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?

@literarybitery
We had to keep her off school for several days because the diarrhea was so bad. I'm confused how she'd go straight to explosive diarrhea if her problem was constipation

Look up movicol mummies on Facebook

She’s not recognizing she needs to go to the loo. She’s not reading or receiving those signals. So when she is on the toilet that signals to her body to go, but she’s not consciously aware before that. Hence it gets to the stage she soils herself.

The bowel and evacuation is actually a really complex process that still isn’t fully understood by researchers and lots can go wrong with it.

her bowel could be stretched for example. And yes if she was constipated, the movical could still give her diarrhea as there could be a big blockage basically- you need expert medical advice.

it is likely she has lost the urge to go because of the withholding. You are not doing the right thing - losing with her and forcing her on the toilet.

Definitely GP and onwards referral, you need to get to the root of the problem as having dealt with constipation with my eldest, it is a long way back to normal bowel movements.

If she went straight to diarrhea maybe it’s not constipation. Did you go back to the GP to talk about it? If you did the full disimpaction regime ( gradually increase the dose of movicol over a period of time), then diarrhea is expected in the end stages.

There might be an impaction so the movicol gets the softer stool out from above the impaction first. This looks like diarrhea.

Not washing a child's clothes or providing needed things is abusive - you won't get results this way.

Calling her 'lazy' is also not going to help. It is actually very lazy parenting to dismiss things as lazy! It would be far easier for her to do the right thing, so there must be something going on either physically, emotionally or behaviourally.

Try to help her by getting outside advice and trying to get her to open up to you by listening and being supportive.

@literarybitery
Yes maybe I just have to stick the course with the forced sitting on the toilet but it's very frustrating. We've never got to a point where she'll just take herself to do this voluntarily.

I think she does know when she needs to go tbh. We can sometimes tell from her body language. GP asked if she passes wind a lot and told him that when I first sit her on the toilet she often does which he said is a sign she's been holding it

@qwertyqwertyqwertyqwerty
I've said that to her, and maybe I shouldn't have, but I've never not washed or provided her with nickers and clothes etc. I might be making lots of mistakes here but at my wits end. I like to think she's not just being lazy or stubborn but it's very hard to keep my temper either way

@Katiemonkey15 - it’s very unlikely she can recognise the urge to go anymore. When a child starts to withhold it is a long way back to training the bowel. This is why you need expert advice.

See this website

https://eric.org.uk/

@literarybitery
Yes if I remember rightly we started on 4 sachets and then went up to 8 and that's when the diarrhea got very bad

@mollyfolk
When you say she can't recognise the urge to go do you mean physically she doesn't feel anything or she doesn't connect the feeling in her brain to the need to get to the toilet?

@Katiemonkey15 In the nicest mum to mum way possible, I’d step back from what you believe may or may not be causing it and start from scratch by investigating both routes simultaneously. Take her to GP for referral to paeds bowel clinic and ask their advice on the best route to go to explore if it’s psychological. It’s very easy for a parent to believe a child knows more than they do, are lazy, are getting the physical signals they need or aren’t afraid of something, when in reality we can’t really know without medical tests being done. Doctors will find it helpful to know when it started, how often it happens (and the times it doesn’t, did you or she instigate toilet trip), diet etc.

It’s so crucial this is solved asap. Lots of things could contribute and the fact it’s emerged years after potty training is concerning. She’s at an age where this is very unusual and the very fact she would have soiled herself at a birthday party rather than use a toilet at age 10 is very worrying. It’s a big worry for a child close to starting secondary, who is usually at an age of wanting increasing independence and starting to be more aware of how they appear to others.

I’m going to say this next part because I believe it’s important to be aware of, but I am not saying this does relate to your daughter. Fecal soiling can be a sign of abuse, especially when it appears out of nowhere. It can also be totally unrelated and down to health issues. I’m sorry to mention it, but didn’t want to leave it out in case.

Equally, it could be a phobia, a neurological issue, a bowel system issue, constipation, sphincter dysfunction etc. I do think because of her age and the regularity of it, it’s really important to explore the physical reasons it could occur through a doctor.

It's more common than people realise because there's a huge amount of shame surrounding having an older child with a continence problem.

I've had two. Ds1 is older and fine now but soiled occasionally due to withholding up to the age of 13-14. Ds2 is still going through it at a similar age to your dd but it's a cyclical issue with him and can resolve for months if we keep rigidly on top of it, then take a couple of months to fix if there's a slip back.

I've been dealing with scraping poo out of pants for 15 years and I hate it. Anyway:

• The potential fix is rigid adherence to non-negotiable toilet use. If child is non complient then having them sit there for ages won't help.

• She will be constipated which can include having a stretched/sluggish bowel from withholding which means she can't go. Movicol helps with this.

• It's not always obvious when they're constipated. Ds1 seemed to be doing semi regular poos but scans showed his bowel was full and very stretched.

• You should get professional help to rule out anything else but don't have your hopes too high on a quick fix. It's mostly psychological, a very ingrained habit and difficult to break.

• it's not the child's "fault" and shouting, punishment etc doesn't work. But we are humans, it's very stressful for us too, and we need to be kind to ourselves when we slip up and just try to do better.

• Yes, there may be an underlying reason for the anxiety or refusal so bear that in mind, but sometimes there's not.

Will take her back to GP Monday and ask for referral to a bowel doctor and a psychologist?

Is there anything specific I should ask from GP or the referrals?

Does anyone have any experience of this where the issue isn't actually constipation? So many responses saying that must be the problem that I know i need to rule it out now but if that's not it I'm just stuck with this?

Both you and your younger dd can see a change in body language just before she goes.
This suggests she can feel something.
Once it starts the smell would alert her even if she couldn't feel anything so one would think this would trigger her to rush off to the loo.

It's her apparent lack of concern about soiling herself that sounds peculiar as a 10 year old with no cognitive dysfunction should not feel comfortable soiling themselves.

You need to seek professional help OP

Yes that’s it. It’s unfortunate if your GP did not explain to you that this was expected, or give you a leaflet about it. Mine did, but never explained we had to keep up a lower dose of movicol after doing the disimpaction. Which you do need to do to help establish regular bowel movements.

You can also get things like squatty stools or something. , they are stools you can put your feet on when you are in the loo and they put you in more of a squatting position which helps make it easier to empty your bowels.

I think you need to read some of the info on the Eric site and go and gave another chat with the GP.

@ditalini do your dc feel embarrassed or concerned when they soul themselves? The apparent lack of concern the OP seems to detail is peculiar

@ditalini soil*

She doesn’t connect the feeling in her brain anymore. She may need strategies to help her do this.

Honestly, you need to stop blaming her for this. I feel so bad for her - all the shame she will have around this medical problem will just compound the issue.

Yes this is what stands out to me. My 6 year old would be mortified and it is unusual that at 10 she seems so unbothered. Physical issues aside why isn't she concerned/embarrassed?

It’s not peculiar at all. it’s really common with Encopresis.

My 8 year old doesn’t seem to notice the smell. 🤷‍♀️