Poo withholding!!!!

[SleepForTheWeak]

Following on from a constipation thread I started a week or so ago....

DD is 2.3, and over the last couple months has suffered from pretty bad constipation. It was awful, but finally with lactulose she started to become regular again and it stopped being such an issue. We had started to wean her off the lactulose to see how she got on but she obviously wasn't ready and became bunged up again.

We upped her lactulose straight back up (2x10ml a day) but now she is actively holding her poo, only tiny bits were coming out which really really irritated her bum and she ended up with terrible nappy rash which was weeping. As a result, she was even more reluctant to go, and I fear we are going to be in a vicious cycle.

We have Movicol but she won't take it disguised in any drink (she is VERY stubborn head strong).

It's heart breaking seeing her struggle and strain, she clenches her bum as tight as she can and stands on her tip toes (she's in nappies and won't at this time even make eye contact with a potty or toilet seat!). Her nappy rash has now stated to improve using a couple creams I was recommended, and when she has managed to go it's been quite soft so don't think she's constipated - it's definitely a reluctance to poo due to her recent bad experience.

I really don't want this to develop into a long term issue, which I'm aware it might be as it's a hard cycle to break. Both my DNeice and DNephew had similar problems when they were young and now they are older and still have issues with going to the toilet

Any advice or similar experiences greatly appreciated

Bump

Desperate bump - it's going from bad to worse

I'd go back to the GP urgently and ask their advice, they must have seen this before with kids holding their poo. My DH had a similar problem as a very little boy and he ended up being really poorly. Sorry I can't offer any pearls of wisdom except to seek some professional advice ASAP.

If it's getting worse tonight I'd phone 101. Your last post sounds like something more has happened.

Had very similar issues with DS. The only thing that works is the movicol as he is unable to hold the poo. Lactulose didn't really gave any effect.
We have tried reducing the dose but then the problems start again.
The only way he will take the movicol is in his Milk at bedtime.

Hope things improve for you soon, I know how heartbreaking it is to see them struggling and in pain xx

Following. One of mine is similar. She is on powder from gp to mix in water and lactolose. But when she needs to go she goes like a beanpole. Nursery now agree with us that it is psychological.
I feel your pain

I can't get her to take the Movicol at all

She's absolutely miserable (as are we all!). I finally managed to get her to sleep at 10 (it's much worse in the evenings) and she woke 10 minutes later crying and straining. It breaks my heart. She's had a couple small pops today but nothing worth celebrating.

Have been to the docs twice, two different doctors, but they've both been quite dismissive and I felt like I was over reacting taking her in.

The lactulose doesn't seem to be doing anything now, or maybe it is but she's just withholding REALLY well.

We can't even go out during the day at the moment as she has so many episodes of trying - or not trying as the case may be - to go.

ERIC has a lot of sound advice - great website for all things toileting related.

I think as a priority I would keep giving her the Lactulose which can be further increased if need be, but making sure that her bum is as comfortable as can be, so working hard on clearing up the nappy rash completely.
Then, I would make no fuss whatsoever around obvious withholding, no comment, no encouragement to go, but praise like crazy when she does go (even if she is incontinent). Some will disagree with me, but I believe in bribery and corruption and chocolate buttons would feature highly in my strategy

Pooing in the bath can be much more comfortable, so you could try to time her bath to when she looks like she needs to go.

Make doing a poo an exciting and positive experience, and downplay any problems.
Hopefully she'll get the hand of it quickly.

Ask the GP for childrens glycerin suppositories. They work, use a little ky jelly to help them in, she will poo within minutes.

I've had this problem with my child, since birth.

My daughter's the same age with exactly the same problem. Withholding started a year or so ago - we had about five months without constipation or withholding which was lovely but she's back doing it again in the last few weeks.

The problem is they hold it when they're constipated because it hurts and then when the laxatives finally work they hold it again because the diarrhoea causes nappy rash.

My daughter will take movicol luckily - we give it in milk. You can mix it in milk for her cereal or porridge too. Last weekend she hadn't been for eight days - we upoednto four sachets but it takes three or four days to work. Lactulose is not as effective but up the dose to the very maximum. The doctor also gave us suppositories which we use as a last resort - we did use one and then put her in the bath and the big stuck poo came out. Can you ask the doctor about suppositories to at least get the poo moving a bit?

It's really stressful, I hate it. We have a maintenance dose of one movicol a day which generally keeps it moving but after having diarrhoea after a clear out this week I've noticed she's withholding again tonight. She was using her potty really well and that's regressed completely.

Ah crossed with memyselfand aye!

