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?

We are on her maximum dose now of 12. Still no sign of the 'rusty water' we are meant to take as our signal to start winding back and tomorrow will be a week but does feel like we are maybe over the worst and on the home stretch hopefully. I think she does feel better already (apart from the sore bum) and I'm punching the air that she seems to be feeling some kind of urge to go again.

Does it take a while to start making a difference?

It depends on if it is used correctly. If the diarrhoea is still making contact with her skin, it will continue to burn her. If you can minimise that you should start to see a difference in 3 or 4 days. Wash, dry, apply cream after every bowel movement.

@Katiemonkey15 That sounds like great progress! Sorry to hear re burns, horrid experience for her, but Metanium really is a wonder worker!

Metanium is amazing but you have to put it on first, before every toilet trip and then again after cleaning.

Thanks. Now that the diarrhea has stopped I think that'll be a lot easier for her to manage

TMI, sorry - I had SEPSIS a few years ago and while unconscious in ITU for a week I had really corrosive diarrhoea (according to the Nurses - I wasn't awake to witness it!) When I woke up, my whole bottom was raw and incredibly painful. The Nurses used something to soothe it and it worked wonders. They sent me home with a pump bottle of it when I left a few weeks later, as it had been opened and used for me so would have been thrown away otherwise. Unfortunately it's long gone now, and I can't remember what it was called, but there are other things out there which are stronger than the usual nappy rash creams, so I'd say it's worth asking the GP.

@OliveWah that sounds awful, poor you. Yes if it's not clearing up at all soon I think I'll have to ask GP for something else

Really slather her inner cheeks with it and round the exit. Idea is that poo exits without touching her skin. Then clean herself with water, pat dry and reapply.

@Balloonhearts thanks. Dont think shes been putting nearly enough on. The more it hurts the less she was putting on because it was becoming sore to touch to put it on. She was actually crying with the pain of it yesterday. 😢
She's letting me do it for her a couple of times now and i sent the others off to watch a rugby game with their dad so she could have some bare bum time in peace at home and she's definitely a bit more comfortable today but it still looks really sore.

What I found helpful was stopping wiping DD’s bum but instead rinsing her off in the shower after a poo instead, and then patting dry really gently before reapplying the Metanium.

She was really little so didn’t mind that there wasn’t much dignity involved! Don’t know if your DD would go for that.

Thanks @Rainallnight She can keep herself clean no problem but it's just been harder for her to do the cream cos it's been sore to the touch. Hopefully won't be a problem too much longer. We are at the end stages finally. She's going when she does her sits and rarely in between so she's really feeling like she has some control back. It's been a horrible week but worth it if that's the case.

Good rule is that if you can see the inflamed skin though the cream put more on.

It's sort of peeling and flaking now. It really is like a bad burn.

Got the go ahead to start reducing her sachets by two a day and hoping she'll be fine to go back to school but he wants to see her again in the clinic. What's the standard maintenance dose, 2 sachets?

What's the standard maintenance dose, 2 sachets?

Not necessarily. It really depends on the individual. My daughter was on 3-4 at that age.

You could try a maintenance dose of two, but if that isn’t producing a daily bowel movement you should increase to three. It’s trial and error, figuring out what works.

Once things are back to a more normal level Kefir can really help with not becoming constipated again. It also replenishes the good bacteria in your gut.

9-health-benefits-of-kefir

There isn’t really a standard maintenance dose. My daughter is usually down to half a sachet a day (she’s been on movicol for 5.5 years now) but she had a flare up after Xmas. So then she had to do disimpaction again (luckily not too bad as not massively impacted) and she was on maintenance of 4 sachets for a couple of months. I then gradually reduced by half a sachet every couple of weeks and she’s back on half a sachet a day now with no problems. You just kind of have to do things gradually and see how it goes

Hi @Katiemonkey15 - I’m so pleased your DD is on the home stretch. The sore bum sounds horrible. I think the fresh air idea is great (when possible) as she will be prone to thrush/fungal infection in the warmer weather. (Don’t be afraid to use anti fungal bum cream too. Also Sudocreme. It’s a classic for a reason.) My advice is not to wind back the movicol completely for a very long time. The reason the smaller pebbles are harder to pass is because her bowel motility has been somewhat impaired. She’s possibly still going to need something to encourage “exercise” of those muscles.

Was also going to suggest Metanium. DS used to have persistent 'toddler diarrhoea' as a baby and it caused nappy rash occasionally but the Metanium was great for protecting him.

She's going in on Friday for an examination under anaesthetic 😫It's a bit nervewracking because she's never had a general anaesthetic or anything before and I cant stay with her once shes asleep but they've told me it's a very standard simple thing and she'll be home and fine that afternoon.

Suspicion the rash may be a reaction to the wipes so not going to use them for a while and see if that helps at all.

Hope all goes well! I know it's daunting but she'll know nothing about it and it's great that she's being taken seriously.
Sending you a hand hold

Are they doing a colonoscopy? Was this always the plan as a follow up, or has the disimpaction not gone as planned @Katiemonkey15?

Thanks @Incakewetrust . Just can't wait to get it over with. I know she'll be fine

No the disimpaction went well and think she feels much better, although she's not quite going every day which he really wants, even though he's kept her on 4 sachets a day so she should be really. He wants to rule out any problems that might be causing the constipation because she doesnt have a history of it. I think he has suspicions but he's not sharing them yet and he's saying it's just to rule anything out.

There is a list of things i have to consent to (including a biopsy eeeek) because he can't say for certain what he might need to do until he has a look but he thinks he'll just do thorough exam and a scope (but just of her bottom area, not as far up as her colon) and based on that possibly an ultrasound and that she'll be ready and fine to come home with me very shortly after.

Hope all goes well for her