4 yr old DD holding in poo and staining pants.

[SantaLucia]

DD potty trained easily at 2 yrs 9 months. We've had the odd wet pants if she was rushing to the toilet or if distracted - nothing out of the ordinary.

Pooing was always great. She took to it straight away. She was also dry at night after 1 week of training and has only ever had 1 night accident in her life.

Recently she has had poo stains on her pants. I thought it might be due to inadequate wiping when she is at pre school but it's been getting worse. I'm pretty sure she is holding poo in as she used to go once a day and be very regular. Now it's not regular. Her pops seem soft and normal, she hasn't reported any pain and her anus looks fine. The last few days she has had major weeing in her knickers as well. Really out of character.

I've tried ignoring it, getting her to clean it, throwing away favourite pants and replacing them with boring white ones, reward chart, talking about it, reminding her to go. But it carries on and I'm now at my wits end.

She is otherwise well behaved and enjoying life.

She also fiddles with her bottom a lot and says there is a funny thing in her bottom but I've checked it and it all looks fine. Tried thrush cream too and metanium in case poo causing irritation.
C
Please help!!!!!

Google encopresis.

Constipation? The staining could be leakage around hard stools. Wetting is frequently related to constipation too.

Ds1 had this because he was holding poos in. He ended up having movicol for quite some time but is fine now.

I tried rewards and being cross/understanding. Good diet and plenty to drink. Nothing worked once he had become constipated - so the gp prescribed movicol (after unsuccessful lactulose) and it did the trick.

Wee accidents are a sign of constipation (my dd has had chronnic constipation since she was 2 and she's now 10. She is not currently on Paediatric Movicol but has been for most of her life.

I know what outofbody is saying about encopresis but that assumes she's pooing in her knickers on purpose but with constipation, that's not usually the case. I realise that your dd's poo seem normal and soft but the poo in her knickers (sneaky poo) could be bypassing the other poo and being ejected without her knowing/wanting it to.

Check out the ERIC.org which has a fab section on constipation and soiling before you think she's doing it on purpose.

That said, encopresis could be more likely if she's not happy at preschool. Have you asked her if she's happy there, what the staff are like and whether the other kids are kind to her etc? If there seems to be any probs there, she could be witholding and poo on purpose as a reaction to being unhappy about something.

Hope you get it sorted

And what pooka about the movicol......if it does turn out to be constipation, ask the GP to give you movicol rather than lactulose. It is far more effective and more gentle for kids. Once they become constipated, as pooka's son, it can take double the time or more for the bowel to revert to its normal size.

yes - ERIC helpline fab.

Also check the loos at pre-school. If they are in any way less than sparkling clean, or a bit smelly, or the doors don't give privacy or anything that might make a four-yr-old not want to use them, this could be a clue to what's happening.

If the loos are like tiktok says, you need to show the school the bog standard poster and talk to them about improving their loos.

loopy, encopresis is soiling because of constipation...

accidental. not deliberate at all.

ds1 is 10.

with an ongoing battle against encopresis. has been on various lactulose/ movicol type stuff (now lansoyl with enemas if the soiling recurs). and a referral to camhs to deal with anxiety and toileting phobias.

google encopresis. involuntary soiling.

Yes I know but if you read the site you posted, it implies it's actually soiling in clothes on purpose.

Often, many people think that when the child hides under the table etc and soils their underwear, it's because they are doing it on purpose in their pants, rather than using the loo. This is generally not the case; it's because they are trying to hold it in not poo it out.

i didn't post a site.

i suggested googling encopresis. the first hit that comes up when i do is just wikipedia, where the first line says involuntary.

apologies for not giving a full and detailed explanation. there are also loads of threads about encopresis on here, so searching mn archive would also give loads of info.

i have no idea at all how you got purposeful soiling from anything i posted.

Okay, I see. It says voluntary or involuntary.

You must be so stress outofbody with your ds. How long has he been on movicol? Did his constipation start after potty training? Has it improved now he's in yr 5?

whoops - sorry - no, you didn't post a site. I must have googled and then read something saying it was voluntary

well, he's just started meds for adhd, which they've been suggesting for a while, but it's all a bit chicken and egg tbh. he has good weeks and then it all starts up again.

having a particularly bad week this week though, so have spent much time scrubbing and soaking. apols for being short.

I obviously don't mean stressed with him just stressed and worried about his situation.