I came on to say glycerine suppositories I used to take DD to the doctors and the nurse used to insert them for us. My DD used to dance about refusing to poo it was a nightmare

Paediatric Movicol can be hidden quite nicely in Blackcurrant/Ribena.

Glycerin supps are great for constipation, but may just focus the attention on a 'troublesome' tail end and therefore 'remind' the child to withhold. I'd be cautious with using them as long as you are confident that she is not constipated (they are fantastic for getting a large, hard poo moving without too much distress).

My 3yr old is on movicol for holding his poo and we have just resorted to bribery. He knows now he has to take his special orange medicine to make his tummy better and then he gets a chocolate coin

Pm'd you with my story!

Thanks everyone - think I'll go back to doctors and ask for another GP. It's affecting her behaviour and sleep and I really really want to try get t sorted.

I've tried the Movicol in loads of different juices, she's very suspicious of different flavours though as up until now only had water or milk and now bows that anything different is to try and hide medicine!

I think she's too young yet to bribe her (I've tried!!), and the more I mention to her that she needs to try poo and not hold it in, the mor hysterical she gets

I did this when I was younger, one of my first memories was holding in a poo (weird). I had to have suposetries (sp?) which I hated. I don't remember why I started to do it, I don't think I had any trauma / pain, I just decided I didn't like it and held off going for as long as possible. What did work for me eventually was a star chart for when I went and a prize when I went-The prizes were all farm yard animals and I wanted the full set!

Thanks memy, I can't get my mail through this stupid app, but will read t on the laptop later

Had similar with DD. Presented as a cycle of constipation and withholding around 2.5years. Though now i have read EVERYTHING about it i now realise she was constipated long before that (she'd often do massive poos that involved lots of huffing and puffing - as she was going most days i didn't realise this was a problem).

Anyway, she found doing those big poos tough, so as soon as she realised she could control it, she did, by withholding. Rather than potty training as most kids do about that age.

My advice (know you've done some of this but for others reading):

• seek help asap. From witholding (or being constipated) we had a period of 4-5 months aiming to resolve it with diet, calfig etc. Didn't work. In that time DD generally went every 3-4 days, though could go up to 6 days without pooing. We then sought medical advice, wish I'd done it much sooner.

• movicol is the answer. It softens their poos and means they can't hold it. It takes a while to work, and at the start doses might be quite high. Two sachets a day was right for DD, it took a few days to get going. Then she had a clear out - a fortnight of massive poos nearly every day. Then it settled down to a more normal sized poo most days, sometimes more than once a day.

So for you, OP, the priority is figuring out how to get her to have the movicol. DD had apple juice in the mornings before we started on movicol, which we used to dilute 1 juice/ 5 water. We discovered that movicol diluted as per the instructions with water then mixed with juice on about 1 sachet of movicol / 4 or 5 juice tastes about the same. I'd also go with bribery. What does she really love? Can't remember now, but very likely at the start I'd reward DD with some chocolate buttons if she finished the juice / movicol mix.

• once you've got the movicol built into her routine she will likely need to be on it a while. DD has been on it for 6 months now (though now a lower does). This is becuase, depending on how long she's been constipated for, the bowl and intestine get stretched, so it takes a while for everything to shrink back down and normal patterns and urge to go to be restored. Constipated children sometimes don't feel the urge to go at all (also applies to wees, and i gather lots of bed wetters are actually constipated).

• otherwise: minimise stress. Don't pressure her to go, but reward with an immediate reward of something she likes (for us as above this was a few chocolate buttons) whenever she does go. Having said that, i keep it honest and matter of fact with DD: if she is complaining of a sore tummy etc i tell her that's because she needs to poo and will feel better when she does.

• this is easier said than done, but try also to manage your own stress and worry about it. Find somewhere else to vent, on here, to your partner or understanding family member. THough do that when DD is not around. I still refuse to discuss it in front of her with others - I'm aiming to dial down the pressure and normalise. People asking and pressuring can make that worse. Nursery was a problem here - they were pushing us to potty train, and I'd have to chase them to let me know whether or not she'd been so we could track it.

• observe and work out her mindset. With my DD, she was definitely resisting. I have observed her start to poo, realise what was happening and stop it. I have dealt with this with a variety of talking her through it - so if i see her starting to go, offering reassurance and cuddles and encouraging her to breath and push it out, much like i imagine you support someone in labour. But also sometime distraction worked well, if i knew she needed to go we'd get her really into a game, or playing in the park. She would get absorbed in what she was doing and passed the 'point of no return' before she realised she was pooing. Taking her swimming was also pretty guaranteed - something about the excitment would help!

