DD 4 soiling on a regular basis but doesn't appear constipated or unwell

[soupmaker]

DD is 4 and for last 3 months we've had regular problems with soiled pants. At least 2-3 times a week, sometimes daily. I went to see HV about it but had realised before then that DP and DD had been having bran flakes in the morning which may have caused the problem. She's been off them for 2 months but she's still soiling. She does a poo at least every other day and doesn't seem to have any pain or difficulties with them. She is at nursery 4 days a week while I work so I'm not party to every poo! She has weetabix for breakfast, which she loves, followed by yoghurt and with fruit juice. She eats well, with the exception of fruit which I can only get her to eat every day or so. She has fruit smoothies regularly. She loves pasta, meat and potatoes with veg, eats cheese, yoghurt, humous, oatcakes, soups, cured meats, raw carrots, and basically has what we have for dinner which always includes veg. Anyone else had similar issues? How did they get solved? I'm finding it hard to cope. She still is far from continent and has been in training for over a year. I don't have friends in RL who have toileting issues with their DC, they all are dry and clean and nappy free, so I don't have my usual support network. We still use nappies at night. I'm just not sure what to try.

soiling,do u mean a proper poo in her pants or just a smear?dd did this a lot,pants always slightly wet/dirty stopped when using reward chart/bribing,she is just lazy to go to toilet and hold it in for too long.

A bit of both. I thought it was being lazy too but am not so sure now. It's usually more than just 'skid marks' but only a whole poo on occasion. Been to local pharmacist tonight to get advice and she's suggested lactulose to soften things up. Poor DD has such a sore bum.

Have tried all manner of bribery and rewards to no effect.

Soiling can be down to constipation. When she poos on the loo is it a big poo and is it runny/hard?

It sounds like she has got poo in her bowel, the bowel takes water from faecesnso if it has been in there a while it goes really hard, the new soft poo sits on top and can leak down in between the hard poo which is the soiling.

You need to go to GP to check she hasn't got I lactation. He will,prob give you some paediatric Movicol. It's important to set up a regular toilet routine, best time is half an hour after breakfast or lunch. She needs to be comfortable and in a good position on the loo, ie a footstool, sitting up straight. If she gets bored on the loo you could read her a book or save a treat just for sitting on the loo like blowing bubbles.

Your GP could refer you to your HV or school nurse if she is at school, to support you once she is on Movicol - the GPs usually give out a big box of Movicol and leave you to get on with it!

I am a school nurse, soiling is quite a common problem in reception.

More info on Eric
www.eric.org.uk/Constipation/information_constipation_parents?PHPSESSID=8c8131c2e58b4a719a7e27253429a4c5

Lol I lactation = impaction bloody iPhone!

I second constipation and impaction.

This can also cause wetting too, as well as soiling. It is not done on purpose or within their control - hence star chars do not work.

It can take a while to re-train the bowel and for the child to feel the signals that they need to poo. So starting a good routine of sitting on the loo is as important as trying to clear the impaction.

Lots of water is also key.

Thanks for your replies and the link. I think you are both right, there is something going on that needs checking out. I feel so sorry for DD as she has such sore bits from not being dry and clean.

DD did a poo last night and (TMI alert) I donned the rubber gloves and had a good look at it. It was very much like a normal poo, not too hard and not too soft. However this morning it looked like she'd done a massive fart and followed through in her overnight nappy, which I would not expect if she'd emptied her bowels the night before.

DD has never been consistently dry and this has definately got worse since she started having poo accidents. I so wish I hadn't said to someone, "well she might still be wet, but at least I'm not scraping poo out of pants". So I think they are both connected and hopefully if we can solve the poo problem we can solve the wet problem. I'll up her water consumption, although she does drinks lots during the day when she is with me.

She used to do a poo every morning about half an hour after breakfast, so I think I will instigate her sitting on the loo while I brush my teeth and have a wee story before heading out to nursery.

I've got an appointment with GP next week, we've started the lactulose this morning, and I'll give her a tummy massage to see it that helps over the next week. Sounds like I expect for this to be a long haul.

The constipation and wetting are connected as there could be pressure from the faeces in her rectum on her bladder.

GP is definitely the best first move, but also ask to be referred to HV/school nurse as they have a lot of experience in this area and can support you.

To be able to challenge the GP if he wants to continue LActulose rather than Movicol have a look at the NICE guidelines here, the info is a bit dry and medicalised however you can pick out bits you feel are relevant.

www.nice.org.uk/nicemedia/live/12993/48754/48754.pdf
Polyethylene glycol 3350 + electrolytes is the generic name for Movicol

Thanks Rhino. DD not at school yet, she goes in August, which is another reason to try and get this resolved. Will push to get support from HV, although just knowing that I'm not the only mum dealing with this makes a difference. GP usually very good, but will go armed with NICE guidelines.

