Poo glorious poo!

[Fishandjam]

Or not. Anyone got any ideas or shared experiences?

DS (aged 4, recently diagnosed with mild ASD) has poo problems. To cut a long and stinky story short, he was constipated and probably withholding last year, around age 3.5, at the time he achieved being dry during the day. He then started soiling himself almost every day. After no progress with potty training and after he told me that doing a poo "made [his] bottom cry" I took him to the GP who prescribed Movicol. We then started getting nice soft poos but the soiling continued. We eventually got a referral to a GI paed who diagnosed an over-distended lower bowel with all the accompanying loss of sensation etc. We are now on a twice-weekly Bisacodyl laxative suppository as well as the Movicol - after 2 months we're supposed to stop the Bisacodyl and see if the bowel has returned to its normal size so that he can achieve continence without it.

The problem we have is that DS really doesn't like the idea of sitting on the potty or toilet to do a poo after the Bisacodyl. He wants to wear a nappy and lie in bed to poo. He's also never been even slightly bothered by the idea that he's pooed, whether in nappy or pants. We have tried all kinds of inducements to get him into the idea of sitting on the potty at regular intervals after food, as well as sitting after the suppository, but he's just not interested and gets angry or distressed if we force the issue. I'm at a bit of a loss as to how we can get him to continence if he doesn't even care that he's sitting in shit! We don't want to put him back into nappies as he then gets lazy and wees in them too, rather than going on the potty or toilet.

With primary school looming in September, we just want to get his arse sorted out. We're conscious that he will probably find school enough of a struggle without factoring in the need for a change or two of pants each day. (If the school are even willing to help with that...)

I'm just so sick of the smell of poo.

Can he reliably communicate to you the need to poo, or be taught to do so? It might be better to allow him his nappy to poo in, but he needs to ask for it, first, then, once he's done the job, back to pants. You will, of course, reward him greatly for cooperating with this compromise.

Thanks for responding ouryve. The problem is that without the Bisacodyl, he really doesn't seem to know that he needs to poo. Hence the constant soiling - it comes out in bits and bobs with no warning, due to the colon and rectum being overstretched and unable to contract properly. (At least that's what the GI paed thinks.) If he showed signs that he was doing it - straining, looking thoughtful, going off to hide behind the sofa or whatever - then it would be easier, I think. The Bisacodyl is great in that we know that within an hour of it being inserted, we'll get a dump the size of his head. (Getting him to have the suppository is a performance in itself - understandably, he hates the whole process, and the first time I didn't get it in far enough and the wretched thing kept popping out like some bloody prairie marmot.)

I wonder if we could say that he can have a nappy, and that he needs to sit on the toilet when the poo comes, but with the nappy on?

That might help him make the association. It's definitely worth putting on one him after inserting the suppository (only a SN parent could discuss this stuff, whilst eating lunch!)

DS2's a long way off training, but he has occasionally sat on the loo with a nappy on and weed or pooed.

That awareness of needing to go is so often absent in children on the spectrum, anyhow. DS1 wasn't fully clean and dry until he was 7. He oculd wee in the loo, but hated the sensation of pooing and would rage if we tried to persuade him to do it on the loo. We weren't successful until we noticed that he was often waking up clean and dry. Being physiologically ready made it far easier for him to tackle the sensory and anxiety issues (with huge bribes). He still leaves it too long, quite often, then complains of tummy ache. He refuses point blank to use the toilet at school, even if offered the chance to use the adult loos in the Surestart or even the nice (it's very nice - they all clubbed together to get rid of the grey formica!) staff loo. So it's still not plain sailing.

We'll give it a try. What's the worst that can happen?!