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

Sleep Yes, you can take movicol with lactulose. Lactulose didn't touch the sides for my DD1. If she is bunged up she really needs the movicol.

Soup I can't even drown my sorrows with wine as I'm pregnant

DD doesn't do bribery - if she doesn't want to do something there is nothing on this earth you could promise her to to make her do it.

I've heard so many stories of older children and even adults still having bowel issues which stem back to this very problem - I want to do everything possible to prevent that happening to DD.

I think it might not be that the constipation at a young age causes later bowel issues, rather that it is an early symptom for those prone to them.

Lots of food advice from pp. My dd now 6 has had issues with constipation since potty training and with hindsight (and benefit of Dd2) now see things weren't right long before I realised.

Agree with others about both stress and praise about poos. Should just be another matter of fact part of your day not a celebration if you see what I mean. So feign disinterest and adopt mild reactions.

What helped me was to think about how my reactions would be different if it was problem with eating rather than pooping. I wouldn't hover around the dinner table and cheering every mouthful, that would be quite stressful even as praise.

That's my tip anyway, and as pp have said prepare for long haul, we have been on and off lactulose and movicol over years now. For us I think some diet things are important but mainly common sense eg don't let dd eat 6 babybels in a day

Congratulations Sleep. I'd suggest leaving the potty training until your DD is begging for pants then if you've another DC on the way!

In our situation I am convinced me stressing about DD and the poo caused her to be even more stressed and anxious so you are right to be on the case now and to do as much as possible to prevent the withholding and constipation from becoming seriously chronic.

You know your DD best. So do what you think is best for her and you all. If bribery really won't work, then it's other strategies. Bribery didn't work for us either. You will however be told by everyone and anyone that a sticker chart will sort it all out - just smile and nod and imagine kicking them in the shins.

If she withholds to the extent that she is getting bunged up it really is a case of getting as much movicol into her as you can. I found that when DD1 was asleep she would poo as she was relaxed and her body would take over from her mind.

Good luck, try not to let it get you down (says the woman who has cried more tears about poo than anything else ever) and don't be fobbed off - you and your DD need help and support both for the physical issue and to help with the stress and strain (sic) of the situation.

Now that it's been mentioned, I think this was a problem long before it presented itself as a problem. DDs poos were always firm and always took a bit of straining for her to do them, but because she didn't seem in pain and went every day, I didn't think there was an issue.

Could I be something in her diet? Should I try cutting out a food group? Problem is when she's bad like this is that she really loses her appetite which is a shame as she's normally an amazing eater.

Ok so that's a tough one.

But movicol is your route out of this. Whereas per medications give the urge to go, but if ey can't it makes it worse. Whereas movicol softens the poo that's there.

What would work for her? Take her to the dr and get them to tell her she has to have the medicine every day? Works for some kids

(As an aside, we've been to the gp several times. I take someone with me to mind DD, go in alone first, discuss frankly where we are then bring DD in for a pre planned discussion with the go where we have agreed what will be said).

Long haul: yes quite possible. I was frequently constipated as a child, so it runs in our family I guess. But over learned to manage it fine as I grew up, likewise keeping an eye on what I eat, drinking plenty of water, and I have psyllium husks daily).

Better to accept that long term management is one possible outcome than pressure yourself (and her) to fix it immediately. Different kids find different things easy and hard. They need our support through the challenges, not pressure.

It might resolve quite quickly or she might be prone to it.

I'm pretty sure my DD is, and as much as I regret not spotting it earlier, that may not have made a difference if she is prone to it.

I'm accepting it'll always be something I keep a eye on as she grows up, always have some movicol to hand, etc. There's other things she's done without turning a hair (like, shes an adventurous eater and she's teaching herself to add numbers at three and a half). You gotta take the rough with the smooth.

It'll be ok.

Unmumsnetty hugs

Know this: there is unlikely to be a silver bullet, in terms of diet etc.

DD eats way better than many kids her age. It really Isn't just a matter of more veg / prunes/ a fcking star chart (though we have had fun with the charts at various points, DD looses interest).

Several months in I know too many big portions of carbs and not enough water are problematic for DD. So if she's had pasta or potatoes with lunch, I'll often give her a dinner of, say chicken and baked beans at dinner.

But she can have a exemplary diet and still be constipated. While the kid next to her chows down on chips and chocolate biscuits and their mum tells me a reward chart will fix it.

No.
It.
Won't
*
and breathe

It's good to vent. I've got some useful links I can post will be back later in the week.

We also occasionally use suppositories if she really can't go. Brutal, DD hates them, but effective. Also the spectre of them can get her motivated sometimes to go under her own steam.

I would say not to change her diet now, just follow usual healthy eating advice and plenty of water. Allergy tests /intolerances will be checked if you get referred to on to paed (we have just reached this stage with dd, and are trying lactose free but not sure it's making any difference).

It's a vicious cycle as withholding stretches the bowel, which makes it easier to withhold next time etc. I understand it takes a long time for bowel to 'shrink' back down which is why you may find you need to use lactulose or movicol for 6 months after symptoms gone before trying to wean off.

Other tips I remember is movicol drink through a straw for minimum mouth time. I make a sachet in only half a cup of water +squash.

Bubble mix on the loo is good as you can't blow bubbles and withhold at the same time. Or tablet with favourite show. We found after dinner was main time for likely success got in a routine of after dinner, dd sat on loo for 2 peppa pigs, and if nothing happened said nothing and off loo. I would potter about or brush my teeth etc and pretend not to be listening for sounds of success!

