Help me sort out dd's pooing issues!

[WigWamBam]

Dd has always had some sort of issue with pooing.

When she was first dry in the day, just before she was three, she wouldn't go anywhere near the toilet to poo - she would only ever poo in a nappy, at the same time every day, and in one particular spot (as far away from the loo as she could get, natch). She was terrified of using the toilet to poo and would become completely hysterical - so we stopped trying to force the issue and allowed her to have a nappy. This went on until she was four and a half when she finally began (reluctantly) to use the toilet.

She's coming up for seven now, and still has issues. She will only poo at home, which means she ignores the urge to go when she gets it, and then she then finds it difficult to go when she gets home. She's not constipated as such because the poo is soft, but because she hangs onto it, it compacts and she struggles to pass it.

Even when she's at home she ignores the urge to go - we have to make her sit on the toilet every night before her bath and try for a poo, and every night we get the screaming abdabs because she reckons she doesn't need to go. But if she was left to her own devices she would never go at all, so we have to make her try once a day at least.

We started to get somewhere over the Summer holidays last year - she was just about starting to take herself off to the toilet when she needed to. But once she was back at school she soon stopped that because she won't use the school toilets, and we were back to square one again.

She won't wipe her own bottom either (I've taught her how so she knows how to do it - she just prefers not to). Because she's always at home when she poos, she calls us to wipe her and because of the problems she's had it's always been easier to do it for her. But if we ask her to try, she gets upset because it's horrid and dirty and she can't do it.

She's been seeing a paed for urinary tract problems, and the paed thought that part of the problem was the fact she withholds poo. She asked us to give her Lactulose, which she said would make it hard for dd to withold, and she's been taking 5 teaspoons a night for well over a year ... it hasn't made the blindest bit of difference.

I don't want to resort to laxatives, because she really doesn't need them - her problem isn't constipation, it's a behavioural thing. But I don't know what to do. The GP just says to keep shovelling the Lactulose in, but it's really not helping crack the behavioural problem.

Any thoughts? Anyone been in a similar situation and have any bright ideas?

Our situation is a bit different as my DD is only 21 months but she has been withholding for a few months now. We've had really good results with a homeopathic remedy, DD now goes every other day at least and is starting to do it without any fuss.

Perhaps you could get a referral to a homeopath? We paid £40 for an hour consultation and the remedy, and a chat with the homeopath on DD's progress every week so it's not outrageous but I think NHS sometimes covers it.

I don't think it's the toilet itself - she's always been fine weeing on the toilet. She's a big girl for her age - in age 11 clothes because she's very tall - so wouldn't really fit on a potty. I don't think it would make any difference; she wouldn't poo on the potty even when she was using one!

Linseed ... hadn't thought about anything like that. Is it something you'd put on cereals or take by the spoonful?

Hadn't thought about homoeopathy either ... might be worth a shot.

Thank you!

MIL takes linseed in porridge. She must be mega tall! It can take over family life, hope you get it sorted.

argh I just posted a hugely long response and then pressed some sort of evil button. and it has all gone. argh.

Ok, so, again in a nutshell, here are my thoughts.

have you tried telling her you don't really understand what scares/worries her about pooing, and would like her to try to explain? what's her reaction?

Could it be that somehow she has picked up messages on pooing being a disgusting thing, so she only wants to do it at home (a safe and private place), and doesn't want to wipe so she has as little contact with it as possible?
Normalising the pooing thing - pooing while she is there, your poo being smelly, you not being embarrassed, might well be helpful at showing her she is no different from other people... if that is a worry. Is she generally ok with getting messy, with paints and mud and stuff?

If she finds it difficult to talk about, taking an 'externalising' stance can be really helpful, ie. talking about "the poo factory" rather than "your pooing". It can make it feel less personal, and more playful.. The poo factory analogy can be good, too, because you can talk about various processes going on at the factory.. parts of the factory going on strike etc... all a bit silly but I guess that's kind of the point

I think that is everything in my brain at the moment. hmm. some nutshell.

A laxative might help, even though you say she's not constipated as such, if it compacts it has probably hurt her at some point to have a poo, so she remembers this doesn't want to go again in case it hurts, that makes the poo harder to pass and hurts more-and so on.

A mild laxative could be used to soften the poo sufficiently and actually make her go so that she doesn't have complete control over it (obviously not so much laxative that she has explosive diarrhoea!) Once she starts to go every day with ease and no pain it mighyt become routine.

Mmm, not sure I really want to go down the laxative route. I need her to start listening to her body and reacting to it's signals, and I'm not sure that laxatives are the right way to try and address what I think is essentially a behavioural problem. She's already taking Lactulose to soften the poo - the only bit that's hard and painful is the initial hard lump if she's been witholding, after that her poo is already soft. She doesn't struggle to pass the poo on a day-to-day basis - just refuses to do so - so I don't think laxatives are really what she needs.

I understand what you mean about a painful poo causing witholding, but the problems started before she began to withold. The compacted poo doesn't happen every time, so it isn't always painful for her to poo - usually we manage to get her to poo every couple of days (with a lot of hysterical kicking and screaming).

