constipation - still witholding even on medication?

[SoTiredOfTheWheelsOnTheBus]

sorry if this is too much information. DS is toilet-trained for wees, but for ages would only poo in a nappy. He started using the loo for poos in September, which was great, but then stopped - and I mean stopped completely. We spoke with a pharmacist, who advised lactulose, but after a week with nothing happening, saw the GP who prescribed senna. This did help, but again it would be 5 or 6 days inbetween poos. DS was getting upset ('my tummy really hurts') so (on GP's advice) have now increased the doses (he's on 20 ml lactulose a day and 10 ml senna), but it's still being days in between poos (currently 3 and counting).

This is a rather random question, but is this normal - for a small child to be on quite large doses of laxatives, and still not be going every day or even every other day?

What is his diet like? Does he drink a good volume of fluid?

Quite often with-holding is as a result of emotional upset. Then the poo is hard and painful to pass so they with-hold more because it hurts. I would suggest that even with the medication, the bowel may have lost tone, and might not be pushing the food waste along as it should. What happened at the time DS stopped using the loo? Can he voice his fears?

I think you might need to see someone about this. But in the meantime, try to get DS to eat a high fibre diet and increase the amount of water he drinks.

His diet is not too bad. He drinks enough fluid (usually milk or dilute squash), but I've also been trying to give him freshly squeezed, undiluted juice (I know it's bad for teeth, but one problem at a time!). I've been trying to increase the amounts of fruit and veg with his meals (snacks are currently only fruit), but sometimes he'll eat them, and sometimes they just get left on his plate. We've also cut back on bread, he will occasionally have toast for breakfast, but that is now brown (if it's wholemeal, he picks the bits out).

I have tried to talk to him about it, but he says 'my poo doesn't want to come out'. He admits that it hurts (but TMI alert - the poo is soft when it comes out, which makes me think the lactulose is helping). When he has done one, I ask him if it hurt and he says no.

DS1 was like this when he was toilet training. He was fine with doing wees, but had a major hang up about pooing on the toilet for ages and it was a real struggle. I think some children don't like the feeling of doing a poo on the toilet and letting it go rather than doing it in a nappy iyswim; its like they are letting go of part of their bidy they want to hang onto.

Don't think I've explained that very well (!), but you could try the book called something like 'Poo goes back to Pooland' which our nursery staff gave to us at the time and that really helped DS1 understand the feelings he gets when he needs to do a poo and the reasons why he should act on them and let the poo 'go'. Hope this helps.

*body

BTW there are similar threads about this further down which may be of use to you. Good luck, am about to start training DS2 and not looking forward to it!

Perhaps he means 'I don't want my poo to come out.'

If you aren't already aware, large doses of Lactulose can cause more wind than normal, and if his gut has impacted faeces high up that the softer poo squeezes past, it could be uncomfortable. The other possible source of pain might be an anal fissure, a split caused by passing a hard poo, and fear of this can also cause with-holding.

You don't say where he poos now, if not in the toilet. Does he go and hide, or have you observed him straining for what seems a long time before he does the poo, either to push it out or hold it in? Although he shouldn't be able to hold on forever.

I wouldn't be happy about a child taking something like senna for long periods without being monitored. The gut can become used to the stimulation and this affects it's own motility. It seems that a lot of children are prescribed Movicol, which is for chronic constipation and faecal impaction. If DS has been on his current medication for a few weeks now, I think you need him reviewed and possibly referred to paediatrics. They may be able to find out the emotional cause if they can find no physical reason for DS's troubles.

Something which might help is increasing DS's physical activity every day; running, climbing, jumping etc. not only a workout for the arms and legs, but also the abdominal muscles, which in turn can stimulate the gut.