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.

Please change his nursery, they sound horrible.

I'd change his nursery and put him back in pull-ups if at all possible. They don't sound great.

Firstly the leakage is caused by chronic constipation. When a mass is still inside you get leakage around the side. Also as the mass of poo stays in the colon it stretches it so he gets less sensation of needing to go so also gets leakage.
First you need to get laxative into him to remove the mass and to get him going more regular again. We just used loctalose with dd2 but you can get stronger ones from the gp.
Next you need to remove the anxiety about going to the loo so they stop holding. Often holding poo starts with constipation. It might have hurt them to go so they start to hold it. We used the nhs app "poo goes to poo land" its free and dd2 thought it was hilarious. We also bought a book from Amazon that she like called cone out me poo.
It took time, she'd do a poo and then then maybe hold for a wee or so again and then do another one but all of a sudden she stopped and she realised that it feels better to just go. He'll get there. Just keep talking to him about it. When he does a poo ask him if it feels better in his tummy to let it out etc so he starts to realise it's better to go then hold in. Also use the hello nappy rash cream if the leakage starts to cause a sore bum. That will cause them to hold more as they're bum is literally sore good luck

Some great advice from posters, something else which helps is bubbles, you can not withhold and blow out. So when on the toilet and you suspect a poo is likely, get DC to blow some bubbles with bubble mixture.

Your Gp is terrible tbh. As is the nursery (former nursery nurse)

You’ve had great advice here and i would absolutely continue with movicol regime for disimpaction. It may take a while and it won’t be pretty but he will feel so much better.

After the treatment i love the advice of the apps/books etc and you may need to revisit toilet training a little as it’s been going on a while and he is obviously upset by it all and he is still only young.

If he says his bottom hurts when he was impacted and constipated he may have developed a fissure.

This will now make him fearful of going, so holds and the cycle starts all over again.

Agree that movicol/ laxido routine is needed for a long period.

It holds watt in the bowel making the stool softer and helps decrease the size of a previously stretched bowel.

At one point OP my ds was on 10 sachets a day for months.

Not judging the the problem will not resolve if you keep starting and stopping and the GP should have explained this to you.

Follow a disempaction routine and then maintenance dose.

Your gp sounds dreadful. Ours explained the movicol dosage to us and all about the stretched bowel. We did something like 1.5 sachets a day for a week or 2 and then down to 1 a day for another week or two then one every other day for a week and then half for quite a while after that.

My 5 year old has unfortunately been using Movicol since they were 1. Even as a baby they always had a tough time passing solids. Despite their intake of fruit, vegetables and other healthy (fibrous) foods increasing dramatically, it made no difference. There was a brief 6 months recently where we thought we had cracked it by giving them kids probiotic gummies every morning but then we had a couple of week long episodes like you described with constipation and constant soiling (15 times in one day was the worst) we begrudgingly went back on the Movicol. 1 sachet a day to clear the constipation and then half a sachet mixed with some oat milk before bed. They still have the gummies with breakfast. We had left to them to go to the toilet when they felt the urge, but realised that they are lazy/ignoring the feeling until it's too late. Even when on the Movicol they would only ever "go" twice a week at most, this was their normal. Now it's back under control we make them sit on the toilet at the same time everyday and it happens either every day or every other day without fail. They now have probiotic gummies every morning and half a maintenance dose of Movicol every other evening to keep thing ticking along. It's very frustrating and upsetting, hard not to get angry with them, incredulous that they didn't know they were soiling themselves at the time to feeling so sad for them. It's a horrible experience, and I truly don't know why as their sibling is regular as clockwork with no help. It would be nice to be able to ditch the Movicol altogether, hopefully that time will come.

My nearly 4 year old has been in a very similar position, and in the last few weeks we seem to have resolved it. Here's a breakdown of our history:

• constipation and impaction about a year ago resulted in a disimpaction regime using movicol
• the movicol resulted in him having multiple accidents a day, for MONTHS. He was afraid of going to the toilet and it hurting so would withhold until the last possible moment.

-the withholding resulted in poo leakage and a HUGE poo every three days that was very traumatic for him to pass. -we stopped using the laxatives as it was resulting in too much leakage. -after stopping with laxatives, the leakage stopped, but he would still do a huge painful poo every three days. His bowel had stretched so he could store a lot before the overwhelming urge to go took hold

• we increased the amount he drank, stopped giving him Weetabix, and increased the amount of fruit he ate (1 piece at every meal and snack time). We also reduced dairy.
• after we did that we've had 1 poo each day, with no trauma. He's taken himself off to the potty and called out to me that he's gone, which was unheard of a few weeks ago where we would have had 20 minutes of screaming before passing a stool.

