5 yr old soiling again-advice needed... please

[Saintharry13]

Both myself and my wife need some advice. Our first little boy who is just over 5 has never been fantastic with toilet-ing more specifically he is soiling again. When at pre school he was only there for a morning session and did a poo most nights after bath before bed. He started Primary school in September and since then he has yo-yo'd between dry for days on end, wet or as he is currently he has soiled for last 5 days. I have sought advice on here before about 18 months ago and followed as much as possible. However with it's resurgence, both me and my wife are in complete despair!

We have been to the doctors and they were awful-their suggestion was to bribe him with sweets and toys! We are due to see another later this week. The info on the ERIC website was useful but didn't seem to fit him exactly. We try regularly with him, bought him a more comfortable seat, he has stuff to do or us to talk to, a stool under his seat , etc but the bottom line is that he keeps doing it. He claims to not know when he needs one or if he does, he has to go straight away and this isn't always possible. The ERIC site said about "leakage" but this doesn't seem to be the case as it is mostly firm poo. The school are aware and while not helping massively, I don't think they are hindering. He came home today proud that he had cleaned himself up at school but his polo was covered in it, it upsets me massively.

Life routines changed about 14 months ago when son no. 2 arrived but this hasn't affected it, he did it before and has done it since!

We will of course soldier on, check his diet and fluid intake but we are running seriously short on ideas.... Can anyone relate to this?????

Yup, and this is about the third time this month that I've said 'I could have written your post'.

I have decided that as my dd1 only ever seems to wet herself when she is distracted, she is doing it deliberately. She is enjoying herself and can't be bothered to go. I take a dim view and tell her off. When she does go to the toilet she is rewarded. It's a slow progression but I think we'll get there when she makes her own mind up, like she did when she originally learnt to use a toilet.

Good luck. You're not on your own.

tell GP what you have told us in your OP and press for a referral

I would never usually slag gp's off but to suggest bribery and reward charts-it just smacks of not wanting to understand!

We went to see a paediatrician for the same problem for our ds, who is 4.5. He said that the when children soil it is because they are not focusing enough on their bodies' needs and don't have a proper toileting habit. He told us to give DS laxatives and then to set a time when he had to sit on the toilet every day. We were to make a sticker chart and give him a little sticker for sitting on the toilet and a big sticker for pooing. He said we would have to do this for several months.

Dh and I weren't particularly happy with this advice, especially since we think DS has some kind of tummy problem or food intolerance and the paed wouldn't take that seriously. But since we went to the paed (almost a month ago) DS has only had one accident so we haven't followed it up. If he starts soiling again we will have to decide whether to follow the advice or get a second opinion.

I had this problem with ds3 and can only suggest taking all the pressure off him to perform when it suits you or the school, we had some fab advice from the hospital clinic to stay at home in the morning until he went for a poo after breakfast, we tried to get up a bit earlier to eat and then got a really good routine going with complete support of the school. He was only late on a few occasions.

Make sure you don't overdose on fibre and drink plenty,we also made sure he used a step stool at the right height for sitting comfortably on the toilet and in a slightly rocked forward position.

I was told never to use a sticker chart etc it puts too much pressure on the child.
my ds finally got more control when he went into year 3, he honestly didn't seem to feel it when he needed to go.

I shared the problem with another mother at the school and we would look at each other smiling depending on who got a bag of smelly clothes brought out at the school gates.

As hard as it is chill out and don't rush, but I did used to be very grateful to one TA who did the changing of pants to save me having to go in.

I also remember my son hated going in the school toilets as other children went in at break time and he felt rushed, I arranged with his teachers that he could go out of break time if he needed to, we tried to make him feel it was more a medical problem that he couldn't help so encouraging him to speak up with his teacher. But thats why we were also encouraged to make him go before going to school.
Oh another thing go and check the toilets as when I went the toilet seat was cracked so the school did replace it.

Many thanks for stories- tbh it just helps knowing that other people have faced the same thing, will take on board the advice and talk to doctors and school again....

My ds had this problem but we then found out that it was caused by lactose intolerance. I would seriously try eliminating all dairy products from his food. This can be very difficult as so much food we buy contains milk, but it will be worth it if it sorts the problem out.

I think it's important for you to get a referral to the Paeds outpatients for him to be formerly assessed.

They will look at everything; physical to emotional and then suggest your options. I imagine they'll say about upping his fluid intake (as they always do with DD (9) and suggest Movicol Paediatric sachets.

If he has the sachets, he will feel the natural urge to go and get into a routine every day (perhaps as you said he used to at night) etc and then you would be able to wean him off them until he goes naturally.

