22mo holding in poo and screams when she finally goes (sorry if tmi)

[JuliaGulia]

Hi,

I just wanted some advice on how to help my daughter.

She's nearly 2 and over the past month we've had so much trouble with her poos.

For days she'll start straining and seemingly about to go - she goes red in the face and doesn't want to be picked up or comforted.

After days of terrible straining - which wakes her up crying throughout the night - we intervene and put her on the change mat mid push and hold (force) her legs up. You can see what's about to emerge and she's obviously tightening her bum to stop it coming out - but with lots of encouragement, a very hard and large poo arrives. As soon as she's done it - she's fine.

We then have a day of calm and peace until she starts straining again and we know in about 36/48 hours she'll eventually go again with all the same drama.

She has a good diet with plenty of fruit and veg and drinks enough. We've taken her to the doctor before and they've given her laxatives but it doesn't seem to be helping. I don't think she's constipated as it's not pellets - just a very hard large poo - as if she's been storing it there for days. I described it to the doctor as a bit like contractions - the bouts of straining become more frequent and then finally she goes.

But now I'm starting to worry that she wont go unless we put her on the change mat and hold her legs up but I fear she could be in pain for days, trying to empty her bowels.

The doctor told me that problems with children going for a poo are very commom but that doesn't really make me feel any better - particuarly when she's seems so distressed. I know we'll be potty training next year so I can see us constantly rushing her to the toilet, only for her to stop pushing when the urge has past.

Has anyone been through this before?

Look forward to hearing from you.
JG x

has your gp advised lactulose? This just softens stools but is not a laxative as in causing the bowel to contract. It is good as a short term measure as you are otherwise doing the right things.

My two year old has this problem on and off (off at the minute thank god!) Second what sneezecake says with regards a stool softener, when dd gets bad we will keep her on the stool softener until things settle down a bit as per doctors advice. During her last bad bout she was on stool softeners for just over a week. Plus plenty of drinks and activity to keep the bowels moving and regular. A nice warm bath helps also with the tummy cramps that go with holding it in.

Can you reassess her diet? Is she having a lot of bread/dairy which could be making things harder. Was she a windy baby - maybe she had a mild intolerance. She might need more fluids too. DS drinks loads with every meal plus plenty in-between.
I've also put shed loads of sudocrem on DS's bottom when he had a similar issue so once the poo emerged, it didn't hurt so much.

I have had constipation problems with my DD for years. She started off similar to your DD. With enormous poos building up for days and days and then really hurting when they come out.

Try sitting her on the potty every night after dinner and get her to blow bubbles with those little pots of bubbles. He feet should be on the floor so she can push down.

Have you been given any latulose to give her? I found this wasn't so effective for my DD, in the end when she was 4 we were given Movicol and this was much more effective

Use a sticker chart to reward positive behaviour - doing a poo.

Oh yes, also not too much milk - DD was only allowed one cup per day. Also no apple juice. This really made a difference and even now if she has too much of either of these things she gets bunged up and she is 10 now.

She could be faceally impacted or have a fissure (skin tear) that could be causing the pain.
If she is impacted lactulose will make it worse. Ask to be refered to the pediatric constipation clinic. She probably needs an examination to see if she is impacted and a prescription for movicol.
At this age it may be nothing to do with diet. Some children will just hold it in. Others may start to cause they have a bit of pain.
It will settle but she needs to be seen by the experts before this becomes too much of a habit
Hth

Sneezecakemum, lactulose is very much a laxative

McQueasy. I said not a laxative 'as in' making the bowel contract as sennakot etc does, which is painful. Its a stool softener first and foremost because it draws fluid into the bowel, softening and bulking up the stool. Yes it causes a peristaltic action but it is far more gentle - hence it is sometimes ineffective in children/adults with difficult bowel problems. They will need movicol (children) senna etc (adults)

Lactulose is so gentle it can be given to under ones via the gp.

