Withholding - alternatives to lactulose?

[WigWamBam]

Dd will be 6 next month, and withholds her poos. We recently saw a paediatrician for a completely unrelated problem, which she thinks is being compounded by the poo withholding. So she has asked us to dose dd up with lactulose. We've been giving it for about six weeks now, and it doesn't make a blind bit of difference - she still hangs onto her poo. With 15ml of lactulose her poo is loose almost to the point of runniness and she complains of stomach pains (but still hangs onto it - heaven knows how), with 10ml she's back to pooing every four days.

If anything giving her the lactulose seems to have made her even more determined not to poo than she was before, but the paed was insistent that we need to get her pooing regularly, and that we need to stop the withholding.

Dd has a good diet with plenty of fruit and vegetables so I'm not sure there's anything I can do diet-wise to help. She's always had issues with pooing, which I've always been very laid-back about treating, but the paed made such a fuss about it that dd has picked up on it and as I say, it's made things worse. The paed won't look any further into the other problem until we sort out the pooing.

Does anyone have any suggestions? Alternatives to lactulose, anything I can introduce into her diet so that she won't realise she's taking it?

Watching this with interest WWB, ds hangs on too - despite fruit & veg a-plenty.

Have you tried dried apricots? Or other dried fruits like dates or mango?

We've tried dried fruits, with no joy. Pineapple or kiwi always used to get her going, but they don't do the trick anymore.

It's so frustrating, isn't it!

Anyone? I know it's not the most scintillating of topics but I would really value some input.

My ds was given lactulose and hardly made a difference, but give him Califig and he's a go-er the next day! It has a very strong taste but mixed with juice it normally goes down ok. HTH x

She has Califig if it gets too bad but as it's a laxative rather than a stool softener, I'm not too keen on relying on it to get her going regularly. Thanks anyway, though!

Calfig works with my nephew.

oops x posts

If there is no evidence of a physical problem then the paed. should have offered you access to some psychological support and advice - the holding on is more likely to be a control issue due to some kind of psychological cause. Laxatives are only one part of the treatment, and it sounds as though you haven't been offered enough investigation and information. When did this start? Is it connected to an incident of severe constipation and a painful experience and/or injury such as anal fissure?

Oh, it's almost definitely a control issue, 3littlefrogs!

We had no problems until she stopped wearing nappies during the day just before she was 3. She had a real fear of pooing in the toilet; she would scream the place down if we even suggested it, and after a while we decided to be very relaxed about it and offer her a nappy for a poo. She started going once a day, always at the same time, and always in the same place (about as far away from the toilet as she could get). Nothing else worked; she wouldn't stand in the toilet for a poo, she wouldn't be bribed, she didn't respond to anything other than having a nappy.

She did this for about 15 months, until she was just turned 4, and a bout of diarrhorea got her using the toilet for a poo. She seemed to realise that there was nothing to be scared of, and started taking herself to the toilet whenever she needed to.

And then she started school. Which set us back hugely. She wouldn't (still won't) use the toilets at school for a poo, and stopped going at home as well. She's now been withholding poo for a year or so, we can generally get her to go by giving her Califig when she gets constipated - but of course hanging onto it means that it's hard to pass, it hurts her ... and so she doesn't want to go to the toilet again.

She is seeing the paediatrician for repeated bouts of what seemed like water infections and vaginitis, but the paed seems to think that it could be compounded by the pooing issues. To begin with she didn't fully accept that dd is hanging on (but she is - it's really obvious that she is) and thinks that it may be that she's become desensitised to the feelings of needing to go because of the soreness around her vulva. She reluctantly agreed to go with the idea that dd is withholding, but won't treat the other problems until we have managed to get dd pooing regularly and without pain.

Hence the lactulose ... and hence dd digging her heels in even more now than she was before.

.

Has anyone talkd to you about movicol, WWB?
DD1 was prescribed this for constipation (resulting from withholding) which had been a problem for about a year at the time of prescription. Its a powder which is dissolved in liquid and it is designed so that you keep doubling the dose until you get desired effect
i.e. day 1 - 1 sachet.
no result - day 2 -2 sachets
no result - day 3 - 4 sachets.. and so on - our paed said 16 sachets are often needed though 4 was the max we had to use.

It is a laxative but also softens and you use it daily overa long period of time to get them used to goin frequently and tone up the enlarged/lazy bowel again. Dd1 was on it daily for about 9 mo, then dropped to every other day for a few months, then used it as a troubleshooter when needed. In the last 5 months she has prob had 2 sachets at most.

I highly recommend it. Have a word with your GP about it.

You've probably tried prune juice too?

Hope you get somewhere with this, miserable isn't it?

No, we haven't come across Movicol. Is it prescription only, do you know, or can I buy it over the counter rather than dragging dd off to the GP?

Yep, we've tried prune juice, Tatties. She'll happily eat prunes as well, but she's just so adept at withholding that very little seems to work. And yes, it's miserable - not much fun for the child, either.

