Poo With holding

My 4 year old has been with holding for almost 2 years, we have had a very tough time with the bad moods and the stomach pain that it gives him. We were finally referred to a peadtrician in February and have just had our appointment (7 months later!) She has ordered blood tests and said she will see us again in 6 months and just to continue with one movicol a day. My little boy is only going for a poo once every 7-9 days and it is making him miserable. I'm sure it is not constipation though as his poo is normal and it isn't painful for him when he does finally go. He has also in the last 2 months started soiling himself as he is holding it every time he gets the urge, this is now a worry as he has just started school. The peadtrician has said that it might be psychological (I agree as it all started when he was poorly with constipation and his little brother was born) and said that the school nurse will be in touch to maybe have some talking sessions. Has anyone had a psychologist/ nurse do any of these talking therapies? After waiting so long for this appointment I still don't know what to do/ expect. Sorry for the garbled message, thanks for reading.

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  • It sounds like he needs a disimpaction with the movicol followed by a maintainence dose. Have a look at a YouTube video by a nurse,Sandra Hanson, called tackling childhood constipation with macrogol(movicol). It explains it so much better than I can. I haven't found a magic cure and my daughter still has issues after five years , she is eight now and things have slowly got better. Good luck xx

  • No experience of talking therapt but wish I had, something like this seems to be missing from the local services we have. So i'm curious to follow your post and see if anyone has any experience of talking therapies/psychology help, or if you manage to get some. fingers crossed for you!

  • We saw a psychologist for 6 sessions on the nhs. Basically all that came from it was that things would change as he matures!! it was more like I was in therapy than talking to my son and as a therapist myself I found this bizarre, “How do you talk to him about his problem? Do you have a good support network at home etc etc” a bit patronising to be honest. As a paediatric psychologist she was dealing with a broad spectrum of issues and I’m not really sure she was used to dealing with Incontinence issues. The thing I would say was from our situation is that she didn’t feel it was psychological. Your Gp or school nurse should be able to refer you to your local peds centre or see if you can self refer. I’m biased but I believe talking about it helps them, anything is worth a try. Just to add, she was right though, he did mature and we are getting through this now.

    Have a look for poo goes to poo land, I think it’s on an app now too

  • Wow I can't believe what bad advice you have been given! If it's the same situation as my daughter constipation followed by stool withholding (she's 4.5yr now been going on since she was 18 months) you need to aim for having a nice soft poo once per day! He is definately constipated if he's only pooing that often otherwise where is the poo going?

    It sounds like over flow soiling the soft poo is seeping around the hard blockage, he really needs disempacting with movicol and starting from scratch with a good maintenance dose of movicol, toilet sitting routine, ensure his water intake an diet are helping not hindering the issue.

    I can really recommend this book; stool withholding, what to do when your child wont poo, i got off amazon, made everthing make sense. We had lots of bad advice from gp, consultant said give her water! etc Basiclly were still fighting this problem today daily due to lack of knowledge by head consultant paedatrician as she was left struggling to poo for so long without treatment.

    It's a vicious circle both physical and psychologicol, one impacts the other.

    If you look at thepoonurses.uk that has a great video which explains it all.

    Really hope this helps, I know what a struggle it is!

  • Thank you for your advice. I've bought the book and it has helped me to better understand what he is going through. I'm waiting until half term to disimpact. On the 'poo nurses' video it says not to disimpact without consulting a doctor. To be honest I've had zero help from them over the last two years, do you think it's safe for me to go ahead and do without proper advice? Even after seeing a paediatrician I still feel at a bit of a loss of what to do. She told me to get blood tests but after two visits he will not let them take blood and it's only now I've been told about a specialist phlebotomy unit for children- think it would have been easier if we were sent there in the first instance.

  • It sounds like they are looking for an underlying problem, but from what I've read there rarely is one and if he was ok for a while until he got constipated its probably the constipation withholding cycle that is the issue.

    We've had no help from Dr's either, yes we see the continence team here in Manchester (you can self refer here apparently) 1 person to 200 patients I believe!! So if there's one in your area you could go to your gp and get a referral or self refer. To be honest the only use they have been is to be an NHS point of contact and they are able to help you devise toilet sitting strategies etc which gives you the push to carry on trying when it all seems hopeless! Also they can help you and support you with meetings in school.

    If you think this is the problem then if I was in your position i would try the disimpaction routine in half term, movicol just adds water to the bowel. You could follow the instructions on the poo nurses or the ERIC website and make sure he is completely cleared or the problem will start again. Lots and lots of fluids, make sure he's drinking plenty, nappy cream to prevent a sore bum, and pull ups pants wipes etc! You could tell your GP what you're planning. Mine told me my daughter wasn't constipated after feeling her stomach, she was in an awful state with the worse case of constipation in her life, I of course knew she was, that was then they agreed to refer us to the continence team

    I spoke to the continence nurse over the phone on Friday and have got her to refer my daughter to a psychologist and to prescribe dulcolax alongside movicol. I don't really think the psychologist can help by talking to my daughter but they might help us to understand some of her responses when she refuses to talk about it I suppose.

    I think solving this problem is 1/3 - Being on the right amount of laxatives (after disempaction), 1/3 - ploughing on with toilet sitting routines, reward charts and gentle encouragment whilst knowing when to be firm and when not to push it! and 1/3 - when the child is ready, and their fear of toilets/ pooing has subsided a bit.

    Good Luck x

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