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?

This could be a ND issue. Its quite common to have difficulty in task switching especially when you are focused on one activity. Another issue is poor awareness of body cues and sensation.

I taught a child like this once, a boy and a bit younger, but it became apparent from talking with his family that it was a kind of power issue, and that he was trying to assert his dominance. He really didn't care, he wasn't embarrassed, and the fact that other people cleaned it up was a bonus for him. Like a fox or cat marking his territory.
Unfortunately I don't know how or if the problem was solved. Weirdly, his classmates weren't put off, he wasn't teased about it, and in fact he acted like king of the class.
I think in your case, OP, I'd stop doing the washing - show DD how to use the machine and make her responsible for cleaning up after herself. Stop hurrying her out of events if you think she's likely to soil herself, and let her experience some consequences. You seem quite clear that it is something she is able to control.
Take her to the GP to see if they can suggest anything, but getting appointments for CAMHS is very difficult and a long wait, if you can afford to go for private therapy for her, it might be worth trying that.
I think I'd also limit the activities that are more interesting that taking herself to the toilet, or use the pause button when you think she needs to go. Talk to her about setting reminders to go every hour or so whether she thinks she needs to go or not.

Rule out constipation before assuming it’s anything like laziness.

My dd went through a withholding phase (although she wasn’t soiling) when she was about 8 after a bout of constipation made her poos hard and sore to pass. Holding them in made it worse so it because a vicious cycle.

We we’re doing senna, glycerine suppositories and a ‘poo diary’ on the advice of the specialist but it was stressing her out and making it worse. What helped her in the end was us backing off and not making whether she pooped or not such a big deal. Every night we left her to it in the bathroom for as long as she wanted after a dinner with a bubble bath, some candles, her iPad and books etc and she gradually started to start to get over the anxiety of it and back to normal herself.

Yes, I had a safeguarding course a few years ago that said that this can be a sign of sexual abuse.

Definitely get her some therapy or counselling.

@Windintrees
Yes of course she can lock the door. I'd be delighted if she just many effort to get herself to the loo

@DelphiniumBlue
I think she could be making more effort to get herself to the loo but don't think she's deliberately trying to upset me or be difficult or controlling.

@Ratfan24
What's ND?

I do know how hard this is, as one of my now adult DDs did this at a a similar age. I found it very very hard not to be angry - even knowing that this was the last thing that would help - as I knew she was perfectly capable of using the toilet.

But she only did it for a very short while, as we decided that there must be some psychological reason for it and made the decision not to focus on it at all, but to take steps to give her more of our time totally divorced from the problem. She is a middle child with a very brainy older sibling and a much younger sibling, who inevitably took up a lot of our attention. We felt that she was subconsciously trying to tell us she felt left out. I am sure there was no deliberation in it. But it was of course having the gain of attention.

The strategy worked - and very quickly. It really is worth a try. Deal with "accidents" swiftly and completely without comment, but give her lots of attention at other times - e.g. we would take her out on her own now and again, give her responsibilities etc. We felt that focussing on it would be counter-productive, and that there must be some compelling reason to do it.

If this does not work then she needs to be reassessed medically - I remember working with a boy with encopresis who was being treated by a psychotherapist (who seemed to mainly concentrate on the idea that he might have been "breast-milk-starved" and she got him to draw lots of pictures - one of tulips was interpreted as "two lips" which bore out her theory! - bonkers!). I examined the family's life in some detail and came to the conclusion that there was a medical condition that needed investigating - with a lot of resistance from the psychotherapist. He was seen by a paediatrician who diagnosed a bowel condition which was treated successfully.

Best to start simple - it really did help our DD to virtually ignore it - for it to become a non-topic. I wish you good luck with this - I know what a stress it can be.

@Mischance
What was the bowel condition and did he have symptoms? My dds only symptom is pooing in her pants rather than the toilet but will ask to see a bowel doctor just in case

Neurodivergent/neurodiverse

My DD took ages to toilet train and was still soiling at night at age 10 - we too thought it was laziness.

