Poo withholding - please tell me your happy endings

[parched]

So I'm in tears for the umpteenth time. DS has been withholding since June last year (at which point he was two and a half). I've tried every tip ever posted on mumsnet but nothing seems to work - prune juice, blowing up balloons, blowing bubbles, swimming, treats, senokot, lactulose, loads of fruit - you name it, I've tried it.

Just before xmas things seemed to get a little better - still holding but doing a plum-size poo in his nappy most days. A few weeks ago he woke up and announced "I want to wear pants to nursery" and because withholding is all about control I went with it. Apart from the first day he's had no wee accidents, but now the poo withholding has ramped up a gear. We've told him he can poo in pull-ups but he says he doesn't want to but won't go on toilet either. The last two days he's had a meltdown at the mere suggestion of pull-ups and is now running around wimpering.

Is Movicol the answer? Please tell me how you got through this and it will end eventually (read a horror story on here earlier of a child who was still this at 13!)

My daughter did this. From being about 18 months until she was using the toilet instead of nappies. I found it incredibly distressing, I really feel for you.

She is now 6, has been using the loo since she was just over 3. That was the turning point to be honest.

But what helped break the habit, (because that's what it became to her) was movicol. I used to give it to her in warm juice, only very weak diluted juice, but it became a treat. And a habit formed where she had a poo straight away after, initially because the medicine worked and then that formed the habit.

My health visitor at the time told me it was all about a good habit. Even now she poo's at the same time every day, sometimes we miss one or two days.

I guess what I'm trying to say is, try the movicol, it's not a permanent solution - but you won't need that if you get his habit going. For my daughter her best time is just before her bath, she has time to sit and not be rushed on the loo. Ok, she is a bit older than your son, and understands a lot more now about the consequences of withholding, but I promise you it will get better. She only used movicol for a short time.

Good luck :)

DD had terrible constipation when little, and she used to really suffer when doing a poo so she could go a long time between poos. We tried juice, fruit, mr poo goes to Pooland, singing songs about poos etc! In the end the doctor gave us movicol as I was worried she was becoming scared of going to the loo.

It worked very quickly, and really helped. She is 5 now, and has no problems.

Movicol has been a god send!!! my dd has been with holding/constipation for over a year since 2yrs. only in the past few weeks, after previously using lactose senakot and ducosate, she has finally had 'normal' bowels.
we got so distressed with it she had to have enema which I had to apply myself at home. very distressing for a parent after no poo for 13 days. but after taking Movicol 2 sachets daily she has been nearly every day. no where near using the toilet, but asking for a nappy its so much good progress.
its a long road but she is starting to be a happy girl again instead of being distressed about poo.
if poss ask for chocolate flavour. kids then think its a treat drink rather than medicine
good luck and hope all goes well

ds2 did this and still does to a lesser extent. Was better on movicol and now weve stopped that.

My ds turned 2 in December and we were prescribed movicol a fortnight ago. He withholds and used to go around 5 days between movements and then strain horrendously.
The movicol has worked very quickly. We got up to four sachets and he had three or four soft poos for three days. I reduced it to 2 sachets and then one to see whether one would be enough.
He's not had a poo since Friday now but isn't straining anymore.
Have upped movicol back to 2 sachets and an waiting to see what happens.
I was probably premature in reducing it and feel shit about it.
He isn't distressed anymore which is good but don't want this to be an ongoing problem iykwim??
Are there any issues with taking movicol long term??
I have to mix with juice and although its only the tiniest bit of juice I worry about his teeth and wonder if there's other things I should be aware of??
Sorry for intruding!

I was told the way Movicol works is by adding water to the poo and giving the child extra electrolytes so they dont become dehydrated. there is no ingredient that is absorbed by the body so it isn't harmful long term. the main prob with long term constipation is the bowel becomes over stretched so it takes more poo before the child feels the 'full' urge and gets the recognition to go to the toilet. the Movicol or any meds need to be over a reasonable period for the bowel muscle to shrink back to normal size. HTH x

Not intruding at all wereonourway - think of this as a support group! There are so many families going through this and there doesn't seem to be a cure - just treatment for the symptoms.

It's definitely a psychological rather than medical problem with DS, but I just want him doing regular BMs so I can have my happy little boy back - DH has had a terrible time with him today . I hope the doctor when we see him is sympathetic (he has a tendency to brush you off, hence why I've not been before).

I'm hoping that if I can get to regular and fuss-free BMs in a pull-up I can gently encourage him toward the toilet...

Just to add, when my dd first started with the movicol she was still in nappies. She would kneel up on my knee looking over my shoulder with her arms round my neck trying for a poo (iykwim?) the gravity helped I think and she got to squeeze me for reassurance. Just a thought, she still remembers doing this. I think it helped.