Movic needs to be made up in water first to allow it to bind to the water, before mixing it in with something else. Using a straw bypasses the bitter taste buds and can help.
See here www.eric.org.uk/pdf-how-to-prepare-macrogol-laxatives

I've tried straws, even bought her fancy ones, by to no avail.

I don't understand how anyone can get a two year old to drink it - it's horrid!

Would mixing it with water then topping up with milk work? Does it have to be cold water?

Sleep I'd also recommend getting a hold of Dr Anthony Cohn's book, it was brilliant for helping us and really helped when dealing with HCPs.

I can't help with tips for getting the movicol into your DD, mine seemed to be happy to take it but she would have been 4 by the time she was on it.

Yea I think our problem is her age and although she has a good understanding of most things this is something she's unable to be reasoned with.

I've mixed it with water and topped up with hot milk for her cup of tea this morning so I'm hoping she'll be fooled!

www.amazon.co.uk/Constipation-Withholding-Your-Child-Soiling/dp/1843104911

Here is the link I forgot to put in my last post.

Thanks, have just ordered it :).

She took the Movicol this morning in her cup of tea :)

A small victory, but a victory nonetheless!!

Well done to tonight's Movicol! May it be the start of something good...

the more I mention to her that she needs to try poo and not hold it in, the mor hysterical she gets

This is why you should stop mentioning anything to do with going to the toilet but deliver massive over the top praise when she does go - that's when you give chocolate buttons (or whatever): it's not a bribe (sorry, wrong word used by me), it's a rewards. And trust me, 2 yo DO understand rewards.

Yy to Lactulose and Movicol.
Have you ever tried Glycerin suppositories? You can get little ones for toddlers.

Do not even try potty training while things are so fraught. Totally agree with leaving it until she wants to get in to big girl knickers!

Bowel transit time is very much a genetic thing - some people's bowels move food stuffs faster through their system than others, and diet only makes a little difference to that. So, do be very careful that she gets plenty of fruit and vegetable + lots to drink, but that will not solve your problem.

Physical activity can also help - regular, vigorous exercise may stimulate her bowel enough to go.

The definition of constipation is all about the difficulty of going. People can go every day and still be constipated, otoh they can go twice a week and NOT be constipated. If there is huffing and puffing, and straining, and red faces and eye popping out with effort = constipation. If she passes a soft, but formed stool without effort = not constipated. Just a rough rule of thumb but is usually accurate

Good luck and don't let it bring you down too much!

I've briefed DH and MiL (who looks after DD while I'm at work) NOT to make a fuss or mention poos to her at all - but to praise and recognise IF she does manage one. We are all on the same page now so hopefully that will take some of the pressure off her.

She fell asleep on my lap this evening after a tough couple hours of her struggling. I attempted to clean her bum while she was sleeping as there were a few marks in her nappy and I'm conscious of her bum being irritated. She woke up of course, and as I pushed her legs back to clean her bum a poo started to come out so although she was crying and kicking I kept her in that position until it was out. It was a healthy size but not as big as you would have expected, and although it was firm it wasn't rock solid. She was like a different child after that, really showed me how much this is affecting her.

She had another bad episode right before bed and got very upset with straining, and managed another (small) poo by herself.

Still plenty in there but a big relief that she's at least a bit lighter than she was before!!

Poo update

DD has had two plentiful and soft poos today - neither of which caused her to much distress - I could cry with happiness! The difference in her behaviour and demeanour is huge!!

My question now is, do I continue with the Movicol AND 20ml lactulose or is that overdoing it? Don't want her having a sore bum from constant pooing! Or should I start reducing the lactulose?

Yes!!
Keep going - do NOT stop.

Some of what you are needing to do is allowing her rectum to shrink back to a normal size, for nerve receptors to 'learn' again what a normal full rectum feels like and for her bowel to become re-accustomed to normal function.

Hope you made a huge fuss of her

Keep going with her Movicol twice daily and reduce the Lactulose slowly if you are confident that she is going easily.
Don't stop laxatives for 2-3 months at least, although of course you can reduce amounts, but do it gradually.

Evidence based advice on treatment of constipation/impaction/withholding in children

Same problem & I find it really difficult to watch. We have a just turned 3 year old and he has severe constipation. Tried the potty/toilet etc but nothing seemed to work. Eats loads of fruit/veg so can't understand reasons why. We've just been prescribed movicol too and worked out we can sneak the plain one into bedtime drink & get away with that. We mix it with apple & mango fruit drink which is his favourite. Tried it in other drinks & yogurt but ds was having none of it. It's taken over a week to have any effect which worried me, thought it wasn't doing anything but even ds is surprised when his poo pops right out in seconds rather than days. He was definitely withholding it for days at a time. No experience of anything else, good luck op!

DS had to take Movicol this week, we discovered it tastes much better when you make it in advance and chill in the fridge. We mixed with squash and he said he liked it in the orange best.

She's only on one Movicol a day plus the 2 10ml doses of lactulose (maximum for her age)

She had a third, very messy poo this evening. I'm worried that it's too much now with the Movicol. Might keep it going another couple days and if it's getting more runny I'll start reducing the lactulose

Sleep don't stop with the movicol whatever you do. Much better to have soft squidgy poos than go back to having the constipation. It takes a long time for the bowel to get back to 'normal' after being bunged up.

The last thing you want it to have to be on a disimpaction regime where you have to get to the brown water stage.

Thanks soup, definitely not going to stop the Movicol as that's what seems to be working. Was wondering whether to reduce the lactulose though, she had a verging on diarrhoea poo this morning

Yes, reduce the Lactulose.

And keep going with the ridiculous praise for every poo, no matter how runny/stinky/frequent etc.