To ask for your top tips re constipated 4yo?

[Draineddraineddrained]

I have gone about this all wrong and am keen to get it absolutely right from now on so want experienced advice! I swear I'm not a poo troll.

My 4yo was beautifully potty trained (wees and poos) from about 2.5/3. Hardly ever had an accident. We graduated her to the toilet a bit late and in a bit of a disorganised way; and also at the same time I was pregnant and have recently had a second baby (now 3 months old).

Around that time daughter has begun soiling herself. Usually just a little smear, very rarely a full motion in her pants (this usually only happens at night, in the day it's just smears on her pants).

At first I thought it was just nerves about the new baby, classic regression, tried to be calm and encourage her to try regularly. After a while of this going on and not resolving as all the health advice promised it would, and as she got more and more resistant to going, even when showing obvious signs of needing to go, I have become more frustrated with her and let my temper show on occasion. I feel terrible about this btw.

I'm now coming round to the idea (as this has been going on for months now) that she has a real physical problem (possibly developed from anxiety witholding initially but now it's beyond her control?). And I want to deal with it in the best way possible, as well as try to undo the damage to her emotionally and psychologically from all these months of stress and conflict around going to the loo 😔

I'd rather not go to the GP as I don't really get on with her - nothing I could put my finger on, I just feel like she doesn't respect me and she makes me nervous.

Has anyone successfully dealt with this - both the physical issue and undoing any emotional harm/psychological issues that will prolong the vicious cycle?

I'm thinking trying to up her fluid intake (I will finally yield to squash to get her to drink more, she never really drinks enough). Maybe trying to get her to eat prunes, or of that's a step too far for her then drinking fruit juice every day to try and add fibre/soften stools. Encouraging her to sit on the loo for a bit on waking, before meals and before bed, but being far more relaxed than I've been about whether she actually goes or not while she's there. And totally revising my approach to accidents, no more recriminations or constant "checking" whether she needs to go (even if she clearly does!) - just try to release my anxiety about it and if it happens it happens, deal with the mess quickly and move on, no biggy. Does this sound like a sensible approach?

I've not had any experience with a constipated child but had terrible constipation when pregnant and what helped was having my knees raised above my hips when on the loo (had my feet on a little step stool) so was in more of a squat position than a sitting position.

Same as the other replies, movicol for a decent period of time gradually reducing the dose. We started on a holiday which did help.

Can I ask anyone who's gone down the movicol route what did you do about nursery/school if they were in pants? Did you keep them off until they had control again? Or revert to nappies? Or enlist school's help to minimise accidents/embarrassment? She's already not the most popular kid in class (just not very social, prefers her own company or the company of adults) and I don't want anything to happen that might turn indifference into bullying 😔

DN became constipated just after being potty trained. The problems are still ongoing, cause pain, soiling and lots of school absence. He's 10 years old now, so please get medical advice and please follow it.

Some great advice I found on here was to ask the child to pretend to blow bubbles when they do go to avoid straining. Mine didn’t manage this well so we used a piece of tissue (2 or 3 squares long) and held it up a few inches from his face and made a game for him to try and blow it as high as he could while I held it. He found this fun and it’s worked every time so far

Been there done that. Lost my shit had to walk away so bloody frustrating. Things we do when constipation occurs

Movicol- need it from docs. When very constipated dose in morning and evening till things move. Then reduce to one morning dose, then after a week or so every other day etc.

Movicol basically retains water in the colon and makes the poo feel soft and light. Tmi moment... have watched it come out a few times you can see the hard dark old poo mixed in with the new soft stuff.

Warning though this came make them soil themselves alot as it makes the loose poo very watery until the blockage is out.

We use cheap thin sanitary pads in the knickers to help with clean up and not having to throw knickers every time.

Sticker chart. Everytime we get a poo in the loo she gets a sticker. 5 stickers gets a book (loving the dinosaur that poo books) 10 stickers a prize. 20 stickers a reasonable choice in the toy shop. By this point things are pretty regular again. We continue with praise and reward though to ensure she doesnt use it to get extra toys.

Prune pouches from aldi. Reduce volume of milk/dairy and increase fruit and veg where possible, just not bananas

Lots and and lots of water.

I also found a book on amazon called "it hurts when I poop" my daughter loves it. It about a little boy who holds in his poo, the doctor tells him a story which explains what happens when you dont poo and why its important. And then also what he can do going forward to be "the boss of his body" just have to change the amercisms when reading it.

When on the toilet do head shoulders knees, also row row your boat, and rub the lower back.

We have a step seat for the toilet which raises the feet up which helps to tilt the hips downwards.

Patience, lots of patience, kind talking, count to 10. If after a few proper tries nothing happens then get them down and try again in half hour.

You have my sympathy. My dd has had issues for nearly 3 years. We now think she started withholding when she started a new nursery and I was having a baby and it caused a blockage and lots of poo and wee accidents.

