At my wits end with DD3 soiling herself

[willowes]

Per the title - a year into potty/toilet training with DD (recently turned 3) and she's still pooing in her knickers every time, sometimes multiple times a day.

DH and I and her nursery are at a bit of loss. Her communication is great and she's generally very bright, but this just seems to be a real sticking point for her. She can't say why she does it - just that she likes doing it in her knickers and doesn't want to do it on the toilet.

Promises of rewards haven't worked - we first offered a highly coveted toy if she did x number of poos on the toilet. When that failed we thought maybe she needed some more immediate motivation so promised an ice cream from the van for each one and a chocolate button straight after doing one, but still no joy.

She's on long term stool softener (with our GP's support) as for a while she started withholding it to the point that she made herself constipated. Now you can see she still tries to hold it in but as we grab her and run to the loo she just does it in her knickers very hurriedly.

Nursery think it is something to do with control but are a bit stuck. DH and I think an element of that. She can also be a bit impatient/prone to boredom so we've all tried reading to her, singing songs and even showing some TV while she sits, and she's perfectly happy to do all that for as long as an hour, and then will just poo as soon as she gets off.

I've seen advice before to get her to clean up after herself each time it happens but she has an immature streak and by this point I don't think we can hack any more mess.

Any words of wisdom?! I'm starting to get quite concerned about the prospect of school next year with no sign of this stopping 😖 We're planning to speak to the HV and the charity ERIC next week.

I think this sounds like past being a habit and something you need professional help with. And I think I'd be using pull ups rather than knickers. If she's not doing even one bowel movement on the toilet, there's no point.

Most likely connected to the constipation rather something behavioural that she could stop doing for an ice cream. I’d go back to the GP and see if she needs a high dose or a full disimpaction and then be patient. It can take a while for the feeling to come back fully. A year until school starts is ages, it’s a third of her life to date, don’t stress about that now.

What is she taking as a stool softener? My dc was prescribed movicol but refused it as he struggled to hold on and worried about soiling himself at school. I would speak to your local health visiting team for current advice.

I know you said you're a year in, which is a long time, but when did she fully crack wees, was that a year ago? As just turned 3 is still young. My daughter was fully trained for wees just before her third birthday and we had the same thing with poos, I remember being so confused by it. I reached out at the time and was told this was really really common. We had her in pull ups until she was reliable with both and she used to poo in every pull up. Then one day she just stopped. I think suggestions of professional help from pp feel a bit premature but I did potty train 10 years ago now so maybe I'm out of touch!

Try taking her to the toilet 30 mins after every meal and getting her to sit there for 5 minutes blowing bubbles.

It worth looking at the ERIC website and ringing their helpline.

This is really common. I've trained all 9 of mine and pooing is imo a different ball game to wees. Several of mine wouldn't poo on the toilet (I mostly trained straight to the toilet) for several months after mastering having a wee. At least 2 of them waited for their night nappy and immediately did a poo in that and I'd have to change it straight away. Time - she'll get there! She's only recently turned 3 you say so she's still very young really. Be patient. Lots and lots of praise if she does manage anything. Give her options - maybe she would like to use the toilet or that might be too scary. Honestly it's really common.

Second the Eric website. Mine eventually stopped the pooing in pull ups when he was 4. He would ask for a nappy to poo in. He was traumatised with constipation. Massive fear because of it.
We ended getting him pooing in a bucket then the potty then the toilet. Dunno why a bucket worked.

So, it's either she's still constipated and it's encopresis (liquid poo going around hard stools), or, the dose of movicol is too high and is giving her diarrhea. Sadly, the only way to work out which is to either increase or decrease the movicol. A trip to the GP may help, as they can palpate her tummy to see if they can feel any hard blocked sections of bowel. My daughter is very sensitive to movicol and only needs a sachet and a third per day, split over two doses. A sachet and a half leads to diarrhea. I've asked the continence team about it and the nurse said that whilst most constipated kids need multiple sachets, there is the odd one who is very sensitive to dose. What we have added is 2.5ml picolax (adult strength) on Friday night to just clear things out once a week. It's not a perfect regime but we're pretty much there (but hot weather, travel, changes to routine all still bugger it up).

You can do a lot with routine and timing. There is a strong reflex that links food hitting stomach to pooing. Harness that with a sitting habit from about 20 mins after meals, for maybe 10/15 mins. Give most calories and drinks in meals rather than dribs and drabs. (Snacks are fine but make it a big snack with a decent drink, and put her on the potty 20 mins after, so to her stomach it's more like a meal.)

Hopefully that should kick start some success and it gives a way to manage it, long term if needed. With an established bowel habit it often settles down to about once a day, and you can then pick a time she is home anyway. Obviously this does not replace getting proper advice through continence team etc when she is old enough.

When you clean her up after pooping in her pants, do you lay her down on a changing mat or have her stand up / bend over in the bathroom as you would with a toddler who has pooped in the potty?

Some kids are very reluctant to leave behind the feeling of being babied on the changing pad. They enjoy the security of mummy or daddy treating them like a baby. It is comforting for them.

If you use a lying down position with wipes, try changing and wiping in the bathroom, followed by a waist-down wash using a shower head or attachment to the bath taps if you only have a bath.

How immature is your daughter - what behaviour indicates to you that she has an immature streak?

After a long similar journey,my 4YO DD eventually saw lots of specialists and after advice from ERIC we sat her on the loo religiously after dinner every night. It trained her brain to expect to go after dinner. Now 9 years later she still does it! Part of it was having very low tone in her core and poor proprioception. She had hypermobility and it affected her whole body including bowel.

My DD5 still poos in her pants. She has two sachets a day of cosmocol. Incontinence team were not very helpful. Took 11 months from referral, and they basically said try a reward chart, poo goes to pooland, special loo toys, etc. All things we've obviously tried. These days, we do "toilet time" after all meals inc. breakfast. She will sometimes take herself outside of these times. Still get poo marks in her pants at least half the week. It's psychological for her. No advice but just offering support - you can do everything "right" and still end up in this situation.