Soiling caused by constipation in 6 yr old

[tigerbalm]

I am looking for advice and support from anyone who has experience of the above and of their child getting better. I havent been on here for years but I used to be on here alot when my kids were younger.

My dd has this problem and has had for 2-3 years. She is now on Movicol and also Sodium picosulfate. Under consultant paediatrician at hospital, and community nurse. Still soiling at least every other day and sometimes every day for several in a row. Has no feeling of needing or doing a poo. Got a toilet time routine in place twice a day, tried rewards for good days, nothing working. Now on a dairy free diet although the doctor says the NHS do not test for dairy intolerance, yet their website says there is a blood test ??

I am desperate to find out how we can stop her getting blocked up and the poo leaking out. Any pointers we havent yet thought of would be appreciated. Thanks

I have no experience of this, but I have seen other posters mention it - there are some out there, so keep bumping this. I hope you find some help, my dh had this as a child and he is still very sensitive when he has skiddy boxer shorts.

Thanks :-)

DD had this for approx a year after I had DS and she had movicol too. She has been fine since the summer holidays started and the only thing that I think has changed is that I am making sure she has LOADS of water every day. What is your dds fluid intake like?

What's her diet like? If its carb heavy then that's why she's constipated. Does she eat much bread, pasta? For every 1g of carbs you eat, your body needs 3 x as much water to digest it, if you don't then you'll get an obstructed bowel.

Has she tried Magnesium citrate? It's very safe, you can get it over the counter, doesnt require a prescription... or off Amazon, comes in tablets, softgels, powder or liquid. Magnesium is a really effective laxative.

She is not a naturally thirsty person and doesnt drink much unless prompted which is what has caused the problem at the outset I think, but since then we make sure she drinks alot, as far as possible although she still resists this.

Yes her diet is carb heavy but I thought this was normal for children. But she also eats fruit and veg. What do children eat other than bread and pasta?? This is not something that has ever been mentioned by the doctors and nurses they just talk about fibre and fluids.

Thanks I will bear this in mind although I have no idea what she will eat!! Also vegetarian and now because of this on a dairy free diet. Gulp. There is only fruit and veg left.

Magnesium have never had that recommended before - where did you find out about this butterfingerz if you dont mind me asking?

Thanks for your suggestions, we are really really keen to make progress on this during the summer hols.

Soluble fibre is the key rather than fibre. I have IBS and fibre, like wholewheat and bran, causes me no end of trouble.

Try googling a list of soluble fibre foods - there are lots.

I really think water is the way to go. DD now only has water, I used to give her fruit juice too. I also make sure she has more fruit as that seems to loosen the bowels a bit. So she has more apples, strawberries, melon, pineapple etc which are water based whereas before she would always choose a banana. Honestly the extra water has made a world of difference to us. Good luck, it is such a difficult and stressful situation to go through. The above is just what I think worked for us by the way, I don't know any medical stuff!

Don't really have many tips am afraid - but you have my sympathies. DS (5) has been through ups and downs of 'holding in' resulting in constipation and leaking :( - seems to be going through a good phase - long may it last! No idea why he does it - always such a struggle to get him to admit he needs the toilet.

All I can say is, when we have lost our temper it has only worsened the problem, but it is so hard sometimes not to!

These days I try to keep him regular with lots of fruit juice, smoothies etc, and I buy mangoes which are really fibrous and he loves them. He does eat a lot of fresh vegetables, salad etc, and he has dairy allergy so no dairy. We make salads interesting by doing a 'salad shaker' (like Jaime Oliver!) putting the salad in a clip-closing pot and he shakes it up with the dressing, he loves that.

Good luck!

I used to find that fresh orange juice was always effective in getting things going.

I had this problem with my DD & what solved it in the end, was sitting down with her and showing her a few websites that explained exactly what was going on with diagrams so she understood it fully. She realised that there were no quick fixes - once the bowel is stretched it can take a year or more to fully resolve - and she then started to cooperate 100% with me. She began to drink more fluid and try on the toilet more often. I think that part of her problem was that she was reluctant to go to the toilet, but once she realised the implications of this, then it really helped her to try harder.

Before that I tried every form of sticker chart, reward system etc and none of it really worked in the long term. However, she turned the corner and we have no problems at all now.

It is a very difficult thing to have to deal with the constant soiling as a parent, but at the time, my DD was not really bothered by it at all. I thought that it was never going to end, but it did thank goodness. I think it is more common than a lot of people realise.

My daughter went through this from age 3 up to 6ish.... She still has constipation issues occasionally. We were told in her case it is genetic.. but avoiding excess fibre helps in our case.

