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.

Argh, just lost massive post! Here we go. I am a major lurker but reading this with great interest.

DS (5, in reception) has been prescribed with movicol today after a couple of discussions with GP - one sachet a day.

My question is whether he definitely needs it. He often has damp pants and is nowhere near wet at night but some of this is definitely due to being too engrossed in what he is doing.

He is also soiling quite often although we can have good patches for a few weeks. Soiling can vary from a little bit of loose poo to full on poosplosions down trouser legs (fortunately it hasn't been too bad at school yet).

He probably poos on average 3 times a week and often seems to have a good clear out but I suppose there is no way to know this for definite - maybe there is some left behind. He also usually has very little or no warning, suggesting lack of sensation (but it's true that watching Tree Fu Tom etc would be far more important to him than making it to the toilet in time!)

My worry is that perhaps it is more that he would rather be playing than that he is constipated. The GP did not attempt to examine - she said it's really impossible to know conclusively if they are constipated as just because it can't be detected doesn't mean they aren't.

His diet is ok ish with good amount of fruit and drinks although he doesn't drink much at school as he is not keen on water and will only sip rather than guzzling it. They are only allowed water for lunch as well (although a smoothie is allowed so have started putting those in).

Sorry for hijack but advice would be v.welcome.

Thanks Rhino. DD been going off and doing a poo when required and is happy to sit on the loo every morning whilst brushing her teeth. TMI alert - We had a massive pump in the bath with a bit of follow through tonight, but I am not concerned as she has been clean and dry all day. I know this is a long road.

Feel free to hijack Fruit. No advice from me, but hope others can help.

Edit... Nowhere near DRY at night.

Fruit, it sounds as though the movicol would be a good idea to try to get a more regular bowel movement but more importantly, trying to get him into a good routine of sitting on the loo 20mins after both breakfast and tea.

I would avoid smoothies as per earlier discussion in the thread. Would he have water with a dash of juice? If it is a medical need, school should be sympathetic to this.

We set up a star chart for ds in order to get him drinking more water. As he started to drink more, his body then wanted more, iykwim.

It is a long haul and you have to keep at it probably for twice as long as the problem has been there. For ds it was a couple of years before I became less obsessed about when he had pooed in the loo! Even now, years later, when he has to go, he has to go NOW!

Another hijack DD nearly 4 has poo issues. Generally holds on too long. Used to have 'will only poo in a nappy etc. Last couple of weeks all poos have been runny/sludgy and a bit windy/explosive. She is fine otherwise. Lots of 'squigy parps' with a little follow through (including, TMI, a bit of mucus with a fleck of poo this evening) Is this normal??

Considering trying to get an appointment to see a GP tomorrow as have afternoon off but fear i will be wasting everyone's time.

Thanks for advice - have picked up the prescription and thinking of starting Thursday eve with hope that there will be some effect over the weekend. I work Wed, Thurs, Fri and they are at the childminder from 7.15 to 5.45 so it's hard to focus on a routine those days. He hasn't been there that long and I think he'd rather not poo there tbh. He also said this evening that she was cross when he had an accident before so now I need to talk to her about it more! He is a bit over sensitive so maybe she was a bit exasperated rather than cross but who knows. She is v.experienced and comes highly recommended so surely he is not the first child she has come across like this??

I really wish I had started the movicol at the start of the holidays so we could see the effect. He had another accident today - he gets a rabbit in the headlights look in his eyes and did say he needed a poo but it was obviously already out - TMI warning - tennis ball size in pants and more with no problem in the loo - is this really normal for constipation? I really hope the movicol doesn't cause more accidents.

I will ask his teacher about some juice at lunch - I think the dinner ladies just give out cups of water so worried about him standing out. He won't want to be the 'different' one and would worry that it wasn't allowed.

Itchychin - no real advice but won't hurt to see the GP. Surely they would prefer that than a problem potentially getting worse?

Fruit I would stick with the water at lunch but see if someone can make sure he drinks it.

I was more suggesting that he have water in a drinks bottle during the day (with a dash of juice if it makes it more palatable) in the class/at childminders. The childminder should be on board to help too. definitely worth talking to her to make sure she does not tell your dc off if there is an accident.

Hopefully Rhino will be around a some point with some professional advice.

As mentioned before, it can take a while for the rectum to reduce after impaction, which affects the sensation to "go".

One Movicol a day is a maintenance dose, on occasion if a child is impacted they should be on four sachets a day.

A lot of parents can't make the link between soiling and constipation as they think the two co tacit each other, but the link I gave previously gives a really good diagram of how this happens.

I would contact your health visitor/school nurse as you will get more support than a GP has capacity to provide.

Golden rules
Comfortable position on loo. Preferably with a footstool, so legs are not dangling.
Regular toileting 20-30 minutes after meals for at least ten minutes, after breakfast is best.
Reading stories/blowing bubbles, special books to look at only when on the loo to encourage sitting on the loo.
Reward charts based on positive things, ie going to the loo after breakfast, taking Movicol, drinking more water/weak squash (about 1000-1500ml a day), doing a poo on the toilet, but never punishment for soiling.
Sometimes gentle massage tothe lower left abdomens can encourage pooing.
Healthy diet, with fruit and veg. And whole grain foods.
Keep a poo diary with time, size and type of poo to see if there is a pattern/specific times of day it happens.

If there is also wetting, the constipation needs to be sorted out first. Then daytime wetting. Then night time wetting,

The Movicol may cause accidents at first, as Movicol takes water to the bowel, lubricating the faeces there. If your child is used to holding poo, they may not be able to do this once on Movicol and the urge to poo and can get taken by surprise.

Unfortunately it is not a fast process and requires hard work, but it needs to be done. I have worked with secondary school children whose parents haven't addressed soiling and the cost to their self esteem and body image is huge.

*should be on four sachets = COULD be on!

Thanks for advice. We have started a daily sit on loo routine with reward for doing so. I will get a few special books etc for that although he is happy with novelty of being allowed to play with my phone for now. I've started a diary too. The sitting already resulted in a poo on Thursday so am going to hold off on the movicol for a week or so to see if we can get improvement without it.

How are you all getting on? We have regressed yet again unfortunately. Things were going well for about 3 weeks, but despite the daily lactulose and toileting routine, we are still having loads of wee accidents and the odd poo accident. Last night DD sat on me and weed all over me, am afraid on this occassion I lost it and she was bathed and in bed in under 15 minutes. Its just so exhausting. We had a lovely holiday for a wee in Majorca and her eating habits weren't as great as at home, and we had wee accidents every day, so maybe she is still out of sorts from that. Hope there is more success with you all.

That should be *week not wee!