I do wonder if DD's inablity to keep dry for more than a few days at a time for the past 15 months when we commenced toilet training has all been connected to this. Poor DD, I've been so angry with her at times, and looks like she wasn't being lazy or a wee minx at all. Feeling even more guilty now for shouting at her.

You are being really wise sorting this out before school, I get on average 3 referrals from different schools in my area for soiling, one boy had soiled 3 times in one day and had to be sent home as they had run out of spare pants, this was really embarrassing for him.mit may be that your daughter has been holding onto her poo when toilet training as it hurt her, and she has never got out of the habit, resulting in impaction.

It is really common to have all these issues around poo, my nephew had to have a nappy put on to poo in due to reluctance to sit on the loo, until he was 7!

There is a really good picture on the below link which shows how soiling is caused by constipation. You could even show this picture to your daughter to prepare her that the big lump of poo needs to come out.

www.patient.co.uk/health/Constipation-in-Children.htm

*3 referrals a week

Rhino if you are still about I could do with an opinion. DD been on the lactulose since Thu morning 2 x 5ml as directed by pharmacist each morning. Have also upped her fruit smoothie intake. She did a poo on Friday morning, all good. But yesterday had 5 wee accidents and today has had one followed by a massive tummy gurgle and a runny poo. Is this normal? Have appointment with GP on Wednesday but I'm now worried I've given too much lactulose. DD is thankfully happy and not at all concerned.

Hi soup maker

It does sound like she has got impacted poo, hence the normal then the runny poo? LActulose takes about 48 hours to work, so it sounds about right if she started on Thursday. I would keep giving Lactulose as recommended by the pharmacist until you see GP. She is on quite a low dose of Lactulose as the recommended dose for age 1-5 is 2.5 to 10 ml twice daily, rising to 5-20ml twice daily at age 5-18.

Side-effects of Lactulose are nausea (can be reduced by administration with water, fruit juice or with meals), vomiting, flatulence, cramps, and abdominal discomfort (from the children's BNF).

Try not to worry about the wees as the pooing is a priority to sort out.

Thanks Rhino. That's very reassuring. Have been very laid back about all the accidents. Going to keep DD off nursery tomorrow and just keep pretty close to home.

Hopefully the impaction has shifted and it is pressing more on the bladder - hence the more frequent wees.

Good idea to keep her home for a while.

The doctor should feel her abdomen and will be able to tell you for sure if she is impacted.

With children's continence,it is one thing at a time, sorting out the most important thing first, so it would go soiling, daytime wetting, nighttime wetting so as not to overwhelm your dd with too much at once. Also sometimes sorting the big problems out first brings about a natural resolution of the others.

Agree with what Rhino says but please please do not assume a GP will always be able to feel impaction - perhaps they should be able to but they are not always able to, some paeds cant either!

In our case it went undiagnosed for years as DS was not showing the classic straining/hard poos but he actually had most symptoms of impaction such as overflow plus far too frequent day weeing, damp patches and excessive night wetting, distended stomach, no growth, poor appetite, low iron levels confirmed by blood tests, excessive pain and hence anger etc etc.

Took an xray to finally dignose by which time rectum was so stretched it will take years to recover any sensation of needing to poo.

Went to see GP this morning with DD. He didn't seem to think impaction was likely and suggested constipation or psychological issues the most likely cause. I was undeterred and pushed him on the symptoms DD been showing but after having a good feel at her tummy and back he said he couldn't feel anything.

To be fair DD did do a massive poo on Monday morning and hasn't had any poo accidents since Saturday. So we may have caught the problem early enough. Fingers crossed.

He has prescribed lactulose for two weeks and made another appt to see DD at the end of the fortnight to see if there is improvement. DD also managed to do a pee on demand so that he had a sample to test. If things don't improve will push for movicol.

Well it seems that lactulose is helping. DD had no soiling accidents since last weekend and has been doing much better at keeping pants dry, not 100% but mostly just wee dribbles. Let's hope we are on the road again to reasonable continence.

That is great. Well done. Fingers crossed this improvement continues.

Ds1 has had this problem on and off for a while. I notice you mentioned fruit smoothies; when I cut those out, the problem more or less goes away.

That's interesting diddlediddle. My DD is not a big fruit hand so I've used innocent smoothies to get fruit into her. Maybe I should lay of them to see if it helps. It's so hard to get the balance right and to know what to do for the best. She needs to be drinking more and and has developed a thirst for ribena

Bananas can definitely be 'binding'.

As are eggs, chocolate and the usual white bread/rice.

It was innocent smoothies ds1 was having lots of too, I've enough of those fridge magnets to cover the whole fridge! I ended up thinking they must just be too acidic or something for him.

That's great news it seems to be resolving. Make sure you keep up the regular toilet routine to prevent constipation.

Also, beware of too much blackcurrant, as it can irritate the bladder and cause incontinence.