Spink (you don't want to know the typo I just made when I was typing that!) - she doesn't admit to being frightened of pooing at all; her usual response is that she just doesn't need to go. But generally that's because she's needed to go earlier in the day, hung onto it, and then lost the urge to go. I don't know why she thinks that poo is dirty; I'm not even sure she knows herself. She certainly won't have picked that up from either me or dh, and the problems started before she could have picked it up from other children at pre-school/school. She knows that pooing is normal, she knows that everyone does it without even batting an eyelid.

She's never liked her hands having food on them but is otherwise OK with messy stuff like paint and things. Maybe she's worried about getting poo on her hands - but she knows that it all washes off. She seems more concerned about leaving marks in her knickers than getting poo on her hands, though.

She's OK with talking about it when she's not actually being asked to do it - she understands and is interested by the process and asks questions quite happily. It's just getting her to do it away from home that's the problem; if she would just poo when she needed to, most of the other stuff would just fall into place.

WigWamBam-My son is 6 and has SN.

He has sensory issues and has problems with using the toilet also.
It was interesting you mentioned your DD not liking getting food on her hands ,my DS is exactly the same.

Can you think of anything from when she was younger that might have triggered this?

We think with my DS it was when he was about 2 and was in the shower and did a poo and he looked horrified when he saw the poo that that had come from his body.

He has been prescribed movicol but not sure like you whether that is the way to go.
He is seeing a clinical psychologist at the moment for his selective mutism and they are getting him to draw up a chart and visit the toilet and flush it at least 3 times a day at home.

Are they doing anything at school to address the problem?

My DS's TA is taking my DS to the school toilets at different times to get him used to the enviroment.

It is very common from what I have been told for children in school to have a fear of the toilets.
They are often noisy and maybe the cleanliness factor and hygiene might be an issue.

Like your DD my Ds will talk about it to me.
My DS seems intrigued by the whole process in books etc but just can't grasp it for himself.

Has your DD told you why she does'nt like the school toilets?

It's difficult isn't it, SV. Must be even harder in a child with SN as well.

The school aren't doing anything. They tell me that it's not unusual for children not to like school toilets, or for them to refuse to poo in them - apparently lots of children prefer to wait until they get home. But at least they poo when they do get home! Maybe it's worth mentioning to her teacher and the children's mentor; they are really good at handling the children and their problems. I just hadn't thought that it might be something they could help with.

The one set of toilets at school has four cubicles; one she will use, one she doesn't like because the enamel is chipped off in the bowl(!) and the other two toilets scare her because they face the wrong way - the room is L-shaped and the two she doesn't like face away from the rest of the room. I think it's probably because she can't see people coming in and out that she doesn't like them. The toilets in the second block are often dirty (because they are closer to the Reception and Nursery classes, and the younger children often make a mess that they can't clean up). I think the problem with the third set of toilets is that it's a big block - she doesn't particularly like public toilets with lots of cubicles in them either.

It's interesting about the sensory issues; dd is NT but a lot of what you say about your son is very like my daughter. I have wondered about sensory things before - she's OK with most things on her hands but very quick to wash them if she gets dirt or paint on them, and has always hated food on them ... she was the only baby I have ever come across who didn't squidge food in her hands!

I can't think of anything from when she was younger that might have triggered this. She had the odd time when she pooed in the bath but it didn't seem to bother her too much at the time, and it was before she was 2.

I have sometimes wondered whether she actually recognises the signal that she needs a poo, but I think she must do - over the Summer holiday last year she'd pretty much cracked going when she needed to.

WigWamBam-Am sure the school could have some input in helping your DD.
Whether it be through the school nurse who must have dealt with these issues before.
It's no good saying well lots have children have these isues if they are not going to do anything about it.

It reminds me of my DS's teacher last year who said whilst discussing the problem
"well my DD was trained and using the toilet by 3 years old"
Good for you,but your DD is not my DS and all children are different.

Would a reward system help?

My DS responds to sticker charts etc .

It is very difficult and you never know how to handle it for the best.

although I must say the school toilets are not the most welcoming places for children.
Maybe schools should brighten them up a bit with warmer colours of paint rather than the cold clinical white.

I know as an adult I hate going into public toilets,so why should it be any different for a child.

As for sensory issues,does your DD have problems with loud noises at all as the toilets can be pretty over whealming when lots of children are in there at once.

They have a disabled toilet at DS 's school and he goes to that one and takes some kandoo wipes in that are just for him to use to get over the hygiene issue.

They wondered whether my DS knew when he needed to go and asked if when he was a toddler did he ask to be changed straight away after doing a poo but childen can be quite happy to goa nd stay in a pooey nappy so not sure if that is an indication or not.

Have oyu asked your GP for some guideance at all,they might be able to refer you to someone for a chat.
I knoe the childesn services have people that specifically deal with toileting issues who may be able to give you a few pointers.

Let me know how you get on

I'm sure I read somewhere that most people poo at home, and very few children poo at school...but where would I have read that? Would it help if she knew she wasn't expected to go at school as long as she goes at home when she needs to?