I know how it works. In faecal impaction it is ineffective and can exacerbate the problem. In this case it is not necessarily 'gentle.' Movicol is much safer and more effective in these circumstances. Why I would suggest the constipation clinic for an expert opinion and treatment plan before this becomes a chronic viscous circle of constipation and pain

*Vicious circle even!!!

we had very similar problems with our eldest daughter, although it started earlier; she has been on movicol for over a year, although in ever diminishing doses, and she has learned to push poos out - much better since potty training. But things will easily set her back - stress, excitement, a course of antibiotics.

cece interesting about the apple juice - we use juice to give her the movicol (this was ages ago) and it's become a morning ritual, but she does love apple juice; she was lactose intolerant too, although not seriously so. We now have a dd2 and dd1 is (surprise!) mad for milk again - we give her lactose free milk always. Her diet could be better.

good luck op - it's very tough and very distressing - we made it into a joke when this was possible - getting her to do theatrical groans and all. Patience is crucial too. And as much liquid as you can get her to drink -

My DD has a similar problem, I have started to get a tin of prunes & mash them up in custard which she has a pudding once a day. Tastes yummy & has really helped with the whole 'poo' issue.

My DD used to do this too. Movicol sorted her out - I found laxatives worse as my dd still tried to hold her poo in as the laxatives were doing the opposite - she was more distressed and it would leak - it was a terrible time - lasted about a year until I finally heard about Movicol - it softens the stools so that when your child does go it won't hurt - she will then lose the association that pooing is painful and eventually she will be able to go regularly when she needs too.

Good Luck

movicol is great stuff - and doesn't have any side effects. The only problem with it is getting the dosage right, particularly once they are potty training/trained - too much and it can come too fast, too little and they get bunged up. I really think early intervention is important - in our case movicol has saved us from having a more deep-rooted problem.

Another vote for movicol. My son was doing a lot of poo-withholding etc and getting very distressed, movicol solved the problem entirely within a couple of months.

My ds is 3 and has had this problem for a bit over a year it is distressing. Paed has given movicol. Half sachet in pure apple juice each morning and lactulose as needed. He had a tear/fissure a while ago which made him scared to poo
Prune juice will also help.
The biggest help is cutting down on his wheat intake.
It's still a struggle but we are getting there. I hear you on when holding the poo in it is a long couple of days waiting with discomfort.

We had terrible trouble with our eldest - and she is now 11 and still gets problems from time to time. She had BIG poos and would hold them in for 4 or 5 days - in one awful case she had to have a suppository (dulcolax) to "help". We found that increased fibre made things worse, sugar (any of the 'oses) made things worse. Wholemeal bread, bananas, chocolate and apples were particularly awful!

The doctor explained it as a bit of a "lazy bowel" - stuff lingers and if you put more in it just backs up (some poor kids can end up effectively vomiting poop) - so a light diet with easily digested things - fish, rice etc is what got us through.

Thank you all so much for your replies. My husband is taking her to the doctors this afternoon to see if we can get some movicol or a referral to the local hospital to get some expert help. Hopefully they will also be able to give us some advice on her diet to see if we can improve it in any way.(She loves apple juice, cheese and pasta and has sandwhiches most days)

My mistake - she's taking lactulose medicine at the moment but if I'm honest it's not making any difference.

Whilst I'm sorry to hear that others are suffering too, it does give me some relief that it's not as uncommon as I feared.

I shall keep you posted - particularly if we're given any good advice.

Thanks
JG

it's really really common; my paediatrician wasn't particularly moved by dietary solutions (and he is an expert on infant constipation), but for some children there does seem to be a clear correlation. In our case I can't say that there was, although too much dairy doesn't do much for her

I am with Iggy on this, you will need to limit wheat and dairy, as both have this effect if too much

OP read the NICE guidelines on constipation in children here. Your GP is following the guidelines in that he has tried your DD on lactulose, but is not effective enough. He will move on to movicol I am sure now. I deal with this problem in a small way as part of my job, but I'm not an expert. You need to be a parent to be one of those!

PS It is very very common, and as others have said its the vicious cycle of pain and witholding which is the killer in managing this problem, so its best caught and treated early.

My doctor told me that lactulose just coats the poo so it slides out easier...
Which was helpful when he had the tear.

Sorry, posted too soon. Even just taking some wheat out can be helpful. He loves sandwiches but I started making them without bread on some days...etc. doesn't need to be eliminated completely just cut down. It helped us a lot.