to think that DD needs to stop crapping her pants?

[brdgrl]

Every night. EVERY night.
She's almost 4. She has been toilet trained for a year.
Every night.
I sit her on toilet. She insists she doesn't need to and can't go.
I give up eventually and put her to bed. She promises, again, to call me if she needs the toilet. Time passes. Sometimes I check in every so often, but it is always the same - nope, can't go, I'll tell you when I am ready.

Then....she calls. I go. She has not only had a poo, but has undressed herself and tried to clean it up. I spend next twenty minutes cleaning up poo. Tonight I cleaned poo off the wall, off her, her pjs, her sheets, a dish towel that she'd used to try and wipe herself (ok, that one I just threw in the bin).

She gets rash. That makes her try to hold it.

She is not asleep when this happens; in fact, she can't fall asleep until afterwards.

I try not to be too cross, so as to make her more anxious about it and maybe make things worse - she gets anxious about me being cross - but I want her to know it has to stop.

Have tried a reward chart - this has worked with her for everything else so far - no luck.

Every. single. night.

She completely understands. But she doesn't seem able to stop this habit.

The links re squatting, keeping feet supported have helped me too, op. When laying down I am in a foetal position, so now I understand why that helps.

Just a thought But can you put some barrier cream on after she has her bedtime wee? That way it shouldnt sting when she does go and she might become less anxious about it.

This sounds like it may be a fungal (thrush) type of rash which even babies can get in nappy area. It makes the skin raw and split.
You can get a simple anti-fungal cream like Canesten from chemist if you can't get to gp quickly. I've found some own brands of the medication (clotrimazole 1% cream) can sting but Canesten doesn't in my experience.
Best of luck to you both.

look for online for story called sneaky poo. helped my ds.

Thanks, different. :)
I'm going to start putting on a barrier cream (sudocrem or BOF suggested metanium cream) after her evening wee.

Ilove, that's how it is - raw and split.

And I'm going to look for sneaky poo, but not talk too much about toilet stuff!
Trying it all. DH is calling the GP for an appointment this morning while I'm at work.

Ah, poor little mite.
Loads of good advice here already. Just to echo, (and I know you have said you won't do this anyway), but definitely not a good idea, in my opinion, about having favourite pants that now need to be binned.

Hopefully it gets sorted.
Best of luck to both of you.

Another barrier cream you could try is Cavilon.
Its available over the counter at pharmacies but expensive so perhaps your doctor will prescribe it.

Unlike metanium, sudocreme etc it dries on as an invisible layer which may be nicer for her. Also won't interfere with the absorbenvy if her lull ups

Its what the continence care nurses here recommend.
(ds is incontinent due to disability)

When you sit her on the toilet, do you stand there? I'm a nervous toilet go-er and my mum always used to stand in front of me going "do a poo/wee!" and I wouldn't because i felt strange having someone stood there. Mum ended up sitting me on the toilet and leaving me for ten minutes and it was done, maybe she's just a nervous poo-er, you said she was anxious. Try sitting her on the toilet and standing outside the door for ten minutes and keep checking on her, asking her if she's done anything, if she does, lots of hugs and kisses and "do you think we can do that again next time, sweetie?" sort of thing. If this doesn't work, I suggest GP.

If this is psychological, and it seems it is, then I absolutely agree with others about Movicol. You probably won't need very much, it just needs to be runny enough that she CAN'T hold it in, even if she wants to.

There possibly is fecal impaction, where the constipation is so built up that fresh poo just goes around it and leaks out.

This can also take a LONG time to sort out if the bowels become distended.

So PLEASE, PLEASE see your GP asap.

Cavalon really is great, but in the mean time if you do use sudocrem or metanium can i suggest putting a bit in the palm of your hand first and mixing it round with your finger, it will make it warmer & loosen it up a bit- you can apply it more gently and just a thin layer is all that is needed.
Good luck!

Sorry if this has been asked or answered, but has she ever done a poo in a toilet, my DD was dry for ages but still needed a nappy on to do a poo (hid behind curtain to do it) as she wanted to do it standing up, like she was used to, sitting on the toilet for a poo mystery have felt weird for her.

Try asking if she would like a nappy on just to do the poo. She sounds all worked up over it.

We have dealt with a lot of this, it's been a long-term problem for both my kids for different reasons. There's a great book which helped us called Constipation, Witholding and Your Child. (Obvs was a MN recommendation.) And yes, do go to the GP. Movicol is wonderful stuff.

random, I don't know if you meant to sound so judgemental and rude; but you did. A 4 year old soiling themselves night after night would try anyone's patience, regardless. If it wouldn't try yours sometimes, or you wouldn't even become a little exasperated; then have a big, shiney medal because you win parenting.

