DSD constipation/withholding

[PooWorrying12345]

Quite a long story but we think DSD might be withholding when at DH (her dad) and I’s house.

DSD is coming up 4, she’s with us 4 days a fortnight and with mum the rest of the time.
She was quite late potty training, only in the last few months has she mastered weeing.

She still has a nappy for a poo, she did go through a phase of going for a poo on the toilet when with us but never at her mums.

She will normally ask her mum for a nappy but never will with us, she always says she wants to use the toilet.

For the last few years, she’s been suffering from constipation, not formed stools, etc. We’ve done elimination diets, probiotics, etc and are now waiting for a gastro referral.

For about a year, she’s been on lactulose. Recently, this started causing “leakage” so she’s prescribed laxido should she need it.

Before the leakage incident (one weekend), she would try to use the toilet but not be able to go. Since then, she’s been super reluctant to use the toilet but also won’t put a nappy on. Even once persuaded, she doesn’t poo in her nappy. She just doesn’t go.

Whenever she’s not been/is constipated. She’s always grabbing her bum but she won’t really tell us why…we’ve also tried to talk to her about why she’s stopped using the toilet, does she know when she needs a poo, etc but I think she might be a bit young to really understand.

The last two times she’s been here she hasn’t done a poo, this time that meant she hadn’t for a week, but as soon as she gets back to mums then she does one pretty much straight away. She normally poos every day/every other day at her mums.

Does anyone have any experience at differentiating between constipation and withholding?

And how to help with the latter at one parents house but not the other?

Sorry for so much information, I’ve tried to write it down orderly but it seems to jump about a bit!

Are the 4 days shes with you in a row or are they broken up?

@grecianurn82 they’re in a row due to distance. Arrives at tea time one day and home for tea 4 nights after that (if that makes sense).

My son withholds when he isn't at home, he's been constipated since newborn he's now 3.
He has a stimulant to help him go but even on high doses of that he will not poo anywhere but at home.
I hope you have better luck with a gastroenterologist that we have, we've been dismissed by 3 so far, I'm having to seek private care as I'm just told it's normal!
Is she uncomfortable with it? There's not much you can do.
Have a look at ERIC, it's a children's bladder and bowel charity, they have information and you can call a helpline for advice.

When she was having the 'leakage', was it suggested that this was overflow? It may be that she needs a complete clear-out, I think it's something like 12 sachets of laxido.

If there's no physical reason you have to look at the psychology around this. Withholding is very often about control and feeling in control. I wonder is the 4 days a fortnight too long a stretch for her? She doesn't see dad for 10 days but then is away from mum for 4? These are long gaps and stretches for a small child & while some children may cope well with this a lot don't.

@MissingThePoint1
We don’t really know what to expect from the gastro department, whether it’s scans, etc. What was your experience with them?

This time last year, she was experiencing constipation at each home and she has been in a lot of pain. She was so constipated that she couldn’t pee due to the pressure, this happened as recently as 6 months ago. Luckily, she seems to have improved over the last few months but can seem a bit tired, lethargic, lack of appetite, etc.

I didn’t realise ERIC had a helpline. Thank you!

@Littlefish
We thought it could possibly be overflow but I’m not sure as she kept running to the toilet so she could feel it. She also came to me if she’d “leaked” in her knickers so she must have been able to feel something. The dietician recommended stopping the lactulose and switching to Laxido after that and it hasn’t happened since which could suggest it was the Lactulose causing that?
Even on the Lactulose, she would eventually have a massive clear out.

@Magda72
I can appreciate what you’re saying about it being a long time. This has always been the set up, I’ve always had this role in her life and she’s always spent time away from mum (less when she was so small). The current 4 days has been in place over 2 years now so I’m struggling to understand why it would now be a problem.
The other thing that I find odd is that previously both homes were experiencing constipation but now it’s only ours?

I’m not sure how to get to the bottom of it to help her.

I think you'd be lucky to get scans.. my son has never had any physical examinations and groups/forums I'm on seem to have the same experiences.
They'll ask for details and feel her tummy to see if she's impacted. My son has never had any testing done despite not going to the toilet without a high dosage of laxitive since 2 weeks old.

If she goes fine at home just not at yours it probably is psychological as someone else mentioned. As an adult I only like to go in my own home on my own toilet.

I’m not sure how to get to the bottom of it to help her.

Magnesium deficiency?

@MissingThePoint1
Nothing more than the doctor has done then…it’s like the constipation has stopped but the withholding has started.

If it is withholding, what can we do to help?
Is there anything…especially as she’s fine at mums?

@SpaceshiptoMars
Pardon the pun!

I’d not heard of that but would it be more consistent?
She had to have a blood test as she was very late walking so I imagine it would have come back of that too? Maybe not though 🤷🏻‍♀️

Sorry you’re going through this, it’s rotten. My 4yo DD had terrible constipation as a toddler, seemed to grow out of it, then it came back when she started school last Sept. I’m not familiar with laxido but we’ve found movicol to be great for helping with the physical side.

When I spoke with the GP I also mentioned my concerns about the psychological side as she was obviously withholding. They referred me to the local child continence clinic and I had some good advice from them. We found the thing that helped most (apart from laxatives!) was having a routine of sitting and trying for a poo in the morning and the evening - if your DSD has a regular time she sits/goes at her mums you could keep to that too? No big deal if she doesn’t manage to go, but she has to try, and to sit for e.g. 5 mins (on a sand timer). We were recommended to try sticker charts but it didn’t work for us. We also talk about toilet stuff openly so it’s not a big deal/something shameful. Much as I don’t especially enjoy announcing what I’m doing when I’m in the loo!

