DD (4.5) starting YR in Sep, but started soiling herself

[gabsid]

DD (4.5) is a settled, happy little girl, enjoys preschool, but in the last couple of months, since just before Xmas to be exact she has started leaving little amounts of poo in her knickers. This happens most days and often several times per day.

We have seen the GP twice and spoken to the preschool. Everyone seems to think its behavioural and suggested using star charts etc. We tried all that and a friend says her DS did the same because he was disgusted by what came out of him.

It has been going on a while now and she is starting full time school soon where it will be a problem.

Has anyone experienced similar and/or can suggest causes or solutions? I would be very grateful for any input.

Has she been checked for constipation? It could be that she has no control of the soiling and so star charts will never work. I'd ask for a referral to a paediatrician as she may need longterm bowel management and medication put in place as if it is chronic constipation there isn't a quick fix.

She had a mild laxative prescribed which I gave her for a week. The soiling just became more frequent and messier, so I couldn't see the point in carrying on any longer.

By what she is saying I can't really be sure whether she has any control over it. We tried giving her a marshmellow at the end of the day if her knickers stayed clean all day. She seemed very keen on that and promised every morning that her knickers will be clean today and that she will go to the toilet if she feels she has to do a poo. Towards the end of the day she would be dirty and very sad not to get the marshmellow, or she would hide her knickers under the bed.

I just have no idea how to sort that out. It doesn't seem to be cronic constipation or could it be?

As I understand it, if she has chronic constipation you can get "overflow" around the hard poo which she would not be able to control. Another thought might be does she suffer a lot from wind? Perhaps she just expels a bit of poo with the wind?

If it really is chronic constipation (and I'm not a medical professional) a week of medication might not be long enough to resolve the issue. Why not go back to your GP and talk to them, ask about the expected timescales for 1 resolving the constipation initially and 2 timescales for long term management.

One more thing to be aware of when she does start school, some are better than others at helping the children. Do not be surprised if there is poo in her pants from not wiping properly, both mine went through this, as did the child of a friend. Remember at nursery she is probably being helped with this. I just reminded them that if they wiped better they would be more comfortable.

One week wouldn't be in anyway long enough to alter things tbh you will be looking at six months plus. You really do need to get a referral to a paediatrician and start getting this sorted now

I've had to deal with this on and off with my DS, who is now 9, and is pretty much normal in any other respect (ie no diagnosis of ASD or similar). It was only really dealt with when we saw a consultant who prescribed Movicol (a laxative) for him to take. It worked like a dream (albeit messily at first!) clearing him out and making him a lot happier at school, and confirmed to us that it wasn't him being deliberately naughty or disgusting; it was just that the poor little chap had been so bunged up for so long that he didn't have any clue when to go. He's still on Movicol (although only 1 a day now) as he does tend to get constipated very easily unless we force-feed him tons of veg. I think it started at school because so many teachers are rigid about loo breaks and won't let them go during a lesson (which I think totally inappropriate for Year R kids), and also because school loos are in too many cases disgusting and utterly lacking in privacy.

I found that DS needed a really big clear-out to begin with, going five or six times in the first day (he started out with a higher dose, cutting down gradually). It took about a fortnight for him to settle down to two loo trips a day, then (after about 6 months) just one. At first he really did need his change of pants and didn't always make it in time.

Dd2 did this a lot all the way through reception and half way into year 1.

It turned out to be constipation (mainly caused by not drinking enough), and got so bad that she ended up severely dehydrated and with a urine infection, where her bladder was being squashed by the backed up poo.

We started her on Movicol, a strict regime of drinking through the day (asked school to make sure she had drinks bottle on table - had to come back empty, small glass of water at regular intervals during day) and getting more fibre in her diet.

It took a couple of months to break the cycle, but we have now weaned her off the movicol, and she remembers to drink more, and there is no more soiling.

Yep, DD is now 4. She was not toilet trained till Feb, but we'd tried on and off from last summer. She would regularly soil her knickers a bit. Often several times a day. She was constipated. We gave Movicol but it didn't agree with her, so we moved onto apricots, prunes, linseeds, etc. Now it's just a routine thing - in the afternoon she sits on her potty (so knees up, feet supported) and plays with playmobil and does a poo daily. Since she's started pooing daily, no dirty knickers.

Hm, DD was perfectly toilet trained until this started. I didn't really think it was constipation as she did a poo every other day or so. We got Lactulose from the doctor to take 1x per day and things seemed to get very messy for a week, meaning the poo was a lot softer and there was more of it. Some of you said it would take 6 months? To achieve exactly what?

We will try the medication again for a bit longer maybe and go back to the GP.

hazeyjane how often did your DD do no. 2s during that time? Did it take several months to stop her from soiling or to get her off the medication again?

It does sound like constipation to me too based on DS' experience, and I have to say that he's been on movicol for months and GP isn't suggesting he comes off it anytime soon.

There seems to be a cycle of withholding which makes things worse and IME leads to the soiling you described.

