Can anyone help? Niece refusing to poo. Drs not helping

[sarjd]

my sister is getting desperate so I thought I'd ask whether anyone has had similar experience and/or can suggest anything that might help.

My 4yr old niece periodically stops herself doing a poo. This has been going on for a couple of years now. She goes through stages where she does everything she can not to poo. Sometimes she is ok but will generally only do a poo in a nappy ( although she is pretty much potty trained otherwise - during the day at least). When she is going through a stage of not wanting to do one she will bend over double and concentrate hard on not pooing.

My sister has tried talking to her about it - trying to identify what the problem is - shouting, curtailing treats, ignoring it totally, sitting with her, leaving her to do it. She has been to the doctor and been prescribed laxatives and softeners. These have been increasingly strong ones but only make her try harder to keep it in and more painful. The doctors don't seem particularly keen to try anything else or help. My sister is going back to try and get a referral to a psychologist but doesn't want to give my niece the laxatives any more.

My sister says that it is starting to affect her personality and it obviously has an impact on her skin and health as well.

Has anyone experienced anything similar or have any suggestions or recommendations for child psychologists or docs specialising in this field in the South West?

Have you ever heard of a Leaflet called Poo goes to Poo land? I know its helped alot of people and did with my DD when she first started potty training.
Do a search on here... there will be tons of threads on it.

I second Poo goes to Pooland, here

This book and push for a referral (no pun intended).

I wouldn't reccommend that your sister stops with the laxatives, as when your niece goes then it wont hurt her so much, if you stop then you lead to constipation, overflow and it will hurt. Push for a referral, DD sees a community paediatrician, she is seeing her tomorrow in fact. We have been given varous advice on encouraging her but DD gets bored after a while, for instance, we had a sweetie jar, anyone who went to the loo got one. we have got the timing down now that she does not soil herself at school and has not wet herself for a while, unfortunately if she feels the need to poo she will wet herself rather than take herself to the loo, she asks for nappies when she feels that she does need to but has now reached the stage that once she has pooed she asks for them to be changed which is a small but fairly significant step.

Your sister needs to be prepared that there is no quick fix solution, we are now two years down the line and DD will be 6 in January.

As to Doctors, I hear that there is a good on at Southampton hospital but apart from that I don't know. We have taken DD to a child psychologist and talked to him about this matter along with others. It turned out that he had worked with children in a hospital with problems so bad that they had ended up in hospital, he advised to encourage sitting on the loo and practise pushing when she need to do a wee, and have a reward even if nothing came out.

HTH

any OCD issues? What does she think might happen if she has a poo?

Thank you for all your suggestions and your story 5. I've ordered the book for her and sent her the story. Its really worrying and becoming so stressful for them. She has tried the sweet jar and star charts etc.

DD has complicated, chronic constipation/contience issues due to being born with imperforate anus. I have read/heard so much about constipation. I have also had access to a very nice and experienced 'poo nurse' . This is very, very common. Especially in little girls. What tends to happen is the child has a bad experience of doing a poo - usually it's a bit uncomfortable. Then they try to hold of doing it again and when they finally can't hold off doing it any longer they end up doing such a big, uncomfortable poo that the whole cycle starts off again. The association of the poo being painful and the behaviour of withold continues. You can do lots of things like reward charts, books about pooing, special comfy seats, reading books together on the toilet etc, etc but as helpful as these things are, when you have a child who has developed this behaviour, it quite often isn't enough. Our specialist nurse deals with this all the time and says the only way to sort it out, without months or years of problems is to make with diet and meds, the poo so soft that they a) struggle to 'withhold it' and 'b' learn that it isn't painful or uncomfrotable, supported of course by lots of love, time and understanding from the parents. Movicol is usually the medicine of choice for this. It is very effective and easy to take as you can give it to the child as a drink, with a bit of their squash in if they like. So, I would...

Speak to GP and ask specifically about Movicol.
Make the toilet a fab nice place with a comfy seat, books, etc etc. Possibly buy a copy of the childrens book 'everybody poos'.
Setup a reward chart.
Give the little girl lots more water, fruit (especially pears - not bananas/apples), fibre (bran flakes are great), even mixed in with other cereals if she isn't keen.

Hope this helps.

This is so, so common and totally fixable - but it can go on and on if you don't really take firm and committed action. It's a behaviour and can get more and more entrenched. Good luck x x x

We also limit DS use in the house. But DD is allowed to go on it on the toilet. This has been such a good incentive. I think it also helps her relax.

it is surprisingly "normal " (ie within normal range and no other health or psychological problems) for 4 year olds to still insist on pooing in nappies. Am sure ths is distressing for the parent but I would suggest that all the fussing, laxatives, discussion about it, sweets, charts, gps is making it much much worse.

The child may have absolutely no problem pooing at all (and this would appear to be the gps view), but she just isnt ready for potty or toilet yet - I know it sounds bizarre if you havent had a child who does this, but honestly it is totally normal in children with no underlting issues whatsoever.

If medics do not suspect any problem then I would suggest she doesnt mention pooing again and puts child back i nappies for poos. I would be very surprised indeed if she is still in them when she hits 5 years of age, she just needs to let her do it in her own time.