Her gran has a problem where fibre causes gut "laziness" - more fibre, more problems - no matter how much fluid! Oats cause her (them) severe abdominal pain and constipation as do bananas, plums, nectarines and apples. She has to avoid fibre - so please be careful - sometimes trying to fix this problem can cause further - painful - problems.

thank you all for your replies. it does help to know that there is an end to this as we are feeling quite despairing now.

I am sick of the soiling, I am sick of dd whinging and delaying when she knows she needs to go to the toilet, I am annoyed with the NHS for treating it as a behavioural issue at first and giving us no treatment for constipation or even explanation of the existance and symptoms of impaction.

I really have no idea about different types of fibre so I am going to have to do some googling based on the different suggestions here. For example some of the things mentioned are things we alwasy thought were the right things to have - ie oats (porridge) and apples.

thanks again for everythign you have all said

This such a hard problem to deal with. Three\four years on in our house and ds still has to rush to the loo as soon as he feels the urge or he wont get there in time.

I think the stage that you are at, you need to tweak the movicol to make sure that your dd is openning her bowels every day and to keep the poo soft and easy to pass as opposed to hard or too runny. Let the medication do the work for now and get a good daily routine going before you worry about getting her bowels sorted through diet only.

Sticker charts and praise should be for drinking x amount of water and sitting on the loo twice\day with feet on a step (20 mins after eating breakfast and 20 mins after dinner - probably for about 20mins unless a poo comes sooner) not for actually doing a poo, imo. i.e. set her up for success and lots of praise. Ds used to take his DSi with him or we would read a book together.

This whole business makes dcs feel like shit (excuse the pun). It is not something they can control, so dont punish or tell them off for soiling, just tell her to wash and change and where to put the dirty pants (in our case, they often went in the bin if really bad!). Once we started doing this with ds it helped him a lot and he stopped hiding when he had pooed in his pants.

Keep the daily routine (and movicol) going once she is pooing every day in the loo. It took months and months for ds to feel the urge himself and it is the only way to retrain the bowel and give it time to shrink back.

Upping ds' water intake was also the key for him too, I think but the long term bowel training is the way to go.

Good luck!

I feel your pain here. One of my DCs has had this since toddlerhood, and it took nearly 3 years of daily movicol to get him toileting normally. But we've got there (with some big hurdles along the way) and he now, at age 5, will go to the loo by himself just like any other child.

What helped me (apart from the patience of a saint) was a book recommended by another poster. We also set monthly goals. I would say: you are 4 years 2 months tomorrow - boys who are 4 years 2 months always let me know straight after an accident. You are 4 years 3 months, boys who are 4 years 3 months sit on the loo after breakfast and tea for 10 mins...

There wasn't a magic bullet in terms of food and water, but it did help me to know that DS was in control to some extent, and there was a behavioural angle - it wasn't his fault that he'd developed the problems, but he could choose, with some help, not to put off going to the loo when he felt he needed it. That gave me much more hope, and something to work with rather than just waiting for medicine to sort it out. Having said that, I praise the Lord for movicol. DS takes it in milk as he won't drink water, and it's what keeps him on track.

I think once you have got to the soiling / lack of feeling stage it can take a LONG timefor bowel habit to return as the bowel is stetched and does not easily bounce back into shape.

DD1 has had constipation since pre-school (she'll be going into Yr 3). We have fought and fought to get seen, Gp wouldn't refer to community poo nurse, so we went through the school nurse. Finally we had an appointment with a peaditrician who saaid "she has had scans etc....?" er no, last we we had no movicol (after 3 years on the bloody stuff) by last night she hardly slept and was rolling around the bed with tummy ache. She had a scan this morning and more poo.

DD is on a dairy free and soya free diet as her constipation is definitely triggered by these. Although she has been tested for an allergy and nothing shows.

Sadly there is no easy answer just an ongoing slog.

thanks for the further replies.

those who are on a dairy free diet can I ask if your child was tested by NHS for dairy intolerance or did you just work this out by elimination?

Quip can I ask if you used rewards to help your ds comply with what you wanted him to do at every milestone ... ?

tiger our DS has had serious dairy allergy from birth - discovered when tried to introduce formula at 6 months for my return to work (didn't happen). We did struggle to get seen by the proper allergy clinic until he was past 2 years old. We were seen by dietician at the children's hospital, and a rather useless peadiatrician inbetween times...... In the end I took a list of reccommended allergy specialists at London hospitals to our GP, given by a friend of a friend who worked there, and asked to be referred, and presto we were referred to the allergy clinic (chest clinic) locally. He has an epi-pen now.

If you think DC has allergy or possible intolerance you can insist on a referral. research where your nearest NHS chest clinic / allergy clinic is, take the details to your GP. Likewise, do this with the toileting specialist - they have no right to say you don't need to be referred about this.

