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?

Sounds like it was a productive visit @Katiemonkey15 Poor dd- anal fissure sounds nasty. Any idea why GP didn’t spot it before now? Well done you for getting to the bottom of this and onwards and upwards now you know what’s going on.

Oh my goodness @mynewnameis years!! Dd had a terrible time on it last time so really worried about putting her through that again for any length of time but trying to stay positive. Can I ask what the signs are you now know to look for? I feel like the worst mum ever that I didn't realise she was so badly constipated but she didn't have symptoms apart from the accidents and being a bit windy now and then.

Thanks @Kira4 . I feel like we're getting somewhere now anyway.

GP examined her tummy but never looked at her bum

Don't panic the maintenance dose was a small one. Enough to maintain one soft but fully formed poo daily.

The signs with my youngest I meant some small leakage in pants. Neither of my kids drink enough so both prone to it.

I'm so glad you've had some answers today, and that your DD has cleared out her bowel.

I don't think you'll need to use loads of movicol going forward. Just enough to keep things comfortable. You'll get used to the quantity needed.

@Katiemonkey15 Great news. Don’t worry I think all of the “constipation mums” on here have been in a similar place to you not realising what it was at first!

Sorry to tell you, we have also been on movical for years. 1 sachet every second day seems to keep us from having problems.

@TheShellBeach thanks. Yes hoping the clear out she had today will make the movicol easier this time and hoping she never gets this blocked up ever again

@mollyfolk thanks. I'm so grateful to the "constipation mums" because I hadn't a clue what was going on and don't think I'd have ever figured this out myself.

1 sachet every two days is a very low dose. It was when dd moved to 4+ sachets a day as part of a weeks programme GP prescribed that she got terrible problems. We're back on a similar thing now and the specialist said it may take two weeks so I'm panicking about the state it'll leave her tummy and bum by the time it's done (determined to see it through properly this time no matter what) but hoping the clear out she had today in the hospital might make it better this time.

Maybe this is a stupid question but if kids are on movicol for years does it not make them reliant on it? Really afraid dd may not get the sensation fully back to ever poo totally normally and hate to think she'll be reliant on laxatives her whole life

I wouldn’t be happy with that @Katiemonkey15 especially as you took her back a second time and given what you’re dealing with now. If he’d examined her properly before just her prescribing laxatives and clocked the fissure months ago it would have saved dd so much pain.

Dont worry about the school tests. She’s only 10 so they’re not that important anyway but tell the school what’s going on and they can rearrange a sitting for dd if needs must. Much more important that she feels better asap.

Hi, glad she had a productive (!) appointment. She is more likely to become dependent upon laxatives if she doesn't have enough of them for long enough. The whole point of the treatment is to get rid of all those old rocks of poo, and keep any poo coming through soft, so the rectum can gradually heal up and recover. It's that healing up that gradually returns normal function. If you don't give enough, so that they still have rocks of poo sitting in the rectum keeping it stretched, then healing up can't happen and normal function can't properly return. Luckily kids are really good at healing. But generally they need a decent level of treatment for at least as long as the problem has been building up.

I'm actually glad it is constipation, as we suspected. Because although there isn't a quick answer, it is so eminently treatable. You will get there.

@nocoolnamesleft thanks. Yes that's exactly what the Dr said- need to do the movicol for at least as long as the problem has been happening and he said this may have been building for six months rather than six weeks. Dd cant or won't say when she thinks it started and I wasn't in any way vigilant about her pooing habits as she never had problems before so first I knew of any issue was when she started going in her pants but of course by then she was already badly bunged up. I still have a lot of learning to do as never realised how ignorant I actually am about how the digestive system! Have ordered some books some other mums on here kindly recommended.

Thanks for the words of encouragement and positivity!

Yes hindsight is a great thing because at the time tbh I was relieved for dd that he didn't. I did prepare her when we went back last week that he might and maybe he should have and maybe I should have asked him to but either way he'd have referred us for treatment the exact same so just glad we've caught it now anyway.

If this is going to be an ongoing issue for dd and sounds like it will, it might be worth asking dd if she’d prefer to see a female GP? She might have found it easier to discuss and may feel more comfortable being examined by a female especially if she’ll be dealing with this as she goes into puberty. I know my dd who is close in age to yours would feel that way.

So so pleased for you and your dd, @Katiemonkey15 ! Brilliant to hear it’s been diagnosed and is being treated!

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.

Yes 👏 This is all so important to remember.

It’s brilliant that they decided to act there and then rather than send you home. Really impressed with that.

I think you need to stop being so worried about having to do another Movicol disimpaction regime. It won’t be fun but hopefully, now she isn’t badly impacted, she will have better bowel control and will be able to dash to the toilet whenever she needs to. If she doesn’t, it’s OK, better out than in!

She will have watery bowel movements, and a lot of them, but you just need to ride it out and remember it’s necessary.

Then once the regime is done it will be trial and error in terms of getting her maintenance dose correct. In my - sadly quite extensive - experience, don’t be tempted to go too low (one sachet is a low dose for a stubborn gut) and you risk not achieving that magic daily bowel movement you’re aiming for.

Good luck.