In summary, laxatives are useful, but maybe have a look at diet as well. Or, he may just grow out of it all of a sudden.
Our nursery were great by the way, happily supporting him with sometimes up to 10 accidents a day. They took him to the toilet every 15 minutes, had a sticker chart and rewards when it went well and knew he couldn't help the withholding and they were happy to change his pants. They said no to going back to pull ups as they didn't want him to regress further. They couldn't have been nicer about it all.
It's so frustrating and upsetting for everyone involved, really feel for you. X

Go to your local urgent care centre and they'll put you in touch with a pediatrician. Your GP sounds terrible

Google ERIC and call their help line.

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'm really not sure that rule is legal tbh. It's a medical condition that they ought to be able to make reasonable adjustment for. Can you get the health visitor involved?

That said, if you go for full disimpaction (up to 8 sachets a day for under 5's from memory) he's going to want to be at home for that. My eldest was 4 and we did it over half term. Not pretty but it did the trick.

@CoveredinCrap lots of people have offered great advice. And your GP is not great. Ask to see another GP.

Also, your nursery needs a stern talking too. Stool witholding is a recognised medical condition.

ERIC is brilliant and there is a book you can get which helped us enormously.

https://amzn.eu/d/6eVIaEO

It is more common than you think. Long term Movicol helped us get over the crisis of confidence.

Good luck. It does get better.

Also forgot to mention we cut out all dairy: turns out DD is lactose intolerant tolerant. This helped a lot. And get him onto a good kids probiotic.

To be pedantic: movicol is not a laxative. It's a stool softener, works by drawing water out of the intestines. Make sure he is drinking lots of water.

As others have said you need to clear the blockage.

If I remember rightly (I think it's on the instruction leaflet) you give:
4 on day 1
6 on day 2
8 on day 3
10 on day 4 and continue giving 10 until it's pouring out like water. (might have even gone up to 12)

That will totally clear him. You will need to keep him at home over that time.

Reassure him that the medicine is making it like that, and not him.

Once he is cleared you want to be on 2 a day, we gave 1 morning 1 evening.. for probably about 2 years at least. Then you slowly (very slowly) reduce. We spent at least 6 months on 2 one day 1 the next before going to 1 a day. Even then you keep an eye and be ready to increase, albeit temporarily, if needed.

Oh yeah dairy defo bungs up dd2 we've noticed that the less she has the less she struggles to go the toilet. Something to consider op

Just a word of caution as OP's son is only 3 - we were told not to go above 8 sachets in a day for a child under 5.

Thanks. Dd2 was 4 but 15+ years ago so advice may have changed.

thank you so much for all the advice. I do lover MN for how supportive ppl are and taking the time to give me their wisdom! went to GP again who said he doesn't think DS has 'impaction' as his tummy is soft and also DS not weeing himself at night. He said do 1 - 2 sashets a day max for constipation but that should be in at 3 years old. So I'm more confused than ever really. DS still totally confused - said to me tonight "i don't know why it keeps happening mummy". DH saying "it's because you're giving him fuckign laxatives". I feel like I don't know if i'm making things better or worse but i continue to be covered in crap every day!

My DD never had impaction that you could feel. If you can get the book or speak to ERIC then that would be better than your GP for advice on managing this while you trial the Movicol.

Movicol softens the stool, it is not a laxative. It works best if given consistently and over a period of time, so don't be tempted to stop start it, put the dose up or down to try and control the amount of mess.

If you haven't been consistent with the dosage so far, and are still struggling with explosions I would be tempted to stick with 1 sachet a day (night time) for a week and see if it improves. If not, then up to 2 for a week. If no improvement then, go back to your GP to discuss.

Laxatives you can increase/decrease at will. But they tend not to prescribed these for children as it can be explosive and distressing for the child. Movicol is very different.

The GP is talking rubbish as they often do about constipation. It’s impossible to feel for definite if they have impacted poo in their bowel as it can hide in their pelvis. Ring ERIC for advice on their helpline. Post on the Facebook group as well. I’ll explain more later when I have more time. I’ve been dealing with this for 8 years. I have seen leading Gastro experts for children in the UK privately. The only way to know if he’s impacted for sure is. Y xray that they don’t like doing. My advice would be disimpact. It could take a few weeks. He probably needs senna as well so he can recognise when to go, but he’ll need high doses of Movicol or Laxido to disimpact first.

Impaction takes a while to clear, we had to go up to 12 sachets, not pleasant but it basically has to be running out of him, when we do a clear out he has time off school.

Also ring your health visitor. This is a medical condition and if it’s been happening more than 3 months it could be classed as a disability in law. So nursery can’t exclude him!

I honestly thing the gp is wrong. When was the last time he did an actual poo? If it's been over a few days it's all in there still. Honestly you need to clear it as he'll continue to get leakage around the edge and he will continue to soil himself 😊