nearly 4 yr old bum 'leaking'

[Spanglemum]

hi

This is way too much information but my son, who is nearly 4, has a history of stool witholding and was on movicol. He does not appear to be constipated now, in that he can pass normal soft stools, but his bottom is constantly dirty. I am getting through pairs of pants like nobody's business and it nearly reduced me to tears yesterday. IT does not help that he seems to prefer doing it in his pants to the toilet, but I hoestly wonder if he can help it sometimes. He seems to have a constant stream of poo exiting his bottom. GP has examined him and says it's behavioural but I am at my wits' end.

Any help gratefully received

spangle

'Hanging on' and chronic constipation can lead to a less tight squeezy muscle at the bottom! Don't worry, it can be sorted out even though it's a real pain for Mums like you not least cos of the washing!)

If he is regularly passing big fat soft poos of 'respecatble' dimensions (i.e. "Mum, look at this big poo!") then it's unlikely to be overflow liquid seeping past impacted hard poo. If he's not pooing good sized poos, then it could be the soft stuff seeping past stuck, hard poo.

Many community paediatric departments have specialised childhood constipation clinics (its that common!) so see if your GP could refer you on to community aeds for a full MOT and some really good advice/treatments, even if it all turns out to be behavioural.
Good luck x

Thanks everyone! I will have a good look at that website...
It's such hard work and it takes over your life.

Spangle

The medical term for this is encopresis.

Here is a useful link - familydoctor.org/online/famdocen/home/children/parents/toilet/166.html

sounds to me like he has chronic constipation with an impacted bowel.the constant soiling is what is known as 'overflow' this is where his bowel is full of rock solid hard poo, and fresh poo is trying to get past this blockage and seeps out constantly in small bits like you are describing...he needs to go on a high movicol dosage for the next week going from 8 sachets a day to 6 to 4 to 2 untill he is clear. go back to gp and ask if this is the problem as i am not a doctor but know from my 4 year old dd's history of this problem. hope this helps, have spent the last few months trying to clear this up with my dd, and only when she was put on this paediatric movicol plan was the blockage cleared. a lot of diarrhoea will come out at first but as you clear the bowel and cut down on the movicol, you will see more formed stools and no soiling.

my friends dd went through years of this.
Movicol causes a lot of problems when it is used long term. What happens is the nerve endings get desensitised and the child gets used to holding the poo in. Then the poo gets hard and a liquid seeps around the poo. Friends consultant told her it can take over 6 months to get the sensation back in the bowel.
On a practical note to avoid the smell she bought loads of cheap knickers and panty liners and her dd wore those. When she went to the toilet she would have leaked so would pop on a new pair. It helped with her self esteem when she was at school and definitely kept the smell down

yes thats what i did, asda and tesco do super cheap knicks! the reason why movicol is used after the blockage is cleared is to allow the bowel that was previously over stretched with the blockage, time to get back to a normal feeling and size, while still allowing fresh stools to pass through. if you take them off movicol too quick, the overstretched bowel will fill up again as it is bigger than it was before. the 'eric' website is a fabulous source of information for this condition. my dd now on 1 sachet a day to keep things moving which for me is just fantastic, as before she would soil herself up to 20 times a day and was just horrendous. she would'nt be starting school in two weeks had we not got over this.

Thanks everyone, luckily I have some movicol from last time! Looks like that's where we're headed as he even did some poo in the bath today and got v upset. This and headlice has dominated my summer!

Spangle

spangle... ahve you every kept a food diary?
this kind of impaction and leakage is a really common symptom in children with food intolerances.
my little cousin was the same and cutting out wheat and dairy cleared it up within a week or 2.

might be something to bear in mind

A bit like thisisyesterday - my DS2 [6] was soiling. He did have impaction, was treated by movicol which multiplied the soiling ad infinitum. He has been off movicol for a year, soiling went back to pre movicol levels. He had been dx as lactose intolerant and i tried reducing the level of wheat/gluten. It made an improvement to only 1 or 2 accidents a day.
DS3 [4] also lactose intolerant and soiling - never been impacted or on movicol. We were requested by dietician to do food/stool diary. results look like he too could benefit from reduction in gluten as it showed a correlation between meals high in gluten and time of soiling. Will be doing a gluten challenge for 2 - 4 weeks to see if it has any impact.
I'm not saying they are cured, just that they do more regular, solid poos, so it is easier to sense and get to the toilet. The urge has become less frequent too.
DS1 [8] also had problems, but now is able to get to the toilet in time. It's amazing what getting older can cure.

Thanks everyone. The problem seems no better. He is supposed to be starting school nursery soon 'potty trained'. Am going to have to speak to them about whether he can go. He is dry.
We are veggie and I have wondered about food intolerance type problems. He seems to have these 'spasms' when he's trying to withhold and that's when he does the biggest poos. My partner is vegan so cuttung out dairy would not be a big problem, cutting out gluten would be hard but I think I'll keep the food diary. Today was a nightmare he was just constantly leaking poo!
Spangle