18 month old won't poo

[HotGiggity]

Hi,

Sorry for the gross topic and long post but my 18 month old DS refuses to poo unless he literally can't keep it in anymore.

Before Xmas he had a tummy bug which caused diahorrea and then after that he had constipation. We uped his fluid and fruit in take but it didn't get any better after a few days and he seemed in physical pain when trying to poo so we took him to the doctors.

Doctor said he had a small anal fissure and prescribed some lactulose. We were giving this to him and he would try to poo but didn't seem able to. It ended up so that the only time he seemed comfortable pooing was with his nappy off, either laying on his mat or in the bath.

We bought him a potty and thought that maybe if we gave him the option of pooing without his nappy maybe he would be ok. For a while he seemed ok, with us spotting when he seemed to need a poo and putting him on the potty, but since he's been back at nursery things seem to have got bad again.

Either he's not comfortable going to the toilet at nursery with his key worker or they spot it to late. It's gotten so that he isn't pooing at nursery at all, and is only pooing at home every couple of days. I've taken him to the potty at nursery and apart from him being uncomfortable whilst doing the poo he seemed ok sitting on the potty and directly afterwards he was all smiley and happy.

He's obviously uncomfortable when he goes, sometimes even in pain, particular if it's the first one in a couple of days, but the poo that comes out is mainly softish. The problem seems to be more with him trying to control his bowels and hold it in than with the actual poo itself.

I don't really know what to do? Should we go back to the doctors? Should I just up the lactulose dose? Was bringing in a potty the wrong thing to do?

I feel so sorry for him, he is otherwise exceedingly happy and 99% of the time you wouldn't know there was anything wrong. I really don't want this to become a big thing and try not to make to much of a fuss, buts it's clearly not going away by itself.

Thank you for reading if you got all the way through, any advice would be greatly appreciated.

Oh it's a terrible vicious circle isn't it? My DD did this. Is there any way you could take a week off and keep him at home to try and get him straight again?

It can get worse as their bowels get affected...you need to get on top of it. What is his diet like? What helped my DD was eliminating white bread and pasta and rice whch she loved....I got her eating a very good diet...lot''s of veg, pulses, fruit and brown grains...wholewheat bread.

Of course if his poos are soft, but seem to hurt, then it would seem like it''s a fear of going rather than the poo being haard and hurting. IN that case, I do think I would ditch the potty. Fwiw my DD never poos at nursery but does poo daily at home and that's where you need to be really. Although for some kids it's not unusual to not poo daily.

Firstly I would speak to the nursery, then maybe gp again. The nursery staff REALLY need to help with this as the poor child is in pain. The fact that he has been on the potty at nursery with you shows its probably not the place but like you say, them not noticing.

Hopefully with a bit of attention he can feel more confortable going in the potty and, hey, you'll be on your way out of nappies! Mine is still firmly in nappies so I'm sorry to not have any practical advice but I really do feel the nursery need to address it properly. Hope you can get this sorted so it doesn't develop into a serious problem for him.

He does eat a lot of fruit and veg and only has a slice of bread a day generally. He only has fruit or prunes for snacks and has diluted orange juice in the afternoon, as advised by the doctor (although I did question what it would do to his teeth).

We had a more definitive conversation with nursery last week about the potty situation as I don't think they had since him being uncomfortable a needing a poo before.

Before Xmas, I had spoken to his key worker about using the potty and troubles he was having, but I don't think all the Carers on the floor were given the message. Last week they called me to say that they had observed strange behaviour in the afternoon and were concerned that something was wrong.

When I got to the nursery, I talked it through with one of the Carers, as it was his key workers day off, and whilst I was in the room with them he performed his 'strange behaviour'. It consisted of sitting very still and starring into space whilst making a straining face.

I pointed out that that was him needing to go to the toilet. The floor manager was involved in the conversation as the Carers had been filling out observation forms every time he did it. She said that she had suspected it might have been that but one of the Carers had told her he'd been for a poo earlier in the day.

We agreed that they would pop into the potty room on their way to the garden etc, even if he did seem to need a poo just so he knows where it is, and that they would start doing role play with dollies and potties to help him understand that it's nothing to be afraid of.

Generally I'm very happy with his care at nursery and he seems to love it there, it just seems to be on days when he's either not with his key worker or she's not there that he doesn't get the same level of attention.

I suppose also on the flip side of that, he is only 18 months and is in a group of kids the same age, so it's not as if they are all going to the potty yet.

My DS started being constipated at a similar age. You can up the lactulose dose yourself, just little by little. And it's important to get him to drink lots as the lactulose draws water into the bowels and if he's dehydrated it just won't work. If you do a search on here for consitpation or lactulose there is a lot of experience in this!

Hi there,

My daughter hated pooing at this age - it was very distressing - turns out she had an undiagnosed hernie, so everytime she pushed it was super painful. Didn't find hernia till she was 2 and a half.

Sorry - it was a Hernia - in her tummy.

Thanks for all the advice, there's some really useful stuff here.

Day today DS has a small belly button hernia that we were told should heal itself after time, is this something to be more concerned about?

I had two hernias myself as a kid and ended up having surgery to repair them.

Hi,

My daughters hernia does not cause any poo problems anymore - however, it won't heal itself - it is fatty and fused with blood. She had a scan etc. If she feels any tummy pain we must take her straight to specialist but they will also review when 6 and possibly operate. It is quite large and is full of fat.

I think maybe you should ask for a review, scan etc and see if it is contributing to pain when she is straining?

I don't have personal experience, but I understand that toddlers can easily get the 'fear' of pooing, especially if they've had pain/constipation, so it may not be anything more serious, but worth getting checked out.

A note on avoiding constipation - you need soluble fibre as well as insoluble fibre, so not just your usual high fibre breakfast/snacks, but also insoluble fibre stuff I.e. from oats - porridge is a good one. I alternate my DD between weetabix, bitesize shredded wheat & porridge for breakfasts & that helps avoid any major pop-based probs.