Trouble pooping

[Crochetmadmama]

Hi first of, im sorry if this is in the wrong place!

my son is 6 and for his entire life has had issues with pooing, he was constipated a lot as a toddler and unfortunately will now only poo standing up in a nappy, he holds and holds for a few days causing very small accidents in his underwear and then finally poos.

i have tried sitting him on the toilet and he is visible shaking and terrified, will wee fine, so we are focusing on just getting him to poo more often but that doesnt seem to work either, he just holds and causes himself more discomfort and then will only do it stood up which im sure must be uncomfortable for him, the aim is to get him sitting on the toilet but he just wont it ends in tears and screaming from him.

we have been to the doctor but all they recommend is laxatives, we have taken him of laxatives for about 2 months now as they just gave him diarrhea and we tweaked his diet, it does seem to help a little but still hes holding and then finally going in the nappy stood up.

so sorry for the rambling i just feel the gps wont listen and im at a loss i want to help him but i dont know how to get him over his fear.

thank you for reading

p.s little sister poops normally every night so not sure why its so different! :(

Okay, right, this will be long.

He's got chronic constipation. This will have stretched up the last bit of the gut, to make room for old poo, and the stretched out area gets less good at pushing poo out. It also tends to lose sensation of when is a good time to push, and (a bit like a baby's head on the cervix) the bum hole gets stretched up by the poo, so you find the kid both hanging on, but also can be surprised by poo accidents. Psychologically, it will have hurt to poo for so long that he's desperate not to poo.

He may well have a backlog of hard poo sitting in the last bit of his gut (called impaction). When this is the case, when a child first goes on laxatives it loosens up the poo higher up, first, with the idea being that as this comes past it helps to erode the hard poo. But this means that they often get diarrhoea, from the near liquid poo higher up, coming past the hard rocks of poo. And stopping laxatives at that point tends to take you back to square one.

If they've got a lot of backlog/impaction, then they tend to need enormous amounts of laxatives (laxido/movicol) for a week or two, to clear the backlog, and then reduce to smaller amounts. They tend to have a lot of accidents during the clear out period. Once they're cleared out, then the laxatives should be reduced to whatever amount has them pooing every day of a soft squidgy pain free poo. Once the poo is regularly and reliably soft and squidgy, pretty much every day, then you can start trying to work on getting poos to go down the toilet. But keep going with the laxative, to keep poo soft and pain free.

It starts with practicing sitting on the toilet when he doesn't need a poo. Use a foot rest to help him feel more secure. Use distractions (blowing bubbles, playing on your phone, whatever keeps him happy) to have him sit on the toilet for seconds, with no pushing. Then build up through minutes, probably using start charts or similar. Once he can sit on the toilet without being terrified, then try sitting on the toilet for a few minutes 1/2 hour after a meal, as that's when he's most likely to poo. May be worth stories, eg toilet goes to poo land. Star chart then for trying to go, not for succeeding. Don't offer rewards for actually going for a poo until he has a decent chance of doing it. And only come off the laxatives, gradually and slowly, once he has been doing all his poos comfortably in the toilet for some time.

I'd strongly recommend eric.org.uk

Hope that helps.

@nocoolnamesleft thank you for getting back to me. i knew about impaction from my own research and the doctors did check him for it and said he was clear, from pressing on his stomach, however i have been told to stay on laxatives and to also stop using them as body becomes dependent so it is really difficult, i am also struggling as hes at school i cant have him having lots of diarrhea from intense laxido, so i usually have to wait for a school holiday, but on the doctor recommendation it was 2 a day, did not clear him, so i did my own research and found he should be taking 6 for chronic constipation.

also he did a poo this evening and the amount that came out, could he really be impacted? it was a very large amount, i agree with the stretched out, i have read that before but 2 weeks of intense laxatives in the past have not helped and then the diarrhea was an issue so the doctor told us to stop that.

im so confused i just want to help him.

Oh dear, are people still talking about laxative dependence? Not true in children. In children, if you can get rid of any old hard poo, and then have them daily pooing soft poo, then the gut shrinks back down, and you get proper function back. And can then slowly come off the laxido. If they don't have enough, then the gut can't shrink back down, because there's still poo in there stretching it up, so they end up needed laxatives for a lot longer. The thinking on laxative dependence was in the elderly, whose guts don't heal up the same.

I'm afraid it's almost impossible to tell if he's impacted without being able to examine him. But passing such vast amounts pretty much proves that he's stretched up. Or else he wouldn't be able to hold that much.

I agree that where possible school hols are handy for a clear out. Quite a lot of teenagers have extra laxido on Friday and Saturday, so they poo more on Saturday and Sunday, to try to avoid getting too backlogged. Is that worth a try?

@nocoolnamesleft, yes i will give that a try, i just asked my partner again, he dealt with the evening poo and he said it was of a normal size, but he did also poo this morning, sorry to be so graphic, we get a lot of mixed messages from our gp and i often feel fobbed of with oh try laxatives oh have you tried stopping them, at this point we have had a solid 4 years of intense laxatives to stopping them and hes more aware of himself now and gets upset.

i will get him started on the toilet by getting him to sit on probably clothes for a week to try and normalize it for him, thank you for your great advise, unfortunately now our gps are phone consultation only so i cant get him checked for impaction but if schools close i can get him on a laxido regime