Soiling, wetting and not eating! Sigh!

[bangingmyheadoffabrickwall]

What advice can you give to a mum of a DS aged 4 who soils and wets his pants up to 2/3 times a day and has now decided lately to not eat at meal times claiming to be tired or he has had enough?

Back story:
He has been on movicol for a year because from the age of 2 he has held onto his poo and refused to relieve himself.
He takes 1 sachet a day which for months has worked.
His toilet trips are 1/2 times a week.
His poos are 'perfectly' formed but are extremely long (Suspect elongation of the colon).

The issues:
Last few weeks he has been very obviously holding his poos more and more (red faced, hiding, sitting awkwardly to keep it in).
Pants are soiled. not skid marks but lumps of poo.
Claims he doesn't know when to go (suspect a lie - see above about obvious holding)
9/10 times he does then use the toilet after soiling incident.
Always had a dribble in his pants as he leaves it to the last minute to wee.
Lately this has been more than a dribble to the point of full wet patches on his trousers.
He seems unconcerned by this and will 'happily' go about his day wet or even soiled!?!?
Refusing to eat meals more and more and chooses to graze.
Claims he is tired or he has had enough when eating.

My GP did say last year that at this point in the year, just before starting school, there would be a set-back. This may be it, I don't know! I have no idea how to handle this for the best. We are all getting very frustrated by it. I am concerned with how school will deal with it. He has no EHP in place and not even sure if he is eligible for one.

I am going to make an appointment with the GP but worry I will be laughed off because I am not even sure WHAT the GP can do!

[JinkxMonsoon]

Soiling, wetting and not eating all points towards massively constipated. One or two bowel movements a week isn't ideal either. So if I were you I'd up the Movicol to 2/3 sachets a day - even the Movicol disimpaction regime since it's the summer holidays - to get him cleared out. Then consider a higher maintenance dose to make sure he goes every day (or every other day) and out of the habit of withholding.

[Noitsnotteatimeyet]

This was my son at 4 - like yours he'd had a long history of constipation but eventually managed to get a referral to the 'poo nurse' at our local hospital

She was fantastic and we did get him sorted in the end but it was a long, long haul

The soiling and wetting are all connected - his colon will be completely stuffed with poo so it gets stretched and the nerve endings lose their sensitivity so when he says he can't feel he needs to go he's not lying. Liquid matter from further up the digestive tract seeps past and ends up as skid marks and the bladder is being squished hence the wetting. Ds had a very poor appetite but that was because he felt hideous pretty much all the time due to the constipation- it also made him tired and listless and affected his mood

Go back to your GP and insist on a referral to the local paediatric continence clinic

In the meantime I agree with a pp - ditch any rewards/punishments other than rewards for drinking regularly- we had to do little and often and make it into a race. Try to increase the amount of exercise he does as that will help too - and be prepared to have setbacks along the way. Ds had been having problems with constipation since he was about 18 months but the GP kept fobbing me off until finally getting the referral when he was 4. He finally got completely discharged last year at the age of 15 (although for the last few years we've just been seeing the nurse on an ad-hoc basis if we had a crisis). Good luck

[Jessbow]

Refusal to eat meals preferring to graze.......

Yes I am a grazer, I would rather graze than eat a full meal 3 times a day.

I wouldn't worry about it as long as he has adequate food intake. If it really bothers you, stop the grazing

[HollyAndIvyTime]

Join the Facebook group 'Movicol Mummies'. There are many people on there with similar issues and you will get some excellent advice.

Go easy on your son - he probably isn't lieing about not knowing, it's a big issue for many children and not often talked about.

[GingerAndTheBiscuits]

Things we've picked up (with limited success): no rewards or punishments for accidents but reward for water intake (we aim for at least a litre of water a day, should probably be more but I can't physically get it into her!) and reward for changing out of wet clothes immediately (sitting in wet clothes is a real bugbear!). I've noticed my daughter just has no urge to go, like she's lost any bladder/brain connection. She has got better to the extent that she can hold it once it starts so knickers are now mostly damp rather than soaked, but it's still multiple times a day. So stressful so I really do sympathise!

[Watchingitall]

My GP was very good. She has small children herself and referred us without asking twice. We see the continence nurse now who liaises with the school nurse. I get the feeling that it would be an effective partnership if they had something to work with.
They did get a special dispensation to use the teachers toilets at school as the class ones are revolting. It's not made a difference to us but can see how it could have a huge impact with a child with withholding issues.

[GingerAndTheBiscuits]

I would ask for a referral to a paediatrician. It has taken us 18 months of asking health professionals for help and advice on my daughter's daytime enuresis (no signs of constipation) and only now at 5 and a half have we had a referral to a specialist for which we are still awaiting an appointment. I think it's best to get expert advice early if possible. My GP was useless, HV barely better, school nurse very supportive.

[bangingmyheadoffabrickwall]

Thanks! That will be a purchase I will certainly make.

I am hoping to speak to my HV on Tuesday about it and go from there if she thinks a trip to the GP is necessary and ask her if there is a 'constipation clinic' or similar my son can be referred to.

I do suspect starting school may be the issue even though he has been going to the school since January 2014 when he began nursery.

Some tips I have picked up this evening are:
Drinking more fluids during the day
Toilet routines after meals
Back to doing a star chart which we did last year and was successful and ended when he started to forget it was there and using the toilet became 'routine'.

[Watchingitall]

And I'm going to look up that book. Thank you.

[Watchingitall]

No advice, just the same situation here. We've finished nursery today for the summer. There were lots of mums crying about how big the children were getting and I'm just stood there thinking, yep, this marks at least two and a half years of potty training.
My little girl will be five in November and has had maybe ten dry days at nursery. She will quite happily sit all day in damp knickers to the point she often has a sore bottom. She's had scans, MRI's and other tests and the consensus is that she's just too interested in whatever else she's doing to take the time to go to the toilet.
Sorry- nothing to add really- other than you're not the only one. (It sucks).

[Brandnewbrighttomorrow]

We went through a lot of this with our eldest until someone recommended a book called Constipation, Withholding and your Child by Anthony Cohn - absolute lifechanger, can't recommend it highly enough.

Anthony Cohn