She was diagnosed autistic at age 13. She couldn't explain what was happening as didn't understand it herself. Turns out she didn't get the same feelings/signals as most people do, or her brain was unable to interpret the feeling as one of needing the loo. It's like the signals were getting scrambled.

DD is a master at masking. Most people that meet her would not think she was autistic. It's only due to her conversing with psychologists that they gave the diagnosis.

@itsnotyouagain
I don't think dd has any issues like that. She toilet trained no problem and doesn't have any other issues besides this

Have you tried the ignoring strategy with attention paid in other ways? I can assure you it did work for my DD, even though it was not easy to put into action.

Next step is relevant specialist - start with paediatrician.

I am sorry but all this happened so many years ago that I cannot remember the name of the condition - which is no help to you at all I realise - and apologise for that.

@CatStoleMyChocolate
No this is new, since around Easter. She toilet trained no problem. She had one bout of constipation on holiday in France two or three years ago which we put down to the change in diet but I think she was also withholding cos she didn't want to use the campsite toilets. A few spoonfuls of milk of magnesia and some prune juice cleared it up and no more issues in that department ever since until now

Waiting lists for anything will be a while but get her name down asap.
In the meantime, if a lot of the accidents are happening while shes watching tv maybe tell her she cant watch tv until shes been to the toilet - on the toilet then as a reward she can watch the tv. Remind her that none of her friends do this and see if she can explain why she does it.

You say she never had an issue before with toileting, potty trained as normal, may be a bit far fetched but any question is worth asking, did it start around the time your youngest was being toilet trained? Or before? If it was around the time or after do you think it could be an attention thing? Watching how much attention the younger one received while training? It may have absolutely nothing to do with that but ruling out as much as possible may help narrow it down a bit. Would definitely go back to the go though and think about possibilty of SEN issues.

@Mischance
By ignoring do you mean stop encouraging her to use the loo or just pretend not to notice when she has an accident? She has accidents I don't know about where she obviously just goes and cleans herself up but I find the dirty pants and I don't make a big deal out of them every time or anything but I find it impossible to ignore when she clearly poos when I know she could have got to the loo

@Zombiemama84
No this is only going on around three months. We started toilet training youngest before then

Also, if you dont already then give her the responsibility of cleaning herself up. She may get fed up with it. If you think there are no underlying reasons other than just being lazy and not being bothered to go to the toilet then make her use her pocket money to replace all the knickers she is ruining. If you are the one cleaning up after her she's not going to realise the inconvenience it causes unless she is the one that has to keep doing it.

This is not an "accident in her pants", she is deliberately choosing not to go to the loo. I would be seeking psychological counselling over this, it seems emotional/behavioural rather than physical.

I really feel for you OP, did anything happen around Easter that might have triggered this? Holiday or something? It seems very unusual.

@Jackiebrambles
No I have tried to identify any kind of trigger (dietary, physical or emotional) and can't. It started just before Easter so wasn't even all the chocolate! No real difference between during her school holidays and when she was at school.

@Zombiemama84
She does clean herself up. I don't wipe her backside and she enjoys a shower and especially bath so much she's hard to get out of it everyday.

Did she hate being on movicol? Maybe tell
her if she doesnt stop soiling herself she will have to go back on it because holding it in so much will cause problems ans needs to make sure she goes - on the toilet - regularly

@Zombiemama84
She was OK with drinking it (I know other kids struggle) but then it gave her such terrible diarrhea I don't blame her for not wanting to take it again as it was pretty unbearable

I hate to use the worden threaten, it sounds very forceful but what i meant was suggest to her that if these 'accidents' don't stop she may need to start using movicol again (and go through the horrid side effects) to make sure she is going to the toilet regularly. Even if you have no intention of using it again maybe just remind her how unpleasant it was but that she may have to use it if this doesnt stop. If she is choosing to not go to the toilet when she should she may choose to avoid having to use the movicol if it made her feel worse.

Definitely continence referral needed urgently. School nurse may be able to do it.
Google encoperesis and Eric bowel charity.