4 year all never controlled bowels

[whatami2]

My 4yo girl has been able to pee in the toilet since she was 2. However she poos in her pants 3 times a day. Every single day. I have tried the positive approach with plenty of praise whenever she poos on the toilet whenever I force her to sit on the toilet (she farts a lot sometimes before a bowel movement but refuses to go to toilet). She was never ashamed of it. Saying out loud mammy I have poopd my pants, can you get me changed?.
she is in nursery because she wasn’t accepted in any pre school due to fea al incontinence. Doctors and paediatrician are useless. Blood and poop tests normal. Had white poop in a few occasions (blood test normal in ED). Belly sore very often, vomits at least 1 a month. I can’t think of any food allergy. She is very delicate and gags at the smell of her pee and poop.
we started being more strict in the last month and make her clean herself afterwards (however she starts gagging and she vomits if we don’t finish it). Now she is starting to feel some remorse when she poops herself but she cannot tell me why she does it.
we tried laxatives (1 per day) for a while but it made it worse- pooping all day, nursery send her home everyday. I couldn’t cope. Made no difference. ERIC website links everything to constipation but how to tell if she has it? She poops 3 times a day and it’s never hard!! She Denies pain when pooping. Hard to know if she can feel it coming, avoids talking about it. Reading poop books for the last year. Reward chart doesn’t work. Being angry either. She is going to summer camp on July and I don’t know what to do. She never has had a pee accident.

The first line is poop not pee! I wish I could edit!, it makes the whole post confusing!

If she is pooing 3 times a day - never mind where - then there is something amiss. I would not on the door of the medics again.

For a start preschool cannot discriminate against her this way. They are legally bound to accept her poop or no poop!
Secondly, have you any support from a continence nurse? Could the nursery refer her via Senco if GP isn't helping? Social stories (Google) may be more effective than being strict/shaming.

This is driving me crazy. Nursery is always complaining and calling me to pick her up because her poops are soft. Teacher telling they don’t have the resources to clean her x 3 times/day. In primary school they won’t change her, but call me. Does that mean I will have to give up my job? My job is too far to be able to travel to/fro x3/day. can I get my gp to sign her a medical certificate to get help at primary school? Sure if it’s normal, schools should cater for that, and if it’s not normal she needs special needs assistance. I work in the nhs and I couldn’t refuse to get an old person changed, I don’t know how schools get away with having insufficient staff to do this.
she could have chronns or something serious but paediatrician just keeps reviewing her every 6 months with a blood test not having a clue of what to do next.

Paediatrician said that pooing 3 times a day is normal for some kids. We are at the gp every month. Gp said that she Cannot be referred anywhere else (child incontinence nurse is for over 6 year olds). Health visitor could only advise on reward charts. She had a very white poop a few times and blood test in ED came back normal, they said “it happens sometimes, maybe she had had a virus”. I am at my wits end. At least here in Northern Ireland they take her into the school, but I would need to go and get her clean every time she poops, which is not sustainable

If she's pooing 3 times a day and has a sore belly have you tried her being Dairy free for a couple of weeks to see if things improve?

i think she had milk allergy when she was a baby (fully breastfed). I went off milk and she had a milk free diet until she was 1.5 we started reintroducing milk slowly. Even then, she never improved (blood in poo disappeared forever though). I went through a period at 5 month old of being off soya and what not. It drove me crazy. And no change in her. Honestly if it is so hard to see an improvement how am I going to ever find out what ingredient in the whole world she is allergic to? Dietician just discharged us. I never truly believed it was allergy to milk. I have adhd so I cannot remember or write down what she ate. I cannot see changes either unless they are very evident. We tried a period without milk but I could see no changes and it was so hard to avoid traces and everything that I became suicidal. It feels like something airy fairy, if it was something real there would be tests and symptoms

6 month review with paediatrician again and she is just going to be blank face for the whole appointment (she is lovely, just doesn’t know what else’ to do), get a blood and poop test and that’s us for another 6 months. Why can nobody do anything? She has already missed pre school, god knows how many more things she will miss in primary school because of this

Is she neurotypical?
Does she have social and communication difficulties?
Does she wear pull ups?

