Toddler Not Pooped for Over a Week

[Cooki3Monst3r]

Hi.

I'll try to keep this short.(ish)

2y 11month old DS. Still in nappies. Fussy eater. Although can eat a LOT of what he does like. Lots of cereal and milk, banana milkshake (real, homemade), bread, almonds (sliced), pasta, cheese, pate, fruit juice, baby smoothies, sausages , fishcakes , chips .

He has for a long time now not been very frequently opening his bowels. The first time this came to light was when I tried to potty train him by taking his nappy off last summer. He had been showing lots of signs of knowing when he needed to go and interest in visiting the loo / washing his hands.

Anyway, after a couple of days he ended up with compacted constipation and I had to give him laxatives. The size and state of the poo suggested it had been in there a while, so I think it must have been brewing before the nappies came off.

Ever since then he goes just a couple of times a week. Occasionally less often. It will be clear that a poo will be brewing for a couple of days before it actually materialises. Eventually he can't stop it coming and he'll fuss and cry, not wanting to soil his nappy but not wanting the potty either. So I'll hug him and keep him on the potty while he does the business.

I had assumed the constipation was down to his poor diet. But now I'm thinking that actually he might just be holding on. He drinks plenty of water / squash / juice / milk and when the poo does arrive, it's usually very soft.

As of today, he's not had a poo since Thursday before last (10 days ago) and his tummy is huge. He's been really fussy the last couple of days, like you'd expect a poorly toddler to act, saying he's hungry but not eating much.

I'm going to take him to the GPs in the morning. But I'm not sure what it is I need to ask for. It's a long term fix I need. I just don't know what I'm supposed to do. Ride it out? Keep the nappies on? Take them off?

Does anyone else have any experience of anything like this and know who/what I should be asking for? I need a referral to an expert - but what sort, psychologist? paediatrician? poo consultant?!

He was born 12 weeks prem, although at this age I don't think that's relevant any more.

Sorry, that wasn't short!! Thank you for reading.

My daughter started like this at the age of 2. She's now almost 5, and while loads better, still periodically holds on to poo and cries and makes a fuss when she has to go. There seems to be no logic or reason behind when this happens. She generally passes them easily and they are soft (tho shockingly large when she's been holding on!)

The gp will likely give you movicol and put you on the impaction protocol then drop down to a maintenance dose, possibly with lactic ode and or a suppository in the first instance. Be reassured this is terribly common (I'm a HCP and have come across it lots): I would be highly, highly surprised if the gp will refer you on anywhere. The HV usually had some good literature around this. There is also a YouTube video "poo goes to Pooland" which they often recommend.

Hope that helps!

That should have read, lactulose! Damn autocorrect!

My DD had similar problems at slightly older but was late potty trainer too so this might relate. Took DD to GP who examined her and talked to her. GP and I believed that DD's issue was psychological rather than physical. She got very stressed about going for a poo and just held it in- don't know how! GP prescribed movicol (which is a powder you put in water or squash/ fruit juice) and told DD it was important that she went for a poo every day. He told me not to fuss or get stressed when she didn't pass anything for a couple of days but just to give the movicol and to praise lots when she did go. It took a few weeks of this (and me applauding every blooming poo) but it did get better.
Good luck with GP.
P.S. His diet sounds pretty good for a fussy eater so don't beat yourself up over that!

Thanks Chestnut. I'll check out that video.

Out of interest, when did your dd potty train?

I've just found out our hospital has a 'paediatric gastroenterology' team. Constipation being one of their list of things they deal with. I was hoping for a referral to them. Hopefully that's not just wishful thinking!!

Last time I spoke to my GP about this he said that the bowel can become dependent on laxatives so only to use when absolutely necessary. The last time being before xmas after we'd been to Disneyland and ds had eaten literally just white bread, chips and ice-cream for 4 days!

Oh, so the movicol is a semi-permenant thing you keep giving until they've got over / got used to going to the toilet?

Did your dd come off the movicol after a few weeks then 42?

She potty trained herself for wee's at just gone 2. Never had one accident. The poo's were a different thing all together; it was an issue from the get go. I probably made it all worse because I found it very hard to remain calm about it all. Worst ever episode she held in for 14 days. She was literally screaming in pain but refusing to go. Absolute iron will!

It was about as bad as it could get. We turned a corner with a sticker reward chart and I would say we are 90% improved, but its taken almost 3 years!!!