Thank you.
I'm upping it again tomorrow, my gp kind of described it as finding his happy medium but did say it wouldn't be a quick fix.
Stupid of me to reduce it so quickly.
Ds has always gone three or four days and then had a "poo day". This was from him being tiny. Was always brushed off but think its culminated in this. Prior to movicol he was really upset when trying to poo.
Sorry if tmi but when he was pushing his bum would be open and you could see a "wall of poo", impaction rather than constipation I think.
Just hate that he is relying on medication to poo properly iykwim?
Even though he hasn't had a poo for a few days it isn't bothering him and he hasn't strained so if I get plenty of movicol in him the next few days and even it out hopefully we won't get back to straining stage

wereonourway I know how you feel, but I think you just have to think of the longer term - movicol helps him to retrain his bowel so that pooing feels normal and not painful to him. My DDs have both been on it - dd1 is now 4 and started on it at about 15 months; she finally stopped around 3, although by then we were down to tiny doses (1/4 sachet every other day), but we did reduce it very very gradually. Potty training fixed it.

DD2 on it as well, one sachet a day (she is 14 months); no-one suggests it's problematic long-term (we saw paediatrician with specialism in not pooing...)

rhetorician. Thank you, that's reassured me

My DD who is nearly 4 has just come out the other side, if that's any hope to you at all.

I really massively recommend the book 'constipation, withholding and your child' it's very honest.

Movicol might be the answer for you.

For us in the end it was I think a combination of lactulose, the idea of Mr Poo and Mr wee wanting to party in the potty together, another book 'help, it hurts when I poop', getting rid of reward charts, and talking about how boring Poo was and all the fun things we weren't doing/talking about because we were dealing with Poo.

Just to let you know it does get better and it does end! My DS1 was terrible for witholding his poo and once went for 18 loooong day of no poos. I too him to doctors so many times, tried to increase his fruit intake, encourage him to drink more, doctor prescribed movicol but in the end it was psychological not physical so nothing we could do but wait it out. It was horrendous, DS would get himself so stressed out and in the end would only poo in his sleep in a nappy once every week or so :-( It was horrible and I ised to feel so stressed and even angry about it. In the end we just had to relax and try not to keep talking about it in front of him or make him feel bad for it. By the time he was 4 he for some reason would do a poo every day on the toilet. He's 5 now and we still have to remind him to go every day but I think he's just in a habit of having us tell him he needs to have a poo in the evenings so he goes and pretty much can poo on command now. If it was left to him, he probably would still only poo every 3 days or so but then it gets painful. Anyway main point is that it will get better, even if you do nothing.

Thanks everyone. I've got a doctor's appt for Monday, so we'll see what happens.

Just a quick response - we had exactly the same problem with my DD. started around 20 months. We moved to potty training just after 2 to see if that would help but she still withheld it and would put it off so long that she got terrible pains in her tummy. We used orange juice and explained that the only way to get rid of the tummy ache was to go to the toilet and push it out. I went in and helped her push by telling her when to push. Sounds a bit daft now but we got through it in the end and although she puts it off sometimes its really fine now. I think it sorted itself out around 3 yrs.

We're still having trouble but DS is getting better. He was pooing 5 days out of 7 on average (yes we do make notes!) throughout December but had a relapse in January due to illness. He hardly ate anything and therefore had no need to poo, so slipped back into old ways. It was very upsetting because we thought he had cracked it, being so proactive in December.

He's 4 now and has had bowel problems since he was a baby. He's under the care of the Paediatric Continence Nurse and is prescribed Adult Movicol, as the Paediatric Plain sachets weren't working for us. Obviously adult Movicol is not licensed for use with children, so we get phone calls and questioning from the pharmacist (which is reassuring), to make sure that we are giving him the dose recommended by the GP, which is half the minimum adult dose. It works better for us because it is a liquid with a mild orange taste which can be mixed with any drink and doesn't seem to be objectionable to DS (which the powders were).

What we have also tried is telling DS that if he doesn't do his poos in the toilet regularly then we can't go swimming (or soft play, but swimming his favourite) any more. He might not be able to hold a poo in while in the pool, and that would be awful...

I do feel bad about this sort of thing, but I have tried so many things for so long without effect that we have got desperate. If it works, it works, and it's for his own benefit. He can sit on the toilet for ages (his record nearly two hours) without doing a poo, he's got so good at holding it in. He has activity books for looking at whilst he's there, that also seems to help.

The continence nurse has pointed out that it can take as long to resolve the problem as the problem has existed, so it seems we'll have Movicol on repeat prescription for a long time. As Yacka says, the bowel wall gets stretched so it takes time to return to normal.

