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.

There are blood and skin prick tests for some specific allergens https://www.nhs.uk/conditions/allergies/#:~:text=Tests%20you%20may%20have%20include,if%20your%20symptoms%20get%20better

Constipation can be checked for using an x-ray. Lots of runny poos she doesn't feel can be overflow if she's badly constipated. My eldest has been on medication for constipation for 18 months and still going. Movicol not laxatives. Long term constipation stretches the walls of the bowel so 1 year plus treatment is necessary so the bowel can return to the correct shape. Short term treatment can clear the initial problem but it is highly likely to return. Firstly though you need a new doctor and dietician. There's really no excuse for that level of ignorance.

I was a firm believer of constipation last year & The paediatrician touched her belly and told me it wasn’t constipation and to stop giving her laxido (is the same as movicol) as she obviously does big sausage poos every when I get her to the toilet in time (doctor said if she had a blockage she would do perfect sausages).
hard to know what to do, I felt like a crazy mother giving laxatives to her child making her sick for no reason 😢

Have they done a coeliac test? She has classic symptoms (frequent sloppy stools, tummy ache, poor growth and skin rashes). I'd be asking for this just to rule it out.

Yes they did a coeliac blood test at ?8 months and another one at 3.5 years. All normal

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).

Oh please don't do that. She probably feels embarrassed enough as it is. I know it's frustrating and that is no way shaming you as it must be tough but don't let any HCP shut you down. They need to get to the cause of it and don't take no for an answer.

❤️❤️❤️ thank you. I am feeling guilty now, it’s so hard to know if it’s a medical issue or not. HCP are like: oh she eats so well and is so playful, if she was sick she wouldn’t be like this.

I agree with PinkPlastic. She needs a referral to the allergy clinic as well.

They are right that if it's non-ige Cow's Milk Protein Allergy, there's no test, it's usually diagnosed by eliminating it and then seeing if the symptoms lessen.

The allergy clinic can do skin prick tests to see if there's another allergen that she's reacting to and giving her the rashes.

I'd also ask for genetic testing, especially given that you are ND and she's small, there could be a micro-deletion causing problems?

Are you taking any ADHD meds @whatami2? It must be a real struggle to navigate all of this with ADHD. Have you found the ND MNers Section yet in the SN Section?

I hope you get some answers on Thursday. Is there anyway you can prepare a list of things you want to ask for and take it with you? I find putting lists in my phone helps as I usually have my phone with me and paper lists tend to disappear into thin air

@SiouxsieSiouxStiletto thanks for your understanding. I have written a list on my phone (as you, I always lose paper lists/diaries etc even though I love having a new lovely notebook it doesn’t last long). I’m not sure there is any allergy clinic in my trust but I hope the paediatrician can do a bit more this time…
I haven’t checked the ND section, but I will have a look!

There might not be an allergy clinic but I'd still ask. If she were mine id be pushing for the genetic testing too

What’s the genetic testing for? Sorry, I’m not sure I know what microdeletions are!

So she could have a micro deletion on one of her genes. DS has one and it's caused a couple of things that you wouldn't think were related but they are both due to this micro-deletion. Don't want to say what they are as it might be outing as it's fairly rare.

thanks For letting me know, you learn something everyday!

oh she eats so well and is so playful, if she was sick she wouldn’t be like this.

It makes me so cross when HCPs do this.
My dd had a medical issue.
At GP singing and dancing in waiting room. Cats bum face from receptionist who was trying to get an emergency consultant appointment for her.
I returned 3 days later to pick something up and she sarcastically asked me something about dd I replied that she's having emergency surgery at regional hospital on Thursday - cue receptionist looking astonished and saying - Oh so there was something wrong with her!

We've been at A&E with her dancing round the waiting room, then admitted and in an operating theatre by the end of the day. At the point she was admitted she hadn't eaten for 2 days and had had no fluids for 24 hours. But she was still life and soul of the party.

No-one believes that she is ill. But that doesn't mean that she isn't.
Young children are often like this, so don't let them fob you off.