Ongoing Witholding issues and tummy bugs

[VicOsbo]

Hi,

My daughter is five and a half, has had poo withholding issues since potty training at two and a half. After a lot of battles with Health visitors and the GP, she was eventually referred to the hospital where the paediatric consultant started her on a disimpaction regime. To cut a long story short, after several disimpactions, various doses of Senna and later PicoSulfate, we don't seem to have made many much progress. At Christmas my daughter had a tummy bug, this caused her poo to become very loose (not diarrhoea) for the following few weeks and the consultant suggested that perhaps the bug had caused her gut to 'reset' and to trial taking her off all meds. She also suggested that sometimes a tummy bug can cause temporary lactose intolerance. So, we took her off the meds and she started withholding again. I gave her one sachet of Movicol and this produced dramatic diarrhoea but got rid of the tummy ache. No more Movicol. The loose poo continued for a week so I took her off lactose, this helped a bit.

Last weekend, another tummy bug struck. My husband and family are very sceptical about the meds AND the lactose intolerance but have latched onto the 'gut resetting' idea: since Sunday, my husband has asked me to keep her off the medication and let her have lactose to let Nature run it's course. So far, when I am successful in getting my daughter to sit on the loo for 20 mins she can produce a small amount of formed healthy poo. In between loo visits she is having poo accidents in her pants at school. Last night, she cried in pain whilst on the loo doing a poo. She seems to hate sitting on the loo and pushing. She'll happily sit there with my iPad though. I'm at my wits end and cannot see an end to what has become a battle with my gorgeous daughter, and potentially my husband. Has anybody had any experience of their child recovering from withholding issues and constipation following a tummy bug?

[ERIC-Charity Partner]

Hi VicOsbo, we're sorry to hear about your daughters issues with poo. Its common for children who have been constipated to not like to sit on the toilet as they can associate it with feeling uncomfortable. Its a real positive that she will sit with the iPad, anything that can distract her is fantastic. Keep going with a toilet routine and it will hopefully reduce the accidents, we suggest sitting for 5 minutes 20-30 minutes after every meal time, bath time and bedtime. Unfortunately passing painful poo's and soiling are signs that she is still constipated and we would suggest getting her back on a daily dose of Movicol to help keep that poo soft and easy to pass. We would also suggest following our guide to disimpaction if you decide to restart the Movicol. eric.org.uk/Handlers/Downlo.... When she has passed brown water you know that her bowel is completely cleared out and it should become a little easier to find the daily maintenance dose. Because she has been withholding/constipated for some time its likely that her bowel has lost its tone and she may not get reliable poo signals but keeping her on a daily dose of medication and preventing her from becoming constipated will allow the bowel a chance to shrink back and recover.

Its likely that when she has had her tummy bugs that they will have in some way cleared out her bowl but really that's a short term measure as she will still be prone to constipation. Unfortunately we have never heard of a gut resetting following a tummy bug. Its quite common for the gut flora to be changed following a bug and this can lead to diarrhoea. She potentially could have a lactose intolerance but it would be difficult to say as her meds were changed around the same time which would also have had an effect. It can be useful to only change one thing at a time so you can establish whether there is an effect. Natalie@ERIC

[VicOsbo in reply to ERIC-Charity]

Thank you very much for your reply Natalie! I have since restarted her on the Monvicol and she does seem to be settling down a bit - we have a review appointment with the hospital consultant in a few days' time so hopefully that will provide us with a longer term strategy.