Movicol, lactulose, mushy poo and childcare.............................??

[Acinonyx]

Dd (just 4) has been on laxatives since last Xmas for poo witholding. It has been very slow/no/negative progress since then and we just talked to a specialist. We need to increase the latulose, and maybe add senna, so that she goes every day and rectum can shrink back (it is somewhat stretched after all this).

The big problem with this is that when I tried increasing her dose 3 weeks ago the poo became so mushy with more frequent mushy leakages that her CM said she couldn't deal with it and she would have to go back into pull-ups. Very about that since CM has always been pushing for dd to get out of pull-ups. We don't have this problem so much at home because she still has a potty downstairs to get to more easily and can sit on it for a log time if nesessary.

I know there are other mums out there using laxatives and having mushy, leaky poos - how did your nursery or CM cope?

I'm desperate for some improvement before dd starts school - I dont' want her to be the stinky kid with pooey knickers . I'm not convinced that the routine of going everyday will make her stop witholding it - I can't see how we will get off laxatives. Did any dc have any behavioural treatment for the actual witholding problem?

I would remind your CM that she is being paid and isn't at liberty to decide what your DD wears on her bottom or whether or not she can "deal" with it. If the leak isn't too bad you can put a sanitary towel inside her knickers until she is no longer needing laxatives. I would also find out if the CM has been saying negative things to your DD about her poo which might perhaps be contributing to her withholding.

Well, we're testing out the increased dose this week and we'll see how it goes. I'm sure Cm isn't being negative about dd's poo - she's generally very good like that.

I might try a pad in her knickers - the ony probelm with that is that dd will grasp at any excuse to justify accidents and I don't want her to think it's OK because of the pad. I'll only do it if I think she really can't hold it.

I also have no idea how long she will be on laxatives since this is essentially behaviuoral and that's the one aspect of this problem that no-one seems to know how to change. Most kids get liket his because they have had a painful poo but that's not the case with dd - she just doesn't want to let it out I'm not at all convinced that being forced to let it out will make her actually want to do it without laxatives.

Is your DD part of her treatment or is it being done to her? E.g. does she willingly take her meds and know what they're for or is she forced to take them? Laxatives are awful and can make it very hard to control poo. I think you have to treat the physical problem first and actually let her have the accidents without justification (i.e. tell her it's okay and that it's important that she have a poo every day) and treat the witholding problem after.

My DD has been withholding for about a month, so we've had lactulose, and then, when that didn't work, movicol. She's now at the stage where she's doing small, mushy poos frequently, which is a massive improvement, but of course she can't always tell when they're coming in time to get to the loo. Her nursery have been fabulous - they just deal with it and get on. I totally agree with ches - your CM should be happy to deal with this in the way you want her to. I've found the whole thing very stressful - particularly when DD was making herself ill with the withholding. All the advice I've had from health visitors etc has consistantly said that it must be dealt with in as relaxed a way as possible. Putting her back into pullups is hardly doing that, poor thing.

The physical problem is a direct result of the witholding problem. If she doesn't withold, there are no accidents, even with laxatives (I'm better at judging the dose these days). I'm not going to say it's OK to poo her knickers when I know school is coming up and I won't be there to deal with the consequences. The accidents are not anything like a proper poo - they don't consitute having a poo in a day at all - they are the result of NOT having a poo.

She takes her meds (with occaisional protests) and completely understands what they are for. She is getting better about pooing on the toilet but she is still basically witholding and I wish I knew how to treat that. She understands that her body needs to poo but when it comes to it she just doesn't want to let it out. This is not just a poo issue - she has similar problems with alsorts of things - paralysed by the tension between wanting to do something and NOT wanting to do it.

CM has been OK this week so far and if things do go pair-shaped I could take her home all or part of the afternoons in Aug.

It is very stressful. No way is she going back into pull up no matter what.