For us it’s still a work in progress and she’s still on a maintenance dose of the movicol but at least we’ve moved beyond the pain/soiling/distressing bit. As a pp said ERIC has lots of useful info too. Good luck!

Not the classiest of links, but constipation plus anxiety is a bit of pointer.

www.express.co.uk/life-style/health/909493/magnesium-benefits-deficiency-constipation-blood-sugar-pressure

and this, bit more technical:
magnesiumandhealth.com/magnesium-and-constipation/

@Aozora13
Thank you for this. The sitting and trying sounds like a good stepping stone…would I do this with a nappy though or on the loo?

Her routine at mums sounds like mum automatically puts a nappy on each evening and dsd you poo shortly afterwards.

I have to say, I’m glad she’s not starting school this year. She does find it a bit embarrassing no matter how much we all talk about our bowel habits!

@SpaceshiptoMars
Thank you for those 😊 I’ll read up on it!

www.eric.org.uk is the best website for info on this sort of thing.

That’s good she’s got an extra year before she has to deal with toiletting at school.

We do the toilet sit without nappies, so once after breakfast and then once in the evening before bath time. I have to say I personally wouldn’t encourage a routine of putting a nappy on for her to poo in in the evening as presumably she’ll be night-training sooner rather than later so might be confusing for her? But if it’s a choice between that and no poo I can see why it might be tempting!

I’d also really recommend a book called “stool withholding: what to do when your child won’t poo” by Sophia Ferguson. It’s free on Kindle if you do Amazon.

@Aozora13
Thank you, super helpful!
She’s actually dry at night, no nappy. She literally has one on to do a poo at mums and it comes pretty much straight off again by all accounts.

I suppose sitting on the toilet here and not using a nappy can’t hurt as she’s stopped going in a nappy here anyway.

It’s hard to know what to do. I don’t want to force her to use a nappy but then I don’t want her to not poop for days on end.

@nocoolnamesleft
Thank you, I’ll do some reading!

You've not said much about what she eats/the family diet. But the sort of food which is generally good for digestive/bowel health could help.

So moving away from ultra-processed food to stuff that's got a bit more fibre, plus fresh fruit and veg might be worth trying.

@JennieLee
She’s got a really good diet, not much at all in the way of processed foods. She’s been under a dietician too regarding elimination diets, etc. We looked at going down the FODMAP route but, due to the lack of consistency, it’s thought not to be intolerance related.

We have struggled in the past with getting her to eat (obvs being constipated didn’t help with this) but she’s doing brilliantly now.

@PooWorrying12345 ahhh ok hmm that’s an additional complication! I think my inclination would still be towards “we poo in the loo at Daddy & PooWorry’s house” and idk maybe get her a new toilet seat or something to make it more enticing? I’d be a little concerned she’s internalised the message that you can only poo in a nappy so she waits until then. But I think you could do with seeking professional advice on how best to handle it - either via GP or ERIC.

I really feel for you, it’s hard enough managing it in one household, never mind operating across two.

@Aozora13
Thank you, she’s at the gastro department soon so DH can ring ERIC in the meantime.

It’s hard seeing different things across different households, I think it means we have different attitudes to the issue.

Ive been giving her some time in a nappy to try and mirror mums house but she doesn’t even go then. So stressful and I keep worrying that it’s something we’re doing wrong 😰

Thank you for everyone’s advice though!

Could try a nappy in a potty as well. That way she isn’t wearing the nappy but if it’s a comfort type thing. Just leave a clean nappy in a clean potty all day for her to go back and forth too freely in the bathroom she might go.

@Horst
Thank you, I’ll give it a go…it might encourage her to at least try rather than ignoring that she needs to go altogether

@PooWorrying12345 my DD did this while at her Dad's house when she was little & then at school - only place she'd poo was at home! No organic cause so was put down to control/anxiety. We had lactulose / Movicol. DD was also very late potty training (only just by the time she started school at 4.5 and even then we had at least 4 accidents a week). It's really tricky with withholding as over time it can turn into constipation. For DD it started resolve when she was about 6 or 7 and honestly, it wasn't that there was an ''issue'' at her Dads, she just found change very, very hard to adjust to. Some kids do.. its just how they are 'wired'.

You've had some really good advice on this thread, I'd only add probiotics (helped DD ) and establishing a bit of a routine - so encouraging her to sit on the loo at regular times and try. In terms of nappy / no nappy - maybe be led by her? Offer both and let her choose. If the withholding has a psychological root, that's a way of giving her control in a small way. Maybe invest in a 'princess' toilet seat & let her choose some pretty knickers? Also plenty of fluid, not drinking enough can compound and make it harder to go etc.

@MissingThePoint1

I think you'd be lucky to get scans.. my son has never had any physical examinations and groups/forums I'm on seem to have the same experiences. They'll ask for details and feel her tummy to see if she's impacted. My son has never had any testing done despite not going to the toilet without a high dosage of laxitive since 2 weeks old.

If she goes fine at home just not at yours it probably is psychological as someone else mentioned. As an adult I only like to go in my own home on my own toilet.

Palpitating in the bowel isn't always accurate. We were told by multiple doctor's DD was not constipated. When I took her to our to current GP she ordered scans to check. They showed she was severely constipated. It took 2 years to get to that point. She's now been on a treatment plan for over 18 months. Her bowel still isn't back to normal, but the really bad wake up crying pain is gone now, big relief.

OP if there's a show she loves and sits still for you could try putting her on the toilet with her favourite show on tablet, or in front of TV. Try to normalise using the potty/toilet at her Dad's house, attach a positive memory to the use of these