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?

Please insist the gp refers you to the bladder and bowel team, they will have a wealth of specialist knowledge and experience of whatever is going on.

For what it's worth a dr explained to me that when a child has severe constipation diahorrea and leakages can occur as the body tries to unblock itself. Also after the blockage is cleared the bowel can have become sluggish and not move things along normally causing a repeat of the problem. Movicol itself is not a laxative it just allows the contents of the bowel to hold on to more water.

Don't make movicol a threat! She'll probably need it as part of her treatment (and your support!)

Well then you need to educate yourself and get your child the help she needs.

@Apolloneuro
Which is exactly what I'm trying to do. Why bother commenting if you've no intention of being helpful?

@WonderingWanda
Thanks. I just assumed diarrhea was the opposite of constipation and never considered they were linked. Going to GP Monday to at least rule constipation out

https://eric.org.uk/resources/the-poo-nurses-explaining-how-to-disimpact-using-macrogol-laxatives/

I'll just add that movicol is not the only treatment. We decided it wasn't the best for my daughter psychologically. A bowel stimulant medication was very successful for us. Combined with enforced toilet sits, increased drinking etc.
I could tell by her body language too.

Just to say there is hope. We did cure this. Good luck and happy to answer any questions.

My daughter was the same. She hated pooping on the toilet but would wee just fine. She ended up in a & e with a badly stretched bowel that lost its ability to squeeze. We were told that a bag might be fitted. Two years later with hospital intervention and powerful medicine (meant for chemo patients) we're finally there. Her bowel isn't perfect, (can't poop quickly and takes a while) but it's so much better than it was, and doesn't need hospital intervention. You need to explain to her that this can happen and she may end up in hospital. I was originally told, "she'll grow out of it and she'll be fine, because theres ibly so.much she can hold in!" That was completely wrong. Mix in a tea spoon of califig into her daily yoghurt. This will make her stool alot more soft. She won't be able to hold it in. You don't want her to have firm compacted poos, because this is how she's stretching and over extending her bowel. Diarrhoea is far more preferable.

Because mostly all I can see is you saying how annoying it is to you and she’s doing it on purpose.

It’s hardly psychology 101 to think that something happened three months ago that’s triggered it.

Christ. I hope you don’t have children.

So this is a new change to her - no problems beforehand @Katiemonkey15.

Something has happened to cause this. It could be the feeling of sitting on a toilet - when younger you feel like you might fall in, or the feeling of letting the poo go, the feeling of splash back etc. Does she still urinate in the loo ok?

When you remind her, do you have to escort her to the toilet yourself? Be in the room with her? Does she go easily or is there still an issue with passing the poo?

Please don't feel you have to answer any of these personal Qs on here, but I wonder if when DD is open to talking about it, you can ask her which part of using the toilet is putting her off. Break down the steps, write this down on a piece of paper and get her to tick which ones she is OK with if talking about it makes her shut down.

@Mynewnameis
Thanks that video is helpful. If the problem is constipation we obviously stopped the medicine too early but don't know who much longer we could have put her through the diarrhea

@itsnotyouagain
She doesn't seem distressed by being in or on the toilet but she just don't won't take herself independently when she needs to

She often will go and sit on the loo when I nag or remind her to but there are times when I have had to frog march her and physically sit her on the toilet.

I do have children i had 3 lost 1.

I genuinely find it astounding that she's not embarrassed by this...

If GP still thinks constipation and tells us to do the movicol again should we or should we wait until we've seen a bowel doctor and psychologist?

Follow the doctor's advice.

@HollyKnight
If we do the movicol again she will probably get very bad diarrhea again. If it's the same as last time then don't think it'd be possible never mind the best time to examine or assess her because it was awful

Sorry if this has already been mentioned but have you tried rewards? Whatever you think would mean a lot to her, but not anything essential, so not like blackmail.
Everytime she's goes on the toilet (at first with your insistence) she gets lots of praise and a reward. But don't make a deal out of it when she doesn't.

We went through this when our son was 3 and I don't believe it was constipation. Just stubbornness that turned into habit. Collectable rewards fixed it.

My understanding is that movicol is given at a quite high dose to empty a full bowel, and will usually cause diarrhoea as a result. The dose is then weaned down until regular soft stools are the result.

This is then the maintenance dose

@HideTheRockyBars
Yes- she got rewards for x amount of poos in the toilet but she was telling me she did one when I really don't think she had and I was still finding mucky underwear (hidden in the bin as well as in the laundry)

My gut feeling is there IS some SEN going on. Autistic kids very often have quite extreme bowel issues, often linked with withholding (but also diet). They also very often struggle with interoception, in other words the ability to feel and understand internal body sensations. Even the lack of embarrassment could point to a neurodivergent child IMO.

Clearly, at this age, there is a very large piece of the puzzle missing. Yes it could certainly be a physiological issue, but I think neurodivergence should be explored too.

@Houseplanter
Do you know how long is considered normal for the diarrhea? We had 4 days of literally constant stream from her (sorry tmi) so we had to quit

Is there anything she really wants at the moment that you could use as a kind of reward? Something like if you are clean everyday for a week we'll do XX at the weekend, if you do a whole month XX and 90 days / 6 months another reward? Make being clean what gets her your attention praise etc and try to make soiling a neutral thing (not 'rewarded' by attention or a big fuss)

The fact this has started recently does make me think something happened or changed to trigger it.