OP, you're dealing with this really well. You've had great advice on here; definitely go to the GP and don't leave without a referral. Young children can't always put into words how they're feeling and what's wrong. Good luck to you.

what time is she having a poo? Is it so late that you couldn't keep her up and put her to bed after she's been? You could still do the bath/bedtime routine and then have quiet time with her until she is ready to have a poo, then straight to bed after that.

Another advocate of the wonders of Movicol. It draws water into the bowel & prevents impaction caused by withholding. I wish it was over the counter.

You need to give it for weeks or even months though - you have to give her muscles time to repair themselves & develop strength and sensation again so that she has control over when she poos. My DD1 was 4 when we went through this too.

My DD (now 6) suffered similarly between the ages of 3 and 5. We were exasperated with the constant cleaning, the constant encouragement to go to the loo etc. We had to keep clean pants and wipes on our person at all times - it was endlessly frustrating.

After she hadn't been to the loo for a week and was looking peaky, we took her to the doctors who diagnosed her with faecal impaction. My poor girl was frightened of going and it was only when she'd had enough Movicol to encourage an elephant to go, that she finally said that she was frightened of pooing as a relative (who I had serious words with) had told her that she was a 'dirty girl' for staining her pants.

I'm so glad to read that you are gentle with her after she's had an accident. It can be such a source of anguish for all.

DD was put on regular Movicol and we gave her plenty of water, wholegrains and did lots of walking. It all did the trick and she grew out of it just after the age of 5.

I second the barrier cream and also have you tried lotion and cotton wool instead of water? That's what I used for ds and now dd at home as it slides over the skin better than water does and I find it cleans better. I just buy boots sensitive one but any lotion will do, maybe one for sensitive skin so it doesn't irritate it more. A doctor suggested it when I went in despair over ds nappy rash. He also said metanium was the best bum cream.

It won't solve the pooing her pants issue but could you apply a barrier cream before bed to protect her skin when she does go?

Wow, you guys are great, thanks so much. I've made a list of everything to ask the GP about/look for at pharmacy.

She's gone to bed but is still awake, I can hear her on the monitor. I am feeling good about tonight though. When she had her last toilet break, I put a box under her feet so that her legs were bent up a bit, and she had a big poo almost right away. So thanks for that! I didn't make a big fuss over it, just told her 'good job'. I sat down on the floor instead of standing over her and maybe that helped too. Then I put some sudocrem (that's what we have in today, I will get something else) on her bum, read her story, and left her to sleep, with no further talk about the pooping stuff.

Really hoping that means a poop-free night, but if not, I am ready for it.

brdgrl I'm glad the box helped. A couple of times when pregnant I was constipated and I always found using one of the kid's steps to support my feet helped.

There was a really good thread a few weeks ago about raw nappy rash. A lot of the things suggested on it have been repeated here. One thing I haven't seen here was the suggestion of using egg white on the rash. I seem to recall you separate the white and whisk slightly then paint it on. I had a quick look, but I'll see if I can find it.

brdgrl read through this, it is the thread I mentioned. I'm not suggesting your DD has the same problems, it's just it also had lots of nappy rash advice.

www.mumsnet.com/Talk/childrens_health/2063000-dreadful-bleeding-nappy-rash-and-stool-witholding-heartbreaking

I saw this and need to run so haven't had time to read beyond first 10 posts, so apologies if the thread has moved on or this has been said.

We had (different but equally upsetting) poo issues with DS. We got a GP referral to a continence nurse. This was brilliant - 3 sessions with her, a few tweaks to how we were handling things, some medication and her talking to DS about it all helped. Pretty easy to implement, improvements within a week. A minor regression 3 months in, but after discussion with her and ages tweaks, we got there.

Definitely worth asking GP of you have a continence nurse in your area and getting a referral. GPs tend to be about more medicine focused but nurse helps with routine and the psychology of it.

OP you are handling things really well. I had some poo issues at around that age, and chronic bedwetting til 15 (I know!), and neither were handled half as well as you are handling this. I wish I had been taken to see continence nurses etc, my bedwetting at least had a purely physical cause but it was just treated as if I was doing it on purpose :(

Aw, brdgrl, you're last update sounds so much more positive and calm than your first post

Wishing you all the best - the advice you got here from so many is spot on btw.

This gives v comprehensive advice on the management of children with constipation/withholding and, as others have said, it is all about staying calm and supportive and being really, really consistent in your approach. And Movicol - marvellous stuff!
Keep treating for weeks and months after things have improved, even if you reduce the dose of her laxative to retrain muscles/nerves/her confidence.

Fingers crossed here for tonight although that might be a tiny bit optimistic