Absolutely we used rewards. He got two haribos for a poo and one for a wee for what must have been over 2 years at home, and his very helpful teacher agreed to have a sweet jar for him at school and he got a sweet at school every time he did a poo. We weaned him off the home sweets eventually by telling him he could have weekly pocket money when he'd grown out of needing sweets for going to the loo (around 4.7) and his teacher let the jar of sweets finish and then kept on "forgetting" to give me the empty jar to refill.

It's such a horrible problem, and people who haven't experienced it can't imagine how poo issues can dominate all family dynamics, but now that we seem to be coming through the other side of this experience (though still on daily movicol which I won't want reduced until he's had at least as long normal toileting as he had painful constipation) it's as if a burden's been lifted from us.

thanks again

I have increased water intake today

The paed consultant told us only to give rewards for 'clean days' rather than for complying with the toilet routine as she is nearly 7 yrs old, and to be honest I have no idea any more because we have been all over the place with all of it. After the advice on here I am wondering if I should reward for drinkign the water and eating the fruit and sitting for long enough.

I think I also will push the testing for allergies/intolerances as well. I am prepared to continue whatever diet is necessary but I must admit I am finding it difficult given we are vegetarian and also the usual fussiness/limits of children - we only have a handful of meals whcih are dairy-free. So it would be useful to know whether this is really necessary or not.

thanks again for all the input on here. I feel a little less lonely and frustrated now :)

I would definitely reward for her routine (I.e. what she can control) rather than 'clean days'. Why set her up to fail when she has had such a tough time?

I agree with DaftMaul. The soiling isn't her fault so it seems a shame to reward her for something she can't control.

My dd had this same thing for 8 months when she was younger. It was awful so i really feel for you. The thing that worked for us (far better than any medication) was a daily spoonful of Linseeds/flaxseeds and lots of water. You can buy them from any whole food shop for around £5 a box. Google 'linseed and constipation', there's lots of info out there.

Have you thought of maybe decreasing the amount of fibre in her diet? Maybe give her plain white toast with butter + jam or peanut butter. White pasta/rice etc. No wholegrain cereals. Increase the fat in her diet, drench pasta with olive oil, put lots of butter on veg etc.

Dairy allergy is hard to test for, unless you have an immediate reaction to it whereas many have delayed reactions such as 12/24 hrs later - the only way to test that is elimination. And allergy clinics have long waiting lists (my son has nut allergy).

Gluten + cows milk are main offenders, allergy wise. You could switch to Goats milk, yoghurt, cheese - Sainsburys has a wide range. Goats milk is a lot more digestible than cows milk as its a whey-based milk compared to casein in CM which is like glue (you can actually make glue from it!). You can get gluten free pasta which doesn't taste any different from regular pasta. Gluten free bread is a bit meh, but Genius bread is ok. Maybe try for a fortnight and see how it goes.

Really glad ive looked on this website as im at my wits end with what to do with my 4 year old. really concerned as next week she starts school and she has been having problems with going to the toliet for the past year on and off !
ive tried everything diet changes, movicol, luctose , more intake of fuilds etc and nothing seems to be working at the moment she is soiling her pants about 10 times aday with what the doctor calls "overflow". really concerned about school being two weeks away .......... its actually causing my self to be down in the dumps almost depressed !!
anyone have any ideas please !!! just wish i could do something for her ! so we can enjoy the rest of the hoildays !!

It's easier said than done, but try not to be so stressed. I know how it feels and it affects every part of your daily routine, let alone all the washing it creates!

Unfortunately, there are no quick answers and this problem is likely to take some time to resolve. I would give a sticker chart a go. Stick a sticker on the chart every time she tries on the toilet, lots of praise, always focus on the positive. Encourage a regular toilet routine and give small rewards. These could be activities (craft activity, board game) or privileges (10 mins later to bed, TV time etc). Offer a bigger reward to build up to for several days of trying hard (feed the ducks in the park, milkshake in a cafe).

You have already increased her fluids. I found orange juice very effective, but if you could persuade her to eat prunes in some form that would be fantastic. Apricots, plums, peaches and pears are all good high fibre fruit, apples & bananas are not so good.

If she is soiling up to 10 times a day is it worth speaking to your GP again and see if you can up the movicol dose or perhaps a one off use of a stimulant laxative so she can empty her bowel? My DD was older so I'm not sure if 4yrs is too young for this.

Realistically, you could make progress in the 2 weeks before school starts but you definitely won't be 100% through the problem, as the bowel takes time to improve. It will definitely be worth talking to your DD's teacher to make them aware of this issue. I would be very surprised if your DD was the only one in the class! It is something that parents rarely talk about, and you can feel quite isolated, but there are more of us out there than you would ever realise who have gone through or are going through this problem.

My ds had this from the age of 5 to 7. I don't really have any advice for you, but wanted you to know that my ds is 8 now and has not soiled himself for about a year. I've no idea how or why the problem disappeared but hopefully this will just be a stage for your dd too.