focus on routine and toilet time after meals and this was a real Turning point for us.

I was also a member of movicol mummies and found it useful.

If you need to vent please feel free to pm me.