My 3 year old has lost all control of his bowels! Pls help. GP no advice

[CoveredinCrap]

3.5 year has been fully potty trained for a year. He is a v easy going kid and was easy to potty train - no accidents really and took himself to the loo independently for a year.

A couple of months ago he became constipated - no idea why. He started holding onto his poo and not going. Then he started pooing in his pants. Or if just poo himself a bit, so i would smell something and then realise it was on him. It's like he has no control or knowledge of it coming. He gets upset a home about it - he says "I don't know why it happened" and just cries. He hates it being on him

It started at nursery and he's doing it nursery but doesn't tell anyone is has happened.

I've taken him to a GP and they gave him laxatives saying it sound like he had chronic constipation. It actually worked the first time - and for the first time in 2 months he told me he needed to the loo, went there independently and used it - he was so happy withi himself and said 'mummy the medicine worked' but i kept using it daily for the last week but he has gone back to poo in his pants, all over him, he crouches in the corner of the room crying

the nursery are trying to say they can't handle it and asked me to sign something to say they hvae a right to exclude him.

any advice at all? He really really doesn't want to be doing this, but it' slike he has no idea how to control it anymore.

Try the Eric helpline - they have some great resources on impaction and how to treat it.

I think this needs a paediatric referral.

I'd imagine there's a backup of poo if it's been going on a while.

My DD is on laxido and we had to keep her home for a week and follow an increasing number of sachets til her poo was watery, then reduced back down. It can give sore tummies.

It can be a fine balance with laxatives. Perhaps he has diarrhoea secondary to constipation, is he backed up? Has the GP felt his tummy properly to see if he can feel any firm stool? You could also be over using the laxatives now.

Keep a bowel chart and go back to the GP.

Yes I agree he's impacted. It's pretty common so don't worry. Get movicol it will help.

You may need to keep him on it for a while as his bowel will have been stretched and can take up to a year to return to normal.

Chronic constipation and imapction can affect the nerves in the lower bowel so it's hard to feel the need to poo. Look for 'the poo nurses' on YouTube, there is a fab video where two lovely nurses explain very well.

I've had 2 DC with this and GP was a bit useless. Agree with pp, the Eric website is fab and they have a helpline too. Also try the health visitor and see if you can get a children's continence referral. HV should also help with nursery, they should be making reasonable adjustments not excluding.

In the meantime do not stop the laxatives, if they are the powder sachets (laxido/cosmocol/movicol) you have to use them for weeks/months to clear out and prevent a recurrence.

Yes keep using the laxitives. IIRC there is a disimpaction regime on the ERIC website. I would check DS’ prescription against this and ask for it to be adjusted accordingly.

Can you take him out of this nursery because they sound very unprofessional and uncaring - asking to exclude him?! Would he be happy to wear pull ups until the situation is resolved?

The GP was uninterested - just said I needed to revisit potty training but I know my kid - and it's not about potty training. He 100% understands what he should be doing and wants to be using the loo - but he has no control. And he cries when I sit on the loo saying 'it will make my bottom hurt' and refusing to go - and then an hour later he is covered in poo in his clothes. It's heartbreaking.

I persuaded the GP to give me laxatives because i showed them advice on the NHS website about it. They gave me Movicol Paediatric sashets (6.9g) but no advice on how often - she just said 'see how it goes' - so I've been giving him one in the evening - it worked really well the first day - he went for a poo in the loo just before bed, but hasn't seem to have been effective since. Still seems all over the place

So you all suggest I keep using it - do I up the dose? One sachet a day sound about right or should I do 2 x sashets a day?

The poo is smelly, sticky, not rock solid but not healthy either. And certainly not liquid.

I'll keep him off tomorrow and take him back to GP. They said his tummy felt normal.

I refused to sign the thing nursery sent about exclusion and she said they under no stat duty to help other than supply loos and sinks - so i told her they were under the equality act and she hasn't written back. But I don't know if I'm on strong ground there - I've only got that from doing research online - she will know more than me!

I'll call Eric. Thankyou

Didn't the box of movicol come with instructions? If not, google paediatric movicol and the instructions below come up.

www.medicines.org.uk/emc/files/pil.52.pdf

Get the impaction regime from the Eric website and go back on the movicol. Recently had withholding issues with my 4 year old who got toilet anxiety following a bout of constipation and it’s helped her immensely. Your DS obviously has some worries about it hurting which is probably the root of the problem so the movicol will help address this by keeping everything soft.

The Movicol Mummies FB page is great for advice too.

Definitely follow the instructions for disimpaction and if he is withholding you may need to add a stimulant laxative such as Senna.

My 3 yo has 2 sachets of Movicol daily and she started withholding on toilet training her so we added 2.5ml of senna, increasing to 5ml over a few weeks and now a couple of months on we're reducing the senna back down very slowly with the aim of her weaning her off that but will keep on with the Movicol for the foreseeable.

Bless him OP some great advice here.

My DD has been on movicol since she was 2 (she's 11 now).

For years she was on one adult sachet a day (equivalent to 2 kids) and that was just to keep her regular, not to clear a backlog.

We are now down to half a sachet a day. We did recently try to warn her off as we thought as she was older her bowel might have matured. Sadly it hasn't and she ended up massively backed up and we had to use many many sachets a day to clear her.