Like your dd, probably every other day, sometimes daily, but sometimes she had to really strain, sometimes they were really messy (well, poo is always messy, but you know what I mean!) I think she would strain, then that would hurt, so she would start to hold it in, then back up etc. Then she started to have cramps, and started to get really uncomfortable lying down, and wanted to sleep practically sitting up. The dr said that this was where the blocked poo was stuck in a position that was hurting her back.

We tried lactulose at first but found it made her really gassy, and then she would be bloated from the gas. You also have to be really careful to drink more, with lactulose, as it I easy to get dehydrated with it.

The movicol is gentler, the only thing is she wouldn't take it, if she knew it was in her drink, so I had to sneak it in (they do a flavourless one).

It took less than a month for the Movicol, regular, water and extra fibre to start making a difference. She was then on the movicol for about 6 months, with me gradually reducing the dosage.

The last couple of days DD soiled several times a day and I am not sure she has done a proper poo (unflushed toilet but both DC said it wasn't them) so I may recognise this as a bit of constipation, but nothing as you described above, quite the opposite, she used to do nice softish poos every other day or so, therefore I didn't think she was constipated.

Could she still be though?

Definitely get some more professional input to see if she is constipated. There is a lot of information here on the ERIC website www.eric.org.uk/Constipation/information_constipation_parents

I have a DS8 who's been suffering since potty training and has been on Movicol since he was around 4. It's an on-going thing but nagging him to go to the toilet is a normal part of our family life

It takes six months because if a child has chronic constipation then their bowel becomes stretched and it becomes more difficult for them to achieve continence. Laxatives are used to clear out the bowels and then to maintain loose stools and allow the bowel to return to normal and promote continence again.

Thanks for the link I will have a look later when I have time. You all seem to think its constipation.

What puzzles me though is when it started she was doing normal regualr poos every 1 or 2 days?

The GP also asked whether there were any changes in her life or routines but I didn't think so as far as I could see. Pre-school said that was something a lot of DC go though and maybe try star charts.

We have gone back to the medication now and keep trying a bit longer as she seems a bit less regular as she was but we will go back and ask for more specialist help.

Even though she was going regularly she might have had a build up that was becoming drier and harder.The soft poos then seep round the hard poo adding to the build up. This initially appears as normal bowel movements. As time goes on the build up stretches the bowel and soft poo starts leaking which sounds like what is happening now.Your dd has no control over the leaking because the build up stretches the bowel leaving it slightly open.

Thanks for the explanation. The GP just talked about constipation and gave no indication about how long I should administer the medication for.

And the friend who said that it was behavioural for her DS is a GP as well.

My eldest ds had this problem, I think a paediatrician would be far more understanding tbh. Ds took laxatives for a couple of years to get things working properly again and then we had to be really obsessive about him getting into a routine of using the toilet. Busy five year olds get the urge and ignore it because they have other things to do this then leaves the stool to dry out and harden making it difficult and maybe painful to pass which then makes a child reluctant to poo and so the problem takes hold. There isn't a quick fix and you do have to manage it for them for quite a while.

I was about to post a link to ERIC but see I have been beaten to it. I'd really recommend a read of their website though.

One thing they do recommend us rewarding the behaviour you want rather than the result ie rewards for regular toilet trips and drinking rather than clean pants (at this stage she may not fully be in control of the state of her pants iyswim?) Ds had issues with wee rather than poo but it's worth bearing in mind that what starts as a behavioural issue can become a physical one. Hth

OP- I think the advice you have had on here is first class :-)

Soiling in childhood is almost always attributable to constipation.

Do the following:

1. Check out ERIC
2. Increase fluid intake at that age ensure she is having around 1.5 litres per day to drink.
3. sit her on the toilet for 5-10 mins after each meal. Get her to blow bubbles or trumpet or similar (she blows not you.) Feet should be flat on a step stool. Reward sitting on the toilet whether she poos or not.
4. get some Movicol Paediatric Plain from your GP and referral to paediatrician local to you as there are rare underlying causes of constipation that may need to be excluded.
5. Make sure she does plenty of exercise (keeps the bowels moving)
6. expect her to be on Movicol for a few months at least after things have gone back to normal and soiling stopped.

Good luck :-)

Thanks again!!! I have just been on the ERIC website (I had no idea it existed) and I now feel I know what the problem is and how to go about solving it.

Thank you all!!!

Starting school can actually trigger problems where there weren't any because they can be anxious about using the toilet there and end up constipated.

Good luck gabsid. Glad the ERIC website was useful...I have had lovely personalised advice from ERIC by emailing them too, when I've been having a panic about this with DS.

FWIW my DS who's 8 now goes to the toilet at least every other day. But he has a long term habit of putting off going (both wees and poos unfortunately) which must have started at potty training and got worse when he started school. So he has never done a poo at school ever and I was told that even holding it for a few hours can result in a bit of soiling in a child prone to this problem.

Also if you get Movicol paed, it's not absorbed into the child's body which means that it's very safe. That's one of the reasons I don't mind that my DS has been on it so long.

The complication of this kind of problem is that it is physical and psychological and the two play into each other. So it does have to be handled carefully with professional support. But, I tell myself it could be something far worse and as the school nurse said, time will also play a great part in fixing it.