It’s well worth calling the Eric helpline for advice. I also found the health visitor quite helpful. They allocated us one who specialises in toilet issues and she was in regular contact. Our gp was not that helpful and the ones I’ve spoken to haven’t known much about constipation. I just tend to call them to tell them what medication she needs. My daughter takes movicol to make the poo soft and pico sulphate to make her go for a poo. We were advised after several months that movicol alone don’t work as they just get blocked up again.
If she’s blocked then it could take 2 plus weeks to clear it and they recommend not going to nursery.

It’s only though mumsnet that I eventually found Eric and began to figure out the problem as I really struggled to find info before. There’s also a Facebook group called movicol mummies which is helpful.

Re nursery with movicol.

A few times we went back to pull ups but after a time she was then wetting herself. So we stuck to knickers with the sanitary pads.

Also bought alot of cheap knickers so I didnt mind throwing them.

I talked to nursery and explained what we were doing. They had so many kids needing movicol that they knew what to do.

Mine was the same and I had the same reaction as you which I felt awful about.
We have gone down the Laxido route and it has worked for us. 1 sachet at breakfast and 1 after school. Keep this up until well after the first BM to make sure they are cleared out. My mistake the first time was thinking they were cured but there is a lot more in there than I realised!
I also make sure he has fruit at breakfast and plenty of fluids but I think until they've had a good clear out, you're fighting a losing battle.
With impaction, you can increase the dosage of sachets so if the GP agrees I think it's up to 8 sachets in a day. If you're doing this, I think its sensible to miss school. If you do the slower approach of 1-2 sachets, she should be ok to go to school.

Same problem - we often used raisins and it RUINED her teeth. To the point where she got referred to a hospital dentist, who told us they were as bad as sweets and doctors should be strung up for ever recommending them.

My daughter really suffered when she was about 3-4 years of age and the only thing that worked and worked quickly was movicol. Never had a problem since.

Apple or pear with breakfast, carrots for snacks. Movicol is great whilst you're moving them over to a diet with more soluble fibre in it. Routine is also really useful for my son. He sits on the toilet before breakfast every morning for about 10 mins with a book and again after school. He has a step to put his feet on and a seat that brings him more forward so he's more in a squat position. Generally he doesn't then need to withhold at school.

Thank you all so much for sharing. I feel so much better knowing there's a way forward and we're not alone in having dropped the ball on this! MN is a mixed bag sometimes but the kindness and helpfulness people sometimes show to total strangers is just heartwarming sometimes ❤️

Just to add, starting in a week off meant that once the 9 days were up they were alright to manage in childcare having had the big clear outs already. We didn't have any real accidents, just some skid marks.

If for whatever reason you don't get on with your GP, perhaps change your GP. I hope the tips given by others avoid any need to go to the GP, but just in case they are ineffective.

We have had this, almost to the letter of what you describe (anxiety/withholding as a toddler, soiling from age 3.5 onwards, turned out to be chronic constipation, he’s now 5.5). You need to see the GP.

In our case they detected no constipation on examination but referred to the local hospital and the first thing hospital did was X-ray him. Despite no sign of constipation in terms of either bowel habits or on tummy examination, he was backed up to his ribs.

We did a faecal disimpaction regime and no way can they go to school or nursery while that is ongoing! He is now on a maintenance dose of Movicol but we are far from having solved the problem. Be prepared for it to take a long time.

And I’d be lying if I said I’d never shown any signs of frustration as it can have behavioural elements as well - my DC is much more likely to have an accident when distracted - so well done for being mindful of your reactions. But there is an underlying physical cause and it must be addressed. Insist on a referral for X-ray if the GP says it can’t be constipation.

Also, make sure other adults involved in their care are briefed on the issue and how to handle it as well or the child can very quickly get into a cycle of soiling and feeling shamed. Generally, I think lots of positive attention is important for all children but especially here if there’s a subconscious attention factor. But everyone involved in their care needs to be very relaxed and matter of fact about accidents. Sadly in my DC’s case, that didn’t happen with some of the adults involved in his care who thought it was exclusively behavioural and he needed disciplining for it, and it has become a Thing and caused huge problems.

DD had this, around the same age.

Movicol didn’t do anything, it caused more problems if any. The GP wasn’t a big help unfortunately, it seems the number of children where Movicol doesn’t work is too small for them to think of alternatives.
In the end we pushed for a private referral to a paediatrician specialist for gastro issues. He put her on Senecot which worked like a treat. Together with lots of fluid, good diet and lots of encouragement and no punishment it took a year for her to be on what most would call regular.

The school was informed all the time and DD had a bags with spare underwear, wet wipes etc always with her.

The Eric website is good for information but you really need to see a GP.

We had the same problem! DD would refuse to go to the toilet and then cry and cry when she had to go as she was so constipated.

We asked the pharmacist but they said to go to the GP as the problem had been happening over a month. She was prescribed Laxido and we kept it up for around 3 months (as well as giving her a little treat every time she went to the toilet) and she is fine now!

It was a very stressful time though, for everyone!

A footstool can help as raises the legs up into more of a squat position, ideally one of the two step kind.

I kept my DD off nursery when clearing out.