Your GP has been absolutely useless. I'd get him taking at least 4+ sachets a day (keep him home) until he's cleared. You may need more.

The movicol mummies FB group is great.

Good luck OP it's horrible to go through.

FYI we've had our DD seen privately by a gastro pediatric consultant and they still don't know what causes her constipation 😬

I'm so confused about dosage. GP wasn't helpful. I was doing 1 sachet a day but I can see that's not enough. I've given him 2 sachets today and he's pooed himself really badly twice - all over his clothes and crying so much - it seems counter intuitive that I'm giving him laxatives and he keeps pooing himself with no control. I feel I should stop but I stopped for a couple of days last week and he didnt poo at all. I'm so confused because I presume it is constipation and certainly laxatives seems to be advice but the issue is no control....the poo is v smelly and thick but not proper poo. Sorry I know this is gross but you all clearly understand! Never had this problem with other kids and the nursery are so unsupportive. I work full time and really can't lose our childcare place. And I feel so bad for DS. My hands smell of poo permanently!! People going to start hiding from me on the commute!! Haha.

At this point I think you have to do whatever will reduce the stress surrounding this. It might mean going back to pull ups. Child in distress on a daily basis because of poo on them/their clothes will only be building issues around toileting.

By that I'm not saying that you didn't potty train fully but I know of a child at a very similar age who having been previously potty trained started withholding poo. It was absolutely awful for all concerned and she made herself really really uncomfortable. She would poo if they put a nappy on her so they did that to regain control of the situation even though it felt like a massive step backwards. Once the stress was taken away they were able to get back to always using the toilet.

I'd also look at whether he's finding nursery stressful for other reasons. When my DD went backwards with potty training I took a closer look at what was going on at nursery and realised that environment was overwhelming for her. A different quieter nursery with older staff made all the difference.

I'd also check that he's comfortable using the toilets at nursery. Maybe there's something about them that's off-putting.

Hi OP, it takes a couple of days for a change in dose to take effect so if your DS pooped himself really badly today that's much too soon to be because you went from one sachet to two.
From my experience do at least 3 days at each dose before changing it. You can do half sachets (especially when decreasing). The poo nurses' video on YouTube will help with dosing.

Agree with pp back to pullups or fabric training pants might be helpful especially with regards to being able to stay in nursery. Scheduled toilet sits to try for a poo after breakfast, lunch and dinner are also helpful.

How long has it been like this? Sounds like he has a severe impaction and this is faecal leakage around it.

Tbh I'd be tempted to take him to paediatric a&e and talk to them about the psychological impact too

id be tempted to take him into a and e - get a referral with a specialist if your GP has been no help clearly

poor poor boy, thats so upsetting to read

FB group Movicol Mummies will be your best friend in this situation. Full of parents going or having been through this. Lots of great advice and suggestions for getting on top of it there.

It really does sound like overflow around a blockage rather than a case of too much laxative. Did the GP even examine him? Have a look at ERIC page and the NICE guidelines, children should have a physical examination before laxatives are prescribed. If the GP didn't physically check his stomach for a blockage he needs seeing ASAP as the treatment will be different than for acute constipation.

@soberfabulous thank you and I'm so sorry for what your DD has experienced.

Do you suggest building up to 4 sashets a day or can I go straight in with that? I could do 2 for the next couple of days, then three for a few days, then 4. Do I keep going until it's liquid?

He hasn't been eating properly either the last couple of weeks.

I'm taking him back to the GP in the morning. Hopefully I'll get someone else as I was reading the nhs website to her. She just kept talking about potty training. They felt his tummy for a few secs @EdithGrantham

He's so confused when he finds poo on himself and he keeps saying "sorry mummy. I'm so sorry". It's so heart breaking poor lad

I definitely think fear of nursery triggered the whole thing as it started as soon as he joined in Sep. But now it's far beyond that

The pre school won't let him be in nappies. It's their rule they won't change nappies. So I'd need to keep him off and not go to work.

I've requested to join the FB group

Mine was definitely on more than 2 packets a day when he started witholding and became constipated. Once it 'cleared it' as it were we gradually reduced dose and now he's not on it. He needed to get over the hurting/constipated bit and know a poo was not painful

*CoveredinCrap *if it's possible i would get as many into him as you can. bear in mind it may take a day or two for the full blockage to come out. at first you may thing he's poo-0ing himself but it's overflow seeping out as the blockage is broken down. by day 3 i would expect huge amounts of poo to come out - keep going don't stop until it's liquid/he feels better.

She would cry the first couple of times when the first hard bit came out - it kills me every time.

I think my DD' record was 12 poos in a day - we are talking huge explosive giant piles of crap!!!! and yes my DD also didn't want to eat when she was was blocked - they are totally full poor kids no wonder their bodies don't want any more food going inside them.

the good news is once you have cleared this blockage he will feel amazing and you can switch to a maintenance dose only. like i said my DD was on one adult sachet for years, we're now down to half and she poos easily with no problems. i do have to keep an eye on her though and any signs of not having been for even a day, i up the dose back to one sachet.

It's horrible but keep at it and soon he will be feeling better. Can you WFH and stay with him for a few days? the unblocking is best done at home near your own toilet!