Toddler poo withholding is going to give me a breakdown

[AintOverUntilTheCatLadySings]

My 2.5 year old has always hated pooing. We decided to potty train her a few weeks ago because she was refusing a nappy and wanted to wee and poo on the floor.

She picked it up pretty quickly but has now decided that she won't poo at all. Which is causing her pain. She'll hold it in to the point that she's constantly soiling herself with tiny fragments and smears of poo.

Her poor bum is really sore from the constant dirtiness and wiping.

We've taken her to the doctor to rules out any physical problems and have been prescribed lactulose for her twice a day.

The constant crying and soiling is pushing me to the brink of a breakdown. Although I'm outwardly calm and positive.

I've tried books about poo, reward charts, letting her watch me poo, talking about poo, the Pooland app, high fibre foods etc.

She tells me her tummy hurts constantly (because she always needs to poo but is holding it in) and it's dominating our every waking hour.

I'm having to combine childcare with a full time job and am 4 weeks pregnant after 4mcs so just really need her to help me out here and poo literally anywhere. Potty, nappy even floor would be better.

She's back in nappies right now because she's asked for them.

Lactulose is so mild it’s actually pretty useless for bad constipation. What dose are you giving her? It’s probably not enough.

My advice as a veteran of bowel issues in kids is get yourself a prescription for paediatric Movicol (or buy it yourself OTC until you can get a prescription). It’s far, FAR more effective than blooming Lactulose. It’s a stool softener and totally safe for very long term use. Tastes a little gross so highly recommend mixing in juice or squash and not plain water.

What you need to do is a) make the stool so soft they can’t physically hold it in and b) break the long term association of pooing and pain. You’ll have to keep this up for months rather than weeks to win this battle. Start with a large dose (look up the disimpaction regime in the link I’ve given below) then gradually reduce until she’s pooing every day without a problem. Getting the dose right is trial and error but even if you give them too much, it’s not a big deal. People worry about giving kids too much, but the worst that can happen is liquid poo, which is usually a relief for everyone after weeks of withholding!

This website is really good and worth a read - www.thepoonurses.uk/

I see goldie04 agrees with me that Lactulose is rubbish. Laxido, Movicol and Cosmocol are all the same thing - just make sure you get the paediatric version.

We went through this too (also have an extremely wilful daughter). I agree with everyone else saying get movicol. My DD is 5 and still on a small dose of it. We went on holiday to France when she was 2.5 and in the middle of this and she did not poo for the entire 2.5 weeks. It was so stressful. But movicol did the trick.

Oh yes - definitely make sure you get the paediatric version - we were initially prescribed the adult version which was traumatic for all concerned (though did unblock her quite effectively!) I also recommend the ERIC helpline, they are very reassuring.

The adult version is basically double the dose of active ingredient, so you can give it to kids but half a sachet of adult is equivalent to one sachet of paediatric 😄

Everything Playitagain says apart from change Movicil to Laxido. GPs now give Laxido as it’s the same active ingredient as Movicol but it’s cheaper.

One of mine is like this. He was prescribed cosmacol as lactulose didn't work very well. Cleared him right out and then we start it all again. He's currently back in pull ups as the pooing in pants was driving me mad.

Yes, I've had to give DS2 a half dose of the adult version (available OTC) when his prescription wasn't ready and we'd run out. It is exactly the same, just a double dose in each sachet.

It works very effectively - a bit too effectively for DS until we got the dose right! If you do use it, I'd make sure you stay at home the next day just in case. It helped us break the cycle and stopped DS soiling constantly due to liquid poo leaking around his blockage. We had the same with DS1 during potty training, but lactulose was enough to sort it for him.

I agree with everyone else that Movicol is better than Lactulose, and as said above the adult version can be bought in chemists and is just double the dose of the child version. It needs to be mixed with plain water to make sure it dissolves properly, then you can add cordial or juice once it’s all dissolved.

My local chemist wouldn’t sell me adult Movicol as I’d told them it was for my child.

I suspect no chemist would sell it to someone who said they were giving it to a child, they’d be breaking the guidelines, like they won’t sell most things to a pregnant women apart from paracetamol. I would just say it was for me if they ask you. Or get a phone app with the GP OP I’m sure they’ll prescribe it if you say the lactulose hasn’t worked.

We have a similar issue with my 3 year old (although not quite as severe). She isn't scared of doing a poo, its like she just doesn't want to stop what she is doing, so holds it in! We have exactly the same issues with smears and tiny bits needing constant wiping, sometimes 15 times in a day. She will have 3 or so days of this, then do a massive poo (which she doesn't complain about, its just like she can't physically hold it any longer).

