At my wits end

[JCAMRM]

My daughter is 3.5. Started potty training last November. She got good at asking to go do pees, and then something would just put her right back to the start. She was good again and now having more frequent accidents. With poos, she has never been good. Would be prone to constipation. Have been giving lactulose which does soften the motions. A few weeks ago she cried when doing a poo and it has been awful ever since. One day I’d to change her 7 times.
Now even getting her to sit on the toilet is an ordeal and she holds on so long with her pees that sometimes she asks to go but then we don’t get to the loo in time.
I am at a loss as to what to do now. Might bring back a reward chart.

Is the constipation under control? Is she on a daily maintenance dose of movicol? Until that is sorted it will impact on her ability to know when she needs a wee and how urgently, as well as making her scared to have a poo leading to more accidents.

She is taking Lactulose daily. I feel it is under control but I could be wrong. She tries to stop herself doing a poo. Also doesn’t appear to be bothered when she poos her pants. She does get upset if she wets herself.

We had issues with poo withholding. Lactulose just contracts the bowel, it doesn't soften the poo so it'll still be sore when she's passing it. She needs to be on a proper stool softener such as laxido or movicol to help with the constipation and to make the poo softer coming out and so she doesn't associate it with pain. Laxido/movicol are what should be first line treatments for poo issues. Too often Lactulose is prescribed by doctors who aren't clued up on bowel issues.

The poo nurses website and the ERIC website all have really good information on this.