Soiling - not constipation (perhaps?)

[Sugarpaper]

My DD is in reception. She started soiling just after Christmas. It began as some marks in knickers occasionally. It has progressed since then to large soils, including full poos and parts of poos every day sometimes multiple times a day. It is happening at school and at home. It seems to be when she needs a poo she soils first. She then does a normal sized poo afterwards which usually looks like a healthy number 4 on that poo chart. 3 different GPs have checked her for constipation and all said that her tummy is soft. This, combined with the fact that she is doing daily soft poos, made them all think that it is not a constipation issue. We have followed advice from the ERIC website like toilet time, blowing bubbles etc and have increased her water and veggie intake but nothing has helped so far. She says that she can't feel when she needs to go. She does seem to know when the soiling has happened as she gets a bit embarrassed. I try to be very breezy about it and just clean and change her. We are going through a ridiculous amount of knickers as I often just have to throw them away. The last GP referred us to the continence team and to the general paediatrician but both have waiting times of over 100 weeks. Please help me wise mumsnetters. What can I do to help her? Could it be a food intolerance? Could it be a bowel thing? Should I be asking the GP to check for other things? Could it be a sensory thing? She has a few other sensory quirks. Could it be behavioural? Is it secret constipation? School have given her a poo sticker chart but that does not seem to have helped. Thanks in advance for any help.

Hmmm. It is overwhelmingly most commonly constipation, but have to admit your account makes that less likely, though certainly not impossible. Much less common but possible causes can include sensory issues (forgive me for being blunt, but usually associated with autism), coeliac disease, and inflammatory bowel disease. Though those latter two are usually via the medium of causing diarrhoea they can't hang on to. Coeliac disease can be screened for on a blood test, though a lot of GP practices don't do bloods that young, and IBD on a stool test.

A few questions: what quirks have you noticed? Has she ever appeared constipated in the past? When she's about to have an accident, can you see from her body language that it's going to happen? Does she get abdominal pain?

Does she seem heavily absorbed in activities when she's having accidents? My son has been the same since the age of 4/5 and it's always when he's playing and focused intently on the game, or watching a programme, reading a book, etc. We've found reminding him to go to the loo regularly has been helpful. We just keep on at him "have you tried..." "when did you last..." "do you need to..." etc etc and it seems to have become a bit of a habit now to check himself if he needs to go.

You have described my granddaughter. She has been diagnosed with Coeliac recently.

My DD Had this but it was constipation. Have you tried anything to get her moving?
There's raising the knees too that can help (but like the potty pose)

Could it be withholding? FB group Movicol Mummies might have some advice if so.

Any withholding issues, now or previously? Assuming you would have said if so

My son is ten and still has this issue. He has recently been diagnosed with ADHD and I genuinely think he struggles with subtle sensations and can only feel more intense things, so by the time he feels like he needs to go, it is pretty much too late. We have tackled it by sending him to the toilet to try for a poo after every meal. It has definitely helped and it is mostly manageable now

Exactly how my ds was. It was constipation. He was on movicol for a while to keep things moving. Gp dismissed it as he is autistic (you find that a lot with GPs - apparently everything is down to his Autism. Took years to get an asthma diagnosis) his paediatrician was the one who picked up on it.

Thank you so much everyone - really appreciate all of the replies. To answer some of the questions:

No history of withholding. She has always been and is still very regular - poos every day but also soils in the build up. She hasn't ever seemed constipated in the past to my knowledge and doesn't ever complain of abdominal pain with it.

She does say that it happens when she is very 'busy' with something. I haven't noticed any body language changes when she needs to go but I will watch her more closely for this.

I have wondered about some kind of neurodiversity with her in the past. She has regular big emotional meltdowns often from a sensory trigger. She hates tight clothes on her tummy, seams in socks and wants her shoelaces tied up very tight - she often loses it if these things are not right. She doesn't like loud noises like clapping in assembly or hand dryers. She also talks allllll the time and takes an age to fall to sleep. At school, she finds it hard to sit on the carpet and listens to instructions - she seems to have a lot of behaviour sticker charts!

I spoke to the GP and arranged for a stool sample to be taken next week. Interesting about the coeliac idea - she always gets a lot of mouth ulcers which doctor google tells me is a symptom too. I will request a blood test.

Thank you so much for all your help. I just want someone to say 'this is what is wrong and here is how we can fix it'

Hi, my daughter is exhibiting a lot of the sensory symptoms you describe (lines in socks and leggings, shoes needing to be tight etc). Getting ready in the mornings can be stressful! I wondered if your daughter's blood tests)stool sample revealed anything.

Neurodiverse children can lack interoception. It might just be a case of her maturing and becoming more intune with her body. She won't also feel the urge if she is constipated and even if she's going everyday, wetter stuff can bypass dryer stuff and so essentially whilst it doesn't look like constipation as we might understand it to be, it's still considered to be it because the lower bowel is kind of congested (4 years of being under the continence service here!).

Make sure she's sitting properly on the loo and gets that last bit out as we aren't designed to sit on loos. We're designed to squat but a stool and good sitting practices can replicate the squat. What can happen is the last little bit sometimes isn't evacuated and so this bit becomes older, harder darker in colour and can cause constipation.

You can do a sweetcorn test to measure her traction so a bowl of sweetcorn (if she'll eat it)...no other sweetcorn at school or whatever and see how long it takes to completely pass through. Continence service will suggest this should be 1-2 days...if it's more than this then that's a slow traction and ideally would need to be addressed as a constipation situation.

Hi, it is good you are going to be having a stool test, a stool test will more than likely show up anything wrong.

My daughter was suffering with mouth ulcers for a year and our gp kept dismissing them saying they are just a childhood thing. Thankfully I decided to get the mouth ulcers checked out at our dental hospital. They knew straight away it was crohns disease just by looking. It was from there that she had a stool test and blood test that got the ball rolling.

Keep pushing until you get answers.

Try keeping a daily food diary and mark down when she poos and what number it is. This will help the docs rule out food intorlance while u wait for apoitments

Thanks for your responses. I should add that my daughter doesn't have any soiling issues, it was more the sensory symptoms that I can relate to. She had some blood tests and stool samples two weeks ago. Her bloods were all normal, but her stool sample revealed very high inflammation and we have been referred to a paediatric gastro Doctor. I hope to get some answers as my daughter has been very irritable of late and not herself.