10 year old won't use toilet

[Katiemonkey15]

We are at our wits end now with 10yo dd who has fairly frequent accidents in her pants because she just won't go to the loo.

She eats a good diet, no food allergies (we tested), no learning or behavioural issues and nobody else in the family has any issues. We have a 3yo who just toilet trained like a dream yet were dealing with this with a 10yo. I do try not to get too cross or overly embarrass her about it but it's really tough because she will literally sit on the sofa and poo her pants rather than take herself to the loo. Sometimes her sister will tell me that she's doing it cos she can tell by her body language (and the smell and somwtkmes noise) but dd herself just sits there and shows no urgency to get herself to the loo. Unless I frog march her and make her sit she won't go to the loo at all.

Have tried incentives, punishments and nothing seems to work. GP thought she might be constipated so we tried laxative drink sachets for a while but only made it worse as gave her diarrhea.

Anyone any advice on how to basically re-toilet train a ten year old?

Maybe you can offer the OP some expert advice?

TBH the chances of seeing a professional like you is remote. In your opinion how long will she have to wait?

I've asked another poster twice what tests her child had to prove there was no physical issue and she's not replied.

I am not saying 100% there is no physical issue.

But as a professional with training in psychology, my money's on behavioural and family dynamics.

I did a very lengthy advice post yesterday.

@nocoolnamesleft
And very helpful it was too, thank you.

I know it might vary from area to area but roughly how long do you think it'll take to get our private appointment? GP seemed confident it'd only be a few weeks? Really hoping to get to see them in time to sort or at least help things before summer holidays

Has anyone used califig syrup? GP still thinks she is probably constipated (tummy a bit tender and gassy but she says no pain) so he's recommended califig syrup as the movicol was obviously too much for her tummy. He had a good long chat with d (around twenty minutes) and was very nice but wasn't letting her away with evading any questions. Can't say we made massive inroads as she's still saying she doesn't know why this is happening (she was quite embarrassed to talk about it too tbh) but I think it was productive to discuss it all with him all the same. He's made both referrals for us (thinks we might get to see a paediatric gastrointerologist within two to three weeks but wait time, even privately, for child psychologist in our area can be quite long but fingers crossed).

Yes I use 1 tea spoon of califig mixed with her yoghurt. She can't have movicol because it gives her diarrhoea, califig is perfect for her now.

Sorry, I really don't know for private appointments, as everyone in my department only does NHS work. For NHS appointments, once you know where you're going to be seen, if you ring up and say you'll take a late cancellation, that can really cut the wait.

@Beautiful3
Movicol did the same to my dd

@nocoolnamesleft
OK thanks. No harm in making a call to secretary of this chap and saying we'll take a late cancellation too I suppose. We're only down the road so could be there within the hour!

It worked! Thanks @nocoolnamesleft. Got a call back just now to ask if we could make Thursday morning!

Excellent news!

Is she taking the Califig?

@LittleBearPad
Yes we started the califig syrup today. Didn't want to give it to her in the morning in case it upset her tummy at school.

Brilliant. I really hope the appointment is productive.

Thank you @nocoolnamesleft . Me too!

I was told it'll take about an hour and that d can eat, drink and take medication etc totally as normal beforehand. Does that sound right to those of you who've experience of these appointments?

Just to add here OP, and I can see a paediatrician has already commented on this.

I am a clinical psychologist and I work in the nhs in a child development team, I also work privately, I am very familiar with families who experience these problems.

Services vary wildly depending on your location. If your GP refers you to the NhS for psychological support you will be seen within 28 days for an initial assessment (meeting) with a qualified member of the team. This is a legal process for all CAMHS services. If this doesn’t happen it’ll be roughly around that timeframe. During that appt you will have a risk assessment and the team will think about where you go next (on a waiting list for instance). During the initial assessment if there is genuine concern around any sort of possible significant trauma you would be allocated immediately.

We really would need to rule out a physical cause first. You can formulate all the psychological difficulties in the world but honestly, unless you’ve had the medical investigations there’s no proof that it isn’t physical or that a physical cause is leading to a psychological response.

Another point to add here is that as Psychologists we would seek to formulate what might be happening with you and your daughter and we may be more skilled than most at getting that information but that doesn’t mean that we would ever definitely be able to say why it is happening. Generally we see parents and children as experts in themselves and they usually have a pretty good sense of what is going on.