I think the advice is to keep them in a maintenance diss of movicol for a long time; months and months, just to try and take away the stress of going. We ceryaiy had problems when we stopped it too early (tho she doesn't have it now and hasn't for some time). It can be mixed into juice or there is a chocolate flavoured one

It's horrible, isn't it? When they're in pain and just won't damn listen to your very logical advice!

I'll do him a reward chart tomorrow. That's where the movicol would help. Because otherwise it's going to be a very empty sticker chart!

GP prescribed a huge box of the stuff to have at home for when it was needed. She got it every other day for a week or so then just when I felt she was overdue a poo! She also asked for it occasionally if she knew she needed to go but couldn't. If she asked for it, I only gave her half a sachet as I knew she just felt she needed to know she'd had it before she'd even try to poo.
(I have never written the word poo so many times before - the joys!!)

Your GP prescribed it on-going chestnut?

This is what I asked the GP before and he said not a good idea. . My exact words were "just so he can get used to going to the toilet frequently".

Ahh... this is a relief. Thank you chestnut and 42!

Yes, I've spoken to quite a few gp's who I rate as clued up about it (as well as HV who I know through work). If its not being used for feacal impaction it is definitely designed to be used not as a quick fix. Sounds like your LO is not constipated, but is with holding. Two totally separate things. They withhold for psychological reasons. 5 days of movicol won't change that. That's why it's a longer term solution, as I understand. I think allowing the withholding to continue is actually the riskier issue; can cause distinction of the bowel etc which in turn causes issues in getting them going normally again

Oh God, chestnut who knows what damage has been done.

His poos are ginormous! Bigger than anything I produce. Last one I took the tape measure to (up the in air, rough measure) and it was 20 cms!! That must be his entire colon?

Oh also just wanted to say, I understand how absolutely stressful and worrying what you are going through is. People used to laugh when I told them about it but I used to cry over it (not in front of daughter, obviously!). I totally understand what you are going through

Presumably the with-holding can cause constipation/impaction though? I've given him laxatives (can't remember which one) it does help him go. Mind you, maybe that's coincidence.

Thanks chestnut. It's been horrible. This is the only aspect of my parenting career when I've been totally, utterly clueless.

That's not to say I normally have all the answers, but I do generally have an action plan of some kind!

Yes it does cause impaction for sure. The laxatives will held get a withholder to a point where they have no option but to go!

I didn't realise I was such an expert on this subject it is amazing the amount of knowledge I've acquire on this subject!

Agreed, it's really stressful for DC and parents. I may laugh now that I applauded jobbies... but at the time I felt like giving a standing ovation
Cooki DD is now 6 and maybe has an issue once in every 6/8 weeks but we both know how to deal with it.

This is totally my punishment for feeling so clever at getting dc1 potty trained at 20 months!

My new mother's motto should be "never sit on you laurels, disaster is just round the corner". ha ha ha (must keep laughing!!)

It's a vicious circle. Withholding causes constipation which causes withholding which causes constipation.

Hopefully you'll get the referral you're after OP, because your GP sounds quite misinformed and reluctant to prescribe Movicol.

Last time I spoke to my GP about this he said that the bowel can become dependent on laxatives so only to use when absolutely necessary

This is both true and not true. It very much depends on the laxative. Something like Senna, a stimulant laxative, isn't considered ideal in the long term because that can make the bowel a bit lazy. Movicol is merely a stool bulker and softener. It does not make the bowel lazy and it is safe for long term use (think years and years). A consultant told me this, and said that GPs sometimes get this wrong.

Thanks everyone. Got movicol from GP.

How many sachets have you been told to give? If I were you I'd consider the Movicol disimpaction regime, because it would be pretty impossible NOT to be impacted after this length of time.

Start at 1, then build up to no more than 4 a day. Then back down to 1ish, whatever is needed to keep him regular and comfortable. Then stay at that for 2 weeks then see what happens after weaning him off it.

I had to give him the sachet in pure orange juice to get him to drink it. A small price to pay I guess.

D'ya reckon I should just jump to 4 tomorrow? GP had a feel of his tummy and said the poo didn't feel that big.

Well, for starters, being on Movicol for just two week is going to be no use at all. I can tell you what'll happen when you wean him off: you'll go back to square one.

It takes a long time to get a child out of the mindset that pooing = pain so I'm going to withhold. Months and months, at best. And you can only achieve this by ensuring the bowel movements are so soft they can't be withheld and they won't cause any pain.

This GP is so over cautious they're not following guidelines or even common sense.

Did you ask about a gastro referral? Some trusts even have a children's continence nurse specialising in things like constipation and bedwetting. Failing that, another GP?