Part of the issue for her is fluid intake I have realised - she eats plenty of fibre, but have always struggled to get her to drink enough water. Have started giving her a couple of innocent smoothies a day, which she loves & it really helps increase her fluid. This seems to have helped (for now) and she is going more regularly.

Good luck, hope things settle down soon.

We've had a poo!! Managed to get a doctor to prescribe Movicol, mixed it up - and she did the biggest poo of her life just before I handed it to her.

You guys told me it was good, but I didn't know it would be that good!

A pear a day and keep putting the dr ranj get well soon constipation episode on (on youtube). Also download the poo goes to pooland app.

Pears are my Irish granny's constipation remedy. It works!

That’s brilliant news OP! I once had to get a prescription for Glycerin Suppositories for my toddler and sent his Dad to the next town to collect them as no one had them in stock locally. He then did a poo minutes after his Dad set off, with lots of tears poor kid.
I would agree with a PP that it would make sense to give her the Movicol for a few months at least, until she’s doing a soft poo easily each day, then very slowly wean her off it, to make sure she doesn’t end up struggling again. It’s not a stimulant laxative, it’s just a stool softener, so the bowel doesn’t come to rely on it or anything.
I hope this is the start of things settling down for you.

We had this issue with dd and it took 2 years to completely sort it.

She would hold it in until she was impacted and getting diarrhoea-like overflow etc. Then eventually she’d go (in a pull up or in the bath) and it was enormous and painful.

Lactulose was useless. Laxido did the trick, she wasn’t physically able to hold it in. But we had a lot of accidents and when she started school I had to collect her a few times as she’d soiled. It was either pull up, bath or accident - she absolutely wouldn’t go on the loo.

Suddenly she just started recognising the feeling of needing to go and stopped attempting to hold it in. She also suddenly started using the loo and hasn’t had an accident for weeks now.

She’s nearly 5 and was toilet trained for wee at 2.5 but has only been fine regarding poo for a few weeks now.

Those of you who were prescribed Movicol:?what dose were you given?

The doctor didn't tell us - by the pharmacist said one a day (I'd expected dose to be written on the prescription). But judging by the amount of packets we were prescribed it seems like the doctor was thinking more?

One probably isn’t enough right now. I’d start with two and see how it goes. You want the stool to be kind of... mushy. So she can’t withhold it. It really is trial and error to start with. So try two sachets per day and if she isn’t having a bowel movement daily then increase to 2.5 or 3. Then once you’re in a routine of a bowel movement daily and you think you can try gradually decreasing, then gradually decrease by, say, half a sachet each time. You’ll get an idea of what dose works as a daily maintenance dose eventually.

Yes agreed with Haworthia. When we were first prescribed it, we only gave one a day but it did nothing at all. Then we found a specialist who said give as much as it takes to get her going once a day comfortably. That would be about 3 a day for a while, sometimes more! As a 7 year old she’s still on 2 a day, and in the past when we’ve tried to scale it back it’s caused problems again. There is something on the instructions though I think for if they’re impacted, then it’s a load at the start to flush it all out.

The disimpaction regime @playitagainsam? Joy It’s mentioned at the website I linked above too, I do recommend reading it.

Thank you everyone. We've been following the guidelines on ERIC/NICE for clearing her bum out. We had a giant poo last night and two huge squidgy poos today.

Am finally seeing light at the end of the tunnel. Yesterday I was really upset and couldn't see a way out of this.

We've also been doing the pooland app and have the everyone poos book.

Talking about it seems to have taken away her fear of pooing and she actively seems to want to now.

Hopefully we got this quickly so it'll take months rather than years to rectify

I work closely with the continence team in my local area who say that when clearing an impaction keep up with a high dose of movical for a week or until they are pooing water. You can then start reducing the movical using the Bristol stool chart to find the right consistency and then stick with that dosage of movical.

Brilliant! Agree with @Bubblysqueak, keep up with it. Keep going until you know for sure the gut is completely clear. And don’t be tempted to reduce the dose too much or too soon because you might find yourself back at square one.

People are really wary of giving kids medication for constipation for some reason. They’ll talk about food remedies and water and fibre because somehow people think that “laxatives” are damaging? Just bear in mind that Movicol is not a stimulant laxative and won’t make the gut “lazy”. We used to get all sorts of grief from the in laws about DD being on Movicol long term. Personally, I’d rather give meds indefinitely than have her suffer the effects of constipation, which is so miserable and impacts upon every aspect of normal life.

We've reached watery poo level!

It probably helped that she loves fruit, veg and lentils.

We'll keep up the Movicol until she's happy with pooing again.

Thank you everyone for your help and advice- without you telling me what to ask for this would have dragged on for weeks I imagine

That's great news. Definitely keep up with the movical and use the Bristol stool chart to help with dosage.