The last check up I took DD to, the guy said that their body needs to know a poo routine and certain things can interrupt it and so they hold on again.

DD now takes herself off with her DS console or a book and is getting used to her body telling when she needs to go. She's not holding on like she used to.

GPs aren't generally into the whole constipation in kids thing; however, most hospitals either have thier own constipation clinic or at least an outpatients clinic where he'll be seen by a paed doc who can then formulate a proper care plan, rather than just going back to GP every now and again and starting from scratch.

I've had experience of 4 large hospitals (forces family) (JR at Oxford/ Yeovil/Ipswich/Peterborough) and all 4 have been fab with DD.

Returned from drs earlier on as had an earlier appointment-he has finally been referred to community paediatrician... I hope this is the start of trying to get things sorted....

DD ia like this she is 5 as well, never really toilet trained. She has been under the community paediatrician for a year and has been on lactulose and senakot for over a year. Just to warn you that pour paediatrician went down the reward route and has only just grasped the concept which I have been telling her that they don't work. DD doesn't care whether she wets/soils herself, she is not embarrassed about it at all, so we are now going down the punishment route, not bad punishment, she has to put her dirty clothes in to soak. I was also like this when her age so you do get past it.

With my DD we went to a paediatrician (privately, getting nowhere with GP). He was very thorough and basically concluded that she was scared of pooing, was holding onto them, they would then dry out in her intestine, and when she did eventually go, passing them was terribly painful. As I'm sure you know, the soiling is the poo stuck behind trying to come out. We started using Movicol - only a small dose per day - and it has helped incredibly. Once she started passing stools without pain, and with all the praise we gave her when she did (no charts, but lots of verbal praise and talking about how well she'd done) she became very keen to just go of her own volition. Things are not perfect, 4 months on, but they are so very much improved, as are the lives of all our family, the once a week poo drama had come to dominate everything. I would insist on trying Movicol. Good luck, I know how awful it is.

Our paed doc said that for roughly every month they are constipated without meds, that's how long it should take on meds to get the bowel back to its original shape.

When they withold poo, the bowel becomes stretched and then takes time to go back.

Ds started having difficulties with constipation and soiling in year 1. He is now in year 4 and still has the occasional soiling episode and always has to rush to the loo because of continued lack of sensation for the need to go.

Things that have worked for us are-

Firstly taking off all the pressure and any feelings that it was his fault. It wasn't and he had no control over it. I still feel awful now thinking about how long we blamed him for it . It was like a weight off his mind when I said that I knew it was not his fault, it was a medical problem and that we would tackle it together. He then no longer hid it or denied it when he had soiled and started telling me when he needed to change his clothes. The pressure and shame he must have felt each time I happened must have been immense.

Upping his water intake and upping it some more! We gave stickers for drinking water as that was something achievable and that he could control. He chose a treat at the end of the week if he had finished his water bottle at school each day.

Regular sitting on the loo. We tried about 20 mins after every meal until he started going regularly. He played with his nintendo, had sticker books, we read to him, etc. He got football stickers every time he sat on the loo, whether he pooed or not. Once he had pooed each day, he did not need to sit on te loo again until the next day.

We do try to ensure he eats plenty of fruit and veg but the routine of sitting on the loo throughout the day and drinking loads of water seem to have been the key for him. Also, only rewarding the things he can control e.g. Drinking water, sitting on the loo, telling me when he needed clean clothes, as opposed to the things he could not ie doing a poo on the loo!

Most of this was done without any ongoing support from the gp (although I know she would have given more support had we required it). He had lactulose to get rid of the initial compaction and since then, I think, the soiling has been more to w the lack of sensation rather than another impaction.

I hope you do get some good support for your ds, op. It is not somethin that ca be cured quickly. You are in it for the long haul but I can be done and life will be so much better for your ds and you when you have cracked it.

Sorry it is so long but hopefully some of it may prove useful

Check out the Bristol Poo Chart op for the stages of normal to abnormal poo.

Bristol Stool scale

like daft apeth I too could have wriotten your post even down to the she doesn't know when she needs to poo.

We have been forward and back to the GP's in despair as things improve for a while then take two steps back. They were of the opionion we were managing (even though we were regularly up 2-3 times a night with dd rolling around the bed in pain.

My dd is dairy free as dairy definitely does constipate her, (however she had a skin prick test as a child which was negative), as things were affecting her school work we got refered by the school nurse to the community continence team and had a meeting with the continence nurse a couple of months ago, he upped her laxative (she was on movicol 1 sachet but thats now been increased to 2).

If you can speak to your loacl continence team I throughly recommend it ours was fab and I know if things go pear shaped again I have somewhere to turn to... (thought that was last week but things have improved again.