No, I'm sorry I seemed arsey . I gave up scrubbing knickers; just bought bulk from asda and chucked the soiled ones.

he was never great toileting as a toddler. always prone to constipation really. got fobbed off y doc when he was three with the threat of internal examinations and scarring him for life. problems really started at 4, but soiling issues really mostly from 5.
poor little sod.

i think the camhs referrla will be really helpful. he's noticeably phobic about toileting anywhere except home now.

Bless him .
So what is camsh?

in fact, i need to discuss him using the disabled toilet at school. he won't use the other one at all, but there was a glimmer of possibility when i mentioned the disabled one... i just need to find out if it's private...

oh, sorry. children and adolescent mental health.

tricky now to know how much is due to physiological, and how much is psych... he's had hypnosis and stuff as well (crazy gp at one point - private practitioner looked really hopeful - definite imporvement after one seesion, then gp took over and it was literally the worst i've ever seen him)

just want to reassure op that it's usually v responsive to treatment! it might take a while, but ds is a bit unusual - no need to panic!

Dd2 trained at 2yo, no problems then we found she was constipated when she was about 4.6years. Surprise as she'd had no signs other than tummy ache and wee accidents (which we thought was her not being bothered to go as she was busy doing something) and occasional smears in pants. The medicine worked really well and oonce it was established hardly had accidents. She came off the medicine at about 7.6yo and has been fine ever since.

This is all really useful and reassuring thanks. Im trying out lactulose as we have some in the house but will make an appointment with gp to get movicol. It took me by surprise because she has never been constipated before and loves veggies and fruit - its meat I have the battles with!!! I think something may have happened to make her self conscious about poos as she keeps saying recently that she doesn't like poo because it's horrible and smelly. She is very happy at pre school but I'll speak to them to let them know what is going on. Saw the toilets today and they were pretty clean but DD claims they are dirty. Let's hope we can sort it out. Thanks again.

Just to say my DS (8yo) is having same problem- started with skid marks, which seemed to be the soft poo being forced round hard poo. paediatrician advised movicol. we've tried it, and drinking more fluids. now poos are soft, but he's taken to holding them in, and soiling sometimes

Its hard to stay understanding because I think he's doing it for attention.
I'm getting support from the local CAMHS, and this week they advised me to keep a diary to see if there are any triggers, which is a positive step, so incase it will help anyone here, they have suggested I record, for each incident:

Day and time
Where ( home, school etc)
what DC was doing before? eg he had just woken up and I prompted him to go to the loo
What happened? eg didn't want to go at first but went after about 10 minutes and did a wee
what happened after? eg, he came and told me he had been and I told him he was really good for using the toilet.

Has anyone here got advice on how best to react, or tips?

op - it sounds like faecal impaction to me. Please dont blame your DD and get an xray asap. Go private for speed if you can afford it. If she is saying there is something there in her bottom it will be the feel of the impaction - a child is unlikely to be making this up and you wont be able to see anything. Soft poo does not preclude impaction as it can be overflow. My DS only ever had very soft poo. Wetting is a very classic symptom of impaction.

Avoid CAMHS as all costs at least until you have ruled out medical cause. Once you are with CAMHS they will only look at all non medical causes BUT over 95% of children with soiling is due to impaction so it is essential to rule this out first. Many professionals fail to follow guidelines and correctly rule this out before suggesting there are other reasons.

Dont assume it is behavioural and allow CAMHS to destroy your lives whilst your DD continues to suffer as they will be looking for a reason and if there is none because it is medical then they will have to create one. In our case it was deemed to be hatred of our DS and not feeding him!!! We finally got a 3rd opinion and an xray but I cant even think about the consequences if we had not. Will never understand how such dreadful accusations could be made against a sick child and parents desperately seeking help.

lorrikeet - are you absolutely sure that the impaction was fully cleared as it can take a huge dose. Unless he has other problems and needs I would think it very unlikely to be non medical but obviously dont know your circumsances. Be very wary of CAMHS though as in our case they just wanted to find a cause at all costs and therefore made up lies to support the reason they had come up with for the soiling!

Thanks for that info, cmahsdm. sounds like you had a bit of a nightmare; i really feel for you having to deal with accusations on top of this. Your post makes a lot of sense

I agree with you that kids don't make this stuff up ( I remember as a kid explaining I had 'spiky' poo to my mum, who didn't take any notice/understand the problem).

In fact I think I will go back for another referral as well because this has been going on too long.

Thanks for the prompt, and can you explain please how you went about going private, and if how much it cost. No-one in the nhs has ever suggested an xray to us: is that normal procedure or just when it's very bad?

thanks