Every doctor keeps referring me to the ERIC website, which I find no uselful: the cause of everything is constipation even if she poops too much.

Yea she is neurotypical and very good behaviour wise and very bright. She wears pull ups at night only. Was dry for a long time but 2 months ago started wetting at night every single night

I think there are two things to focus on here. Neither more important than the other, work on both simultaneously.
She needs to be able to wipe her own bottom and get rid of a pull up in the bin. I know she’s young but if you work on it as a skill then she can at least go to school.
Then yeah you’re going to have to start fighting with the NHS. It isn’t good enough that she is starting to miss education because of this. Could there be a psychological element? Does she know when she needs to go - can she feel the urge?

It feels like this is a very difficult case that doctors cannot solve. They just keep pushing the can down the road and say that it is normal for some kids. She had so many blood taken in her 4 years and is terrified of it. All for nothing

Okay so now she’s wetting at night? So this is a change. When is her paediatric review?

on Thursday. Well she hadn’t been wetting the bed for a few months and then she started again. But poop incontinence has been consistent.

i ask her if she can feel it and most times she says no. She wipes herself but she cannot reach her anus her arms are too short (she is very small 92cm at 4 years, but I am small so doctors say it’s normal)

So definitely let the doctor know that. Then tbh I would say - nicely - please can you tell me what other things it could be. There must have been other children in the history of paediatric medicine that have had this and it not be constipation. Ask if an abdo X-ray could be helpful to see if there are faeces in the bowel to rule that out. Ask for immunology to check for allergies. Ask if it could be coeliac disease. Then eventually, if all these things are refused, say you are going to refuse to leave the office until there is a different plan than poo and blood tests and waiting it out.

What's her diet like? what are you feeding her?

Awww that’s difficult then

I have adhd so I cannot remember or write down what she ate.

You provide the food; you could write it down as you cook it. Or at the table.

I think she’s chronically constipated, so has lost the sensation of fullness in her rectum, and is experiencing overflow.

Which laxatives has she been prescribed and in what doses? Has she ever been properly cleared out of poo?

I would start a sit schedule.
Morning, night, and 20 minutes after each meal to make use of the gastrocolic reflex.

Let her watch a tablet or have a fidget toy. Could blow bubbles. Sit for ten min. No pressure to do anything more than sit.

Agree ask for an X-ray to rule out constipation.

OK a few things. I am afraid I am not 100% if this is same in N. Ireland.

school will refuse to change her and say that they will call you every time.
They are not allowed to do this if it is a recognised problem. What they have to do instead is make a care plan for her for school.

So pre-school shoudl have a care plan in place. This will list who can help her clean up and change her. There are some kids who due to medical reasons are not fully toilet trained when starting school.

I order to make this happen, you are probably going to need a letter from the doctor stating that this is a medical issue that she has been under the doctor for for more than a year etc.

The other side is getting to the bottom of what it is.
It is most likely either some sort or allergy or she has some kind of bowel issue (crohns /coeliac etc) because she has both stomach pain and loose stools. Ask for complete set of allergy tests.

You could start to eliminate things from her diet. It really isn't that hard to go dairy free. Stick to one supermarket and to a very simple diet for first week, then slowly start ready the packets and adding things in. So Asda bourbon biscuits are dairy free, add them to the list etc. Then shop with what's on the list.
My dd has a friend who is dairy free and I manage pretty easily to feed him, easiest way is real food (meat potatoes/rice and veg) nothing processed and then there are no lists of ingredients to read.

Stick to any diet chaneg for a couple of weeks.

She eats what we eat: rice or pasta with loads of vegetable. Meat/fish. Fruit at least twice a day. Porridge one a week.
In September she was prescribed laxido for a few days. Had diarrhea for 5 days. nursery would not take her back. She had a stool test which showed norovirus (no vomiting). Next time I gave her laxido she also had loose stools x5 day after only one sachet. So I am afraid of giving it to her again. Surely after norovirus she couldn’t have constipation?
mShe is very skinny with a big tummy and has had rashes on her skin and once she woke up with a swollen knee and X-ray showed liquid in her knee, so I’m thinking it could be chronns or other inflammatory disease

Doctor and dietician told me there are not tests for allergies?