My ds suffered with constipation for about a year. It started when he was 2.5. He was prescribed movicol and we were told that it would take about 6 months of slowly reducing the amount to get it to work. It was a long process, but sure enough by the end of the 6 months he was regularly going every night before his bath and still is now at 6.5 . I feel for you - it is so distressing to watch. Some days both ds and myself would be in tears over it and when he did eventually go it would make small tears, which of course would make the process of going again even worse. Movicol is wonderful stuff and certainly hasn't had any lasting ill effects for ds.

A little update from my ds, we only got to 2 sachets over 2 days and we had a day and a half full of poo(lovely soft poo!). Doctors advice was to then slowly reduce it.
I have him 2 sachets and have now tried one. If we have another episode ill know to stick at 2.

TheNoodlesIncident - we have a book too. It gives me back a sense of control, even though I have none whatsoever (I sometimes ask myself if it's any wonder that I, as a control freak, have a child who is literally anally retentive).

I saw a locum doctor today who was very kind and I have administered the first sachet. As luck would have it DS did a poo on the toilet yesterday (after 30 mins of sitting there crying) so thought it best to start with a low dose. However, have caught him trying to withhold already and am a bit worried about an explosion. Anyone know how long it takes to get a result (IYKWIM)?

Yes, a record is a good idea because you tend to forget exactly what's been done when. The frustration is the worst thing, you can't help any more (than give medicine) but you're desperate to. Our DS just didn't seem to get it. He does seem to be catching on now, his comprehension has improved massively over the last few months (he has autism) and the points we make to him actually seem to be sinking in.

We pointed out that a) his poos are lovely and soft and don't hurt his bottom; b) if he doesn't poo in the toilet but holds it in, then we can't go swimming or to soft play; c) if he holds it in he will get constipated (he does know what this means, the nurse gave him a booklet they issue in these circumstances) and pooing will start to hurt again; d) he's a big boy now, and big boys do their poos in the toilet and e) he gets some ice-cream if he does a reasonable poo.

Previously all this just didn't wash with him. Either he didn't understand or he just didn't believe us. He was on liquid Movicol for a month before he started to relax slightly about letting it out, but it was hard going and there were LOTS of dirty pants, sometimes 3 or 4 a day. It IS getting better though, honest!

Re your question, it takes a while, to be fair - not just to soften the poo, but for the child to start to relax and trust that it will be OK to let the poo out. It has to be happen lots of times, consistently, before the poor LO can start to feel safer about letting go. I can't remember what the leaflet in the Paed Plain said about doses, but I would start with the maximum recommended dose and aim to very gradually reduce it.

(Why are my poo posts always epics??? Sorry for waffling on! )

we had this problem with DD when trying potty training. We had 3 separate attempts and witholding was a problem every time. 3rd time we just dosed her everyday with lactulase and then we happened to be in a cafe and she shared a pretty rich chocolate brownie with me and that was it, we were in poo heaven. A month on she poos every day in her potty, no accidents or problems at all. I think she just 'got it'. (she was 3 in December btw.)

So on day 1 he had one sachet, two sachets on days 2 and 3, but still no "production" (as me and DH refer to poo in front of DS!) and have gone up to 3 sachets this morning. Trying to get DS to drink 180ml of juice was a bit of a battle though. He was running around on tiptoe trying to withhold so I sat him on the toilet, but he was still resisting. I ended up losing my temper, shouting, then crying and now feel like total s**t and a bad mother who is going to traumatise him further. I've burst into tears in front of nursery staff and work colleagues this morning

Ds2 was put back on movicol on Friday. 2 sachets a day. He had lots of liquidy poo yesterday but he's still holding some back.

When he's been withholding a while he gets overflow so we have a charming mix of poo refusing but constantly pooey pants. The pressure also causes him to wet himself constantly.

This has been going on since he toilet trained in September, although it started in as more minor way before the summer on a previous pt attempt.

He's going to be 4 on Saturday and our current situation is as prescription for 3 months of 2 sachets a day with a likely continuation beyond that.

We need to get him totally relaxed about poking before we even consider weaning off the movicol as he's proved simply shifting the blockage and stopping the movicol only makes things worse.

My daughter started to do this when potty training. She was doing so well then seemed to get freaked out by the toilet.
The biggest thing that made a difference was sooo stupid but I did start to get a bit desperate . . . . A poopy sticker chart!
Every time she went she got a sticker to put in a square on the chart and when it was completely full she got a stupidly expensive toy story doll. She was literally squeezing them out near the end of the chart just so that she "could win".

Ds2 is too stubborn for rewards. He gets a jelly for sitting on the loo and a toy car if he poos on the toilet but still won't do it.... Little sod!