• exercise and position - i massaged her tummy daily (Think of it like a square, start bottom left, up, across, down right) and bicycle her legs. Tummy time also good. And crouching (the typical position of sitting on a potty). However DD would resist these things when she needed to go. I was firm about massage, and tried to get the others worked into games etc. Warm bath can also help.

• the typical sitting on a potty position would help, but if she is bothered by that (DD would not entertain it) don't push it at the moment. I recommend abandoning all plans for potty training until she is is in a better place, both in terms of regularity and her mindset to it. DD was very fearful of pooing. Though very pleased when she'd been, she'd act and talk as if she was never doign that again. We are in much better place now, but it has taken months of no pressure support with gentle encouragement and facts (we all poo every day, that's what keeps us healthy etc) for her mindset to gradually change. After she was pooing more regularly with movicol, we started on using the potty for wees. THis has been a slow two steps forward / one step back journey, but now she is potty trained for wees, and has a nappy (often but not always sitting on the potty) to do her poo at a regular time most days. She has had a few weeks of pooing directly into the potty, but lost her nerve, don't know why. At various points we've pushed a bit on pooing in the potty and it has been a mistake. The good news is she has great control and is dry at night. The rare occasions she bed wets i know she needs to poo.

As you can see by this post it has been long road for us. It's 11 months now since i noticed problems, and 7 months on daily movicol. We are in a much better place, but if putting all this behind us means potty trained and regularly pooing without medication we are not there yet.

What's tricky is, the natural instinct to avoid what hurts or is uncomfortable makes things worse when it comes to constipation. And they are too young to understand that (although as set out above i do explain this in an age appropriate way to DD when relevant, particualrly if i can see she is witholding). With our DD now i think really we are waiting until she really grasps that the way to easy comfortable poos is to go every day and not hold on. The holding behaviour has sometimes appeared with wees too, but we have dealt with that by a mixture of handing all the responsilbity to her (so no reminding to go, even if she wets herself) which worked well at home. But out of the house she would refuse. So at the moment I'm careful to think through where we will be, and take her at an appropriate moment, no discussion. I generally set up the next thing we will do (e.g. leaving cafe for the park and take her for a wee just before) so then if she refuses I say, well, we;re not going to the park until you go, and just sit her out.

Got to go as DD has woken hope some of this useful!

final thought: ERIC helpline and website is very helpful. Call them

Also: while diet does matter, it is not the cause for DD. She eats a good mix, plenty of fruit and veg (though i have got stricter about this, and ahve had to make sure our nanny is too, so fruit before a treat etc).

Some kids are just prone to it. I was too. For DD she can dehydrate easily and that is a trigger. Movicol helps this, but the road to no (or less) medication for us is making sure she drinks plenty. Even one day of too many carbs / not enough fruit and veg combined with little water can set us back.

However i use movicol (and now sometimes senakot) to correct that, and then change what she eats for the next few days.

Managing all this can feel all consuming, and i try to minimise that for DD.

Thank you so much goodluck, lots of really helpful advice in there.

I'm feeling really down about it all, seeing how much it's affecting DD.

Going to try Movicol in some milkshake tomorrow and see if that works. Can she have that on top of all the lactulose she's on??

Definitely going to take a step back and not put as much pressure on her

My ds is 6and still withholds to some degree. We eventually weaned him off movicol, because although he was withholding as best as he could it would make him "leak" which he equally hated.
He also HATED potty/toilet. To just get him on was a huge, stressful battle that I didn't handle well. In the end I worked out that if I would sit behind him on the toilet, with a bag of chocolate buttons and the tablet....(Gross but it got him used to just sitting there) he felt safe. Eventually we've worked out that the ONLY thing that works for him is laughter.real full on laughter, it seems to relax him just enough, we quickly began recognising the signs and he squeezes our hands and gets lots of praise. We have special toilet jokes and games (dh will sneak up stairs and squirt us with a water pistol.or we play catch with water balloons, or sing silly songs. We do this every other night before bath time.
I'm not suggesting stopping any medication for your DD. And as pp have said go back to go/seek a second opinion. Just sharing what has worked for us, after lots of tears and tantrums (mine and DS).
Hope you get some resolution soon.

Goodluck has said it all. We didn't handle DD's constipation and subsequent withholding well at all. I had no idea she was constipated as she pooed every day - I didn't know it wasn't normal for babies to always poo overnight - so when potty training started it all quickly went to hell. I won't bore you with all the awfulness but DD1 is now 9 and is still on medication.

I agree get support and help now, movicol is your friend, it's a long haul so settle in for it, try not to get stressed, buy wine, lots of it.