I also just wanted to add something on this post. I think it’s great that the poster has highlighted the importance of enquiring with a suitably qualified professional. With Psychologists you would be looking for a Clinical / Counselling/ Educational psychologist who is registered with HCPC. HCPC is the professional body for practitioner psychologists to register with, not BPS. The BPS is more of a club providing guidelines and resources, but you can register with the BPS with an undergrad degree only and no further training. Similarly the BABCP provides professional registration details of suitably qualified CBT therapists/ other psychological professions, although not practitioner psychologists. Anybody can call themselves a Psychologist but only genuine qualified psychologists are HCPC registered (we are also Dr’s, which helps to weedle out the fake Psychologists a bit when searching for someone). A Psychotherapist specialising in child development may well be cheaper and I’m sure would be helpful.

hope you find the support you’re looking for OP :)

@Psyc2366
Thank you so much, this is very helpful. GP made it sound like I could be waiting more than 28 days? Happy to go private to speed things up but apparently even private wait times in our area are lengthy? Would it be worth me googling and ringing around myself so long as I check they have HCPC registration or should I just potentially wait that bit longer for whoever GP has referred us to? Also would any child psychologist be able to help us or is there a specific type that would be best to deal with this particular problem? (D doesn't have educational needs or any history of emotional or behaviour issues or anything)

Sounds fine. It would be very unusual to do any investigations where eating and drinking, or taking normal meds, would make a difference on a first appointment. First instance is usually history/examination, maybe blood tests, rather than fancier stuff.

OK great thanks @nocoolnamesleft. I just had an experience myself where Id driven two hours for an appointment I'd waited ages for and hadn't been told but they wanted a fasting blood test and it was so frustrating. It's made me a bit paranoid!

@Katiemonkey15 in the meantime, if you have a footstool she can put her feet up on when she’s sitting on the loo, it also eases things along by moving the back passage into a more supported angle. (Gravity will help better this way.) You can also buy one of these…. There are plenty on Amazon under “toilet stool” too.

@Fraaahnces Thanks so much- still working on getting her to put her bum on the toilet before we focus on where her feet but if she does have constipation then will definitely give that a go. The simplest solutions are often the most effective!

Maybe the stool will help with her reluctance to sit on the seat...

@BirthdayRainbow yes maybe, anything is worth a try at this point and the stool does make sense as an aid if she is constipated.

She's had a bit of an upset this evening about going tomorrow. She's anxious as she's never been to a hospital before. She seems afraid she's going to be in trouble or something and she was worried they'll make her stay in the hospital. Have told her not only do i promise she won't have to stay overnight etc but we'll go the cinema in the afternoon just her and I as a little secret when we're done.

Hugs to you and dd for tomorrow @Katiemonkey15 . Hoping your appointment is productive and you get some kind of answers or guidance and also that you both enjoy your cinema trip!

@Katiemonkey15 Really hope hospital trip goes well and cinema is fun.

Thanks so much to everyone who gave me a heads up because constipation is definitely dds issue. Dr thinks the root of the loo avoidance is a small fissure in her bottom he spotted straight away which he thinks was caused by doing hard poos because she was very badly constipated (he said she had a 'rock' of hard poo about the size of a grapefruit in there). Just like some people said, she was in a withholding, constipation, pain cycle and she was too blocked up to feel the urge sensation hence the accidents in her pants. So glad we got this seen to now because he said if it was left to get much bigger it could have really stretched her bowel out. I don't know how her tummy wasn't bloated out.

They gave her two diffent types of enema, one to soften the 'rock' and one to flush it out, but she wasnt able to hold them, especially the first type, for anywhere near the time they wanted her to (the nurses said probably just because she was so blocked up it was hitting a wall at first) so took a few goes and a few tears but worth it because the amount they cleared out was unbelievable. She will have to to feel so much better already.

We are back on the movicol now unfortunately as even with all that they said shes not fully cleared out and dr thinks we will probably need to stay on it for months?! Was this the case for other people? I did explain to him about the awful time she had on it before but he said it probably wont be as bad this time because the enemas cleared a lot out today and that theres no way around it because it just has to come out. The only way to avoid her bowel stretching is keep her cleaned out (at least one poo a day) and the only way to heal the fissure is to keep things soft enough that the muscles don't have to strain. The worst thing we could do would be to come off it too soon as we'd end up back at square one.

Thanks again @Fraaahnces for the suggestion of the stool to lift up her knees when she's on the loo as Dr recommended this too. He also said we should be doing shorter but more frequent sits (no more than 15 minutes but 3-4 times a day) as the longer sits we have been doing before aren't good for her bum at the moment. Today was the first time she indicated any pain at all there (during the consultation part she denied she ever had any but when he was examining her she admitted it was sore- a 5 when she was just sitting but a 9 sometimes when she did a poo). Don't know why she couldn't have told me or GP about it two months ago and saved us all a lot of heartache!

She was sore and exhausted when we left and didn't fancy the cinema so we just came home and snuggled with Netflix and popcorn here. She's asleep now and won't wake her for a while as she didn't sleep well last night with anxiety about today, poor thing. I'm going to wait until Saturday to start the movicol so that she can go to school tomorrow and have a day of normality before the storm because I'll have to keep her off next week to do it properly. We have to go back for another appointment in two weeks so he can rule some problems out. She has assessments in school that week so hoping we'll only miss that one day but won't put off anything he recommends because already feel it's gone on too long and feel really guilty about that tbh.

Thanks again to all you other mums who gave me a heads up on this because even with your wisdom it was a bit of a shock and a tough day but glad its over and hopefully getting somewhere towards solving this for her.

So glad to hear that you have support. You will need to stay on movicol long term I imagine. For us it was years. I very gradually and watchfully decreased it.

Now I know what to look for. So when my younger daughter has symptoms I can treat immediately.