Maybe this is a stupid question but if kids are on movicol for years does it not make them reliant on it? Really afraid dd may not get the sensation fully back to ever poo totally normally and hate to think she'll be reliant on laxatives her whole life

There are different types of laxative. Some are stimulant laxatives that make the bowel contract and force the poo out. IIRC these are the ones that can make the bowel lazy. Then there are osmotic laxatives, or stool softeners, that draw water into the bowel to keep the poo soft - that’s what Movicol does.

A paediatrician explained to me that Movicol doesn’t make the bowel lazy. People worry about kids being on it long term but my kids have been on it for years. They are reliant on it primarily because their autism means they struggle to drink enough and eat a good enough diet. Staying on Movicol is the least-worst option for them.

Hi Op. my daughter has the same issues and has been on movicol for coming up 5 years having had constipation issues for almost 8 years. Disimpaction is always grim but when they are on maintenance doses, they produce normal soft poos not diarrhoea so don’t worry. My daughter is on half a sachet a day now and I’m trying to wean her off although last time I tried she had an accident again and so we went back on them. Make sure your daughter drinks lots as well- mine is always so much worse in the heat. Our consultant told us that as long as the bowel has been stretched for is as long as will take to go back to normal. For my daughter, it had been 3 years of issues and so it took a further 3 years to get much better with accidents as the sensations came back. She very rarely has accidents now. I would advise the movicol mummies group on Facebook if you have Facebook.

Thanks so much @Jellycats4life

It’s brilliant that they decided to act there and then rather than send you home. Really impressed with that.
Why would they have sent us home? As in he could have refused to do the appointment cos she was blocked up? Don't think they ever do any investigations in the first consultation and they didn't give us any prep or diet restrictions or anything so don't he could have been mad about it?

Thanks for the reassurance about the movicol. I know I'm panicking cos I feel bad about not doing it properly the last time and I know she had a terrible time on it last time too whereas she's never complained about pain from the constipation.

I've so much to learn! Thanks for this jnfo

Thanks @Boxerdor . Your poor dd.

That's exactly what Dr said too so I have to try to be patient. Praying the diarrhea stage is shorter and less painful this time and hopefully we get to maintenance dose stage relatively quickly.

Have heard about the Facebook group but haven't used my Facebook in years. Will try to check it out.

Why would they have sent us home? As in he could have refused to do the appointment cos she was blocked up?

No, what I meant was they could have said “Oh dear she’s very badly impacted” and sent you home to start the Movicol disimpaction regime instead of doing enemas.

I think the fact the blockage was right at the “exit”, and so large, meant they decided an immediate enema was a better choice. Which was the right decision.

Is DD feeling better in herself already? She must be. Although it sounds like she’s been quite disassociated from her body for a long time (the withholding, ignoring signals she needs to go, not admitting to pain) so maybe she doesn’t.

What a dreadful ordeal for your DD. Thank goodness the biggest impaction is out of the way. It must be good to have a diagnosis and a plan of action.

@Jellycats4life I have to say they really were fantastic there. Really put me at ease cos they were very matter of fact about it but talked us through everything and I just trusted them instinctively but more importantly they really put dd at ease as much as possible. I hazard to think how long and painful clearing out that amount would have been at home so think it really gave us a headstart.

Dd slept through (had to wake her this morning) despite the long nap yesterday so she must have been exhausted. She was actually a bit clingy when she first got up which I was worried might be a sign she was in some kind of pain but she told me she wasn't (although she told me that before!). She ate breakfast as normal and really wanted to go to school (I'd have kept her off today if she wasn't feeling up for it). We're supposed to do a 5-10 min sit 20 minutes after her breakfast but didn't quite manage that today as the toilets are in high demand in our house at that time in the morning and I need to get more organised with the morning routine to make sure that happens from now on. With a bit of encouragement she did a short sit straight out of the shower and i noticed she had no wind at all which I think must be a good sign as she's normally very gassy when she first sits so that alone must show her tummy is doing a bit better now and must be more comfortable for her.

Asked for a quick meeting later with her teacher to fill her in on why dd will be out next week and to discuss the assessments possibly clashing with doctors appointment and her maybe not being at her best for them etc. Dd really didn't want me to talk to the teacher this morning though and begged me to tell her she'd be at he dentist next week (for a week!) instead so in the spur of the moment in the car i lied to dd and told her I wouldn't tell the teacher the real reason and now I think that was a mistake cos I want her think she can confide in the teacher if she does have pain or an accident or anything when she goes back. Teacher is excellent and subtly encourages her to go to the loo in school to no avail (dd doesn't know we told the teacher about the soiling in case anything happened at school). Thinking now I should own up to dd that I have to tell her teacher the truth?

We're having a fun evening out hopefully later and her grandparents are visiting later too because next week will probably be very quiet and unadventurous. Thinking of the summer holidays and her being able to really enjoy with them is going to keep me motivated to plough through though.

Yes it was still a bit of a shock, even with the advance warning from all the wise mums on here, but glad now we at least know what's going on and can hopefully address it and hoping the worst is behind us.

Yes. And hopefully, all the posters who suggested that you should punish your daughter will hang their heads in shame.