Living in a poo nightmare - DS nearly 5.

[fondantfancier]

He's soiling at school nearly every day. He's been dry in the day for over a year now, although that did take ages. He's never got there with poo. We've had very limited success...and I mean limited. Over 95% are done in his pants, wherever he happens to be. He never tells anyone, not even us, and will deny it til he's blue in the face, but you can tell he knows that it's in there as he won't let you check him. If he's not done it he'll happily let you check.

He's still wet at night, and sometimes soaking in the morning. His little sister isn't dry at night yet, but is fully potty trained and happily talks about ever movement in great detail, but he wont even mention it.

We've tried charts, presents (wrapped up in a bowl by the loo so he can see them) promises of big presents when he reaches the top of the chart...he either eventually gets to the top and gets the present without actually being fully trained, or loses interest. We tried a sticker for doing it right, then taking off the sticker for a poo in his pants...that didn't work. He can pretty much clean himself if it's not too dried on. Charming thought, but as he doesn't tell people, then sometimes it gets missed.
We've tried taking toys away, making him sort the pants out, reading books, talking about it, letting him see us...nothing seems to help.

Last year the doctor was absolutely horrified (I'm guessing she didn't have her own kids) and told us to make him stay on the loo til he's done it...that could take days and would just freak him out. The health visitor said he would just get it in his on time and not to worry, but I can't help worrying and want to him to crack it.

He's not constipated, the poos are normal and he can squeeze them out really fast if he needs to.

The school have been Ok, and have changed him, but today suggested getting in touch with the School Health Team which has set me back. We have changed doctors so I'll get him to the new one just to start talking about it more and seeing what support is out there.

Any advice or supportive words gratefully received because I feel like we are all going slightly mad.

How do you know he is not constipated? Has he had X-ray ? If not demand to be checked for this.

My son in the past sounds just like yours, I only found out when he was 9 years old that "normal poo" can occur while chronic constipation with obstruction higher up in the bowel.

2 years on we are still dealing with the issue as the long term constipation has made the muscles so weak we are looking at a long time before things are normal.

Please please please go get an X-ray done to check for constipation higher up the system.

I think you need to go back to the Dr or ask for some more professional advice.

When my DS started school he went through a phase of soiling, I think caused by constipation as his bowel was impacted further up. Because his bowel had been so full for so long he couldn't pick up the signals properly for when to go then We started having 10 minutes 'toilet time' after breakfast and again after his evening meal and gradually he got into a better routine and now 2 years on he's generally not bad although he does still need reminded to go sometimes. I found the ERIC website really helpful.
www.eric.org.uk/Parents/information_constipation_parents

My DD is 4, and we had major problems with poo training. What worked for us was backing right off. No rewards for success on loo, no punishment/fuss with accidents. The idea was poo-ing sould be just another normal matter of fact daily activity free of emotion. What made it click for me was realising I was giving a running commentary on poos all day (do you need a poo, let's try and do a poo, well done on the poo, oh dear an accident etc). I think it was too much pressure on her (including the positive rewards etc).

I won't say its easy to keep a neutral tone when dealing with yet another accident when you can see all the body language signs that its coming and dd should just sit on the blinking loo but backing off worked for us.

We just made toilet time as routine and boring as brushing teeth. At first we did 5 mins on loo with a bland unexciting book and minimal instruction (sit on loo for a few minutes now please) and left her alone, and after 5 mins if no action said 'ready to get off?' and if she said no left her to it for another 5 mins at a time until she wanted to get off.

As pp said don't rule out constipation just because poos look 'normal'. If your son is not going every day get something from gp and use long term until he does (dd is on lactulose).

Hope that is helpful

Thanks for the comments. He has had a prescription of Movicol last year, which didn't seem to help. How long would you generally keep on this? The effects were awful and he was so upset each time as he had no control even a couple of weeks in. With him being at school I don't know how he would cope. I guess we could start it over Christmas so we were with him for the first bit. He does go pretty much every day.
Anyway, he's booked into the new doctor at the end of next week so hopefully that can be a start.
In the meantime we're getting him to sit on the loo regularly after meals and trying not to get too stressed.

My son has been on movicol for nearly two years now, and doctor said it would take that long for the recovery of muscle control following the long term impaction being cleared.

We initially expected it to be around 18 months, but he had another episode of constipation and it has delayed recovery.

Doc and physio say footstool under feet while on toilet and try blowing up a balloon (apparently helps with the right muscles!)

Getting the right dosage of movicol is important. For children with a once off episode of constipation, it is dealt with slightly differently to long term high up impaction.

Please go get this checked properly and get the right help as needed. The earlier it is dealt with the better with impaction.

Oh and my son went daily with normal looking stools too, hence why I was so late getting it properly disgnosed. Daily stools does not mean all is ok.

Has anyone said the term encopresis to you? some good sites out there for parents if you google it. The school health team should have a continence nurse who is usually very helpful. You mentioned books, did they include the one 'sneaky poo'?

Is he scared of the toilet? Some children are scared of the water splashing or falling in or don't like big toilets where their legs are dangling.

Have a look on the ERIC website, there is loads of good stuff on there.

My d's struggled with poo training and then impaction/constipation.

We are finally getting there after a referral to a consultant.

I hated Movicol due to the lack of control you describe and have since found out I gave far too little and never fully cleared the bowel.

Consultant prescribed movicol up to 8 sachets a day and then examined ds to make sure he was completely empty, then we reduced it(over 2 week period) doc also prescribed pico sulphate- ds hadn't had this before and I honestly belive this has made the difference.

First appointment with doc was 3rd October and ds now goes at least every other day and usually every day. He's not had movicol since 14th October but he's continued with his pico.

I was in the exact position you were 4/5 months ago and I remember the anxiety and frustration so well.

Our consultant has been fantastic, I can actually call him to chat anytime and if he's not available he will call back within the hour- I can't speak highly enough of him.

It's really worth getting the referral, I wish I had sooner- I know so much more now about impaction and soiling and deal with things so much better.
Sorry for the essay, hope things improve soon x

Ok so, the doctor was lovely and explained everthing. He reckons DS had a bout of constipation ages ago which hurt when he pooed , then since then has held in his poo and stretched his rectum. DS has been prescribed Movicol again to clear him out, then on to a steady dose until his bowel strengthens. Feeling much better about it all (mainly because the dr drew a very inept picture of a pooing bum) . Just got to get him to take the bloody stuff now.
Has anyone any ideas about how to manage the effects at school? His dad works there which will help, but was thinking pull-ups might be a good idea for a while to help the teachers/support have less of a crappy job.
Thanks.

Glad you're feeling better.

We had the week of maximum Movicol and worried about nursery but ds surprised us all and managed to get to the toilet every time.

It was very loose and explosive but he did it on the toilet every time.

Nursery were fabulous and he had a huge bag of spares just in case.

Ds has managed without movicol for 2 whole months- he's on something called pico sulphate now which has made a huge difference.

Fingers crossed for you

Think I'll ask the Doc about Pico Sulphate as a few people have mentioned it. Think it'll take longer to get him to do it on the toilet as he's only managed a handful of times. we'll get there, just might be a bit of a slog (hidden carefully behind supportive mum face).

It sounds like you have a very good gp, that will definitely help.

I was scared of the movicol initially, scared to give too much but after speaking with consultant it's evident that I wasn't giving enough.

Ds hasn't been today, I've still got anxiety over it- thinking are we going back over? He did do four yesterday though so am assuming he's fairly empty!

Fingers crossed for you