Our 3.5 year old has done the same.
We found drugs didn't help for the same reasons.
What really made a difference was awarding poo prizes. For a couple of months we gave one for every poo (at a cost of around £1 a go) ranging from cars, to felt tips, to a drawing pad, a lollipop etc. (Probably cost us about £40 in all.) Only give prizes now if he gets particularly distressed, but most of the time he seems unaware of it now (still in nappies).
Would this work for your dd?

Yes Movicol is prescription only.

We haven't tried bribery for quite a while, Helly - but it didn't work when we did try it.

She once had a big jar of chocolate lollipops that went completely untouched (actually went out of date) because she wanted to avoid the toilet more than she wanted the chocolate ... and she's a complete chocolate freak.

It might be worth a try now, it's been a couple of years since we last tried, but she's a stubborn little madam!

Ah, that's a shame ... thanks anyway, sassy.

I just thought that if I could get some without her seeing the GP, she wouldn't necessarily need to know what they were for ... a little subterfuge!

Aah, gotcha. Nope, she'll have to see GP I'm afraid.
Keep it in mind though, it really is fab if you keep the regime up.

Thanks - I'll definitely bear it in mind. Am thinking we probably need to see the GP about it if I can't get it sorted any other way.

It sounds as if it has got to the stage of dominating your lives and that must be incredibly stressful for everyone. However, I would have thought that at the age of 6, she could benefit from the input of a clinical psychologist, and I agree with the other things that have been suggested too - motivation and rewards and movicol. How does she feel about it all? Does she want to solve the problem? In one way - even if it is miserable and uncomfortable it must be a huge sense of power to control everybody's lives - but pretty scary too.

I just feel you are not getting the advice and support you need. I am trying to think of the correct scientific term for this - is it encopresis?? My brain isn't working tonight - but I know there is a parents support group and everything for this problem and that might be a good source of help for you.

I googled encopresis and got links to various support groups etc. Encopresis actually means faecal soiling, but the soiling is caused by the withholding of poos.
It is an advanced stage of the same problem, so a lot of the advice and experiences on the parents' forum could be helpful for you.

I'm not sure she has encopresis, frogs. We don't get any leakage or soiling around a blockage and she doesn't have pooing accidents. She's not really constipated in the normal sense of the word either - we can tell that she needs to go to the toilet, and if she listened to her body she'd be going every day, but she just will not go when she needs to. I'll have a look at the encopresis sites, but I'm not sure that's the whole problem.

How does she feel about it ... she doesn't care unless she's being asked to go to the toilet. She would be quite happy never to go for a poo again! It upsets her when we ask her to try for a poo - sometimes we can see she's almost cross-legged trying to hold it in, farting away and turning puce ... but if we tell her that she ought to try for a poo, she gets upset. You'd think we'd asked her to chop her own arm off rather than sit on the toilet.

We try to be laid-back about it all, but it's hard to get the right balance. If we ignore it, the problem gets worse. If we insist on her going to the toilet she kicks up such a fuss that it makes it hard for all of us. We've tried talking to her gently (when she doesn't need to go so is relaxed) about listening to her body, and how not pooing when you need to can hurt your tummy and make you feel poorly and she seems to take it in, but when the time comes to act upon it, she won't.

I'm sure that there's an element of control about it - as you say, it must be an immense power trip to realise that you can use such a simple thing as a method of control. Which is one of the reasons we wanted to be more laid-back about handling it than the paed is expecting us to be. It wasn't causing huge problems until the paed made a big thing of it.

I'd ignore it if I could, but we need the paed to do scans and tests to sort out the other problem - and she won't do them until we sort out the pooing.

She tried to demand that we got dd dry at night too before she'd look at it, but I put my foot down on that one because that's something she really doesn't have any control over and I'm not forcing that.

I'm starting to think that the biggest problem of all is the paed ...

Oh god I can sympathise. My ds2 broke his leg just before he was 3 and he found it very difficult to get comfortable to do a poo becasue the whole leg cast. Our problems began. He was on lactulose and after a few weeks he was pooing because he couldn't hold it in - he tried to though. He is nearly 7 now and still hangs on. Like your dd he is farting away, legs crossed, pulling the most peculiar face with the effort of hanging on!
He is a lot better and will rush to the loo when I tell him to. We don't do lactulose anymore.
Sorry i have no suggestions as we tried most things, but as you say didn't want to get reliant on something to make him poo.
My nephew who is 13 still has problems. He sopends a day once every 10 days going backwards and forwards to the loo all day. Just to make you feeel better!!

13??

Oh no ... I really hope this will be sorted out way before she's 13!

Dh was concerned about using the lactulose at all, because his reasioning is that if it makes the poo so soft that they can't hold it in, then they probably lose the urge to go and so stop recognising the signs that tell them they need to use the toilet.

I feel we're caught between a rock and a hard place. If we try to help her, it stresses her out and makes her dig her heels in even more. If we don't try to help her, it just gets worse and worse.

What I meant was that some of the strategies and advice might be helpful for you. But you do know your own child best and I don't want to advocate anything you are not comfortable with.