4 year old stool withholding

[Tulips14]

Basically that.
my 4 year old has always had issues with pooing ever since a bag bout of constipation when younger. Anyway months and months later seem to have turned a corner and no more lactulose for nearly a year until this week! OMG we came back off holiday (pooing regular) to no poo for 4/5 days then had a massive one on the loo that caused bleeding and it’s been a hellish week since. He’s holding again, soiling regularly in his undies had multiple accidents yesterday, h is moody and aggressive and I’m loosing my mind with worry we are going back down that path again.
any advise?
I've added poo to his reward chart
I'm making him go twice a day just to sit
upped prunes, freshly squeezed orange lolly’s Water and chia seeds
he told my mum yesterday he’s scared of his poo so just trying to keep staying the more often he does it won’t hurt etc.

He’s constipated again, hence the overflow.

Treat him with lactulose again and maybe even try movicol to get it really soft. I know it’s difficult, but try not to mention it to him. Eventually, when he needs to go it will be soft so he knows it isn’t going to hurt,

Thanks for the advise. I will give him some lactulose, not sure weather to give a high dose and work down?
yeah it’s soooo difficult not to get frustrated after so many months of finally going. He’s due to start school in September and currently he won’t poo at nursery so not sure how that’s going to pan out when he’s in school 5 days 🫠

the ERIC uk website has some great advice on this. Usually you will need to address the constipation first and then work on the holding. My youngest goes through bouts of holding and has a slow bowel so will end up severely constipated quite quickly if we don't spot it early enough. I usually treat with doses of movicol until he's having frequent soft poos and then gradually decrease again once he's got used to painless poo.

Thanks @bananabread2000 I will have a look.
I've been giving a daily small dose of lactose and he’s been everyday since I put this post on and he’s no longer complaining of a sore bum. But Tuesday came and then we didn’t have anything (nursery day) Tbf he did go to the toilet and ‘try’ which is better than nothing. He told me he went this morning but I was in bed so not sure how true that is 😂😂