4.5 year daughter in reception partial with holding causing accidents does she need different meds?

[caz205]

Hi There, Im wondering if anyone can help, my 4.5 year old daughter has been on movicol for 3 years and has been constipated since birth and with holding for years I suspect.

She has just started reception and she has been having 4 - 5 accidents per day the last couple of days (we've sent her in pull ups until we can figure out whats going on) The school are ok so far and we have to meet with them tomorrow to formulate a plan of action. If anybody has been dealing with this long term with school age children, can you tell me what we can do for the best to help resolve the problem please, its so stressful and im really worried about the long term psychological and physical damage that's already been caused!

Things we have been trying over the last 3 weeks;

Toilet sits;

- She has only recently started sitting on the toilet to 'try' as she was terrified and hysterical if we asked her to. We are doing it after breakfast and after tea, however she just sits there and I don't think she's 'pushing' or 'trying' as such. She has managed to poo a bit a few times very hit and miss and its always in a pull up. How do I know if she is pushing or actually able to push and knows what im talking about!

- We are praising the trying and rewarding heavily for effort but she doesn't seem that motivated, is this because she just has no control and cant 'try'

- is this pattern of bits of poo 5 x a day always over flow, so she has no control and knowledge that it has happened? This is what I suspect.

The week before she started school we realised that she must be constipated again as she was having lots of little accidents, not knowing anything about them and didn't seem to know when she needed a poo, so we tried to clear her out with movicol which we thought had worked well, but I think she may be constipated again now 3 weeks later - is this possible?

Im wondering if she needs to add in another med to help her push or in your experience do you think when cleared out and on right maintenance dose of movicol this will right itself?

Thanks so much in advance!

[squizita]

If she is not constipated it isn't always "overflow". Other reasons could be holding on and just having to go, then clenching (my daughter does this!!) like a form of partial witholding, or if they are really loose a high dose plus a change in the weather.

Mine is 3 and started nursery school, who said kids with issues always have a bit of a lapse when they start (thankfully to know!) and routine is everything.

I read on a website a good strategy for teaching 'pushing' for a child who won't. Don't tell them to push, tell them to breath in, suck in their tummy button, blow out and try to make their tummy bottom touch their bum hole by pushing it down! Mine found it hilarious and the laughing helped a poo pop out!

Another book I read suggested that having a huge push session every night will l,ong term teach the body to be 'ready' after home time, so that maintaining emptiness will be easier long term.

[Luella19]

I can very much relate to what you are talking about with little bits of poo 5 times a day, my daughter was very similar at age 4. She is 7 now and was seen by a consultant last year, he explained that the little bits are not always overflow, I don't think my child ever had overflow as was never very constipated but he explained that it's literally bits of poo breaking off a whole poo that is in their bottom and ready to come out. Because they are holding it in (probably without much thought as it becomes habitual) but then bits start to leak out.

It sounds like you are doing everything you can, getting school on board is half the battle as it eases your stress. Time, patience, resilience and staying calm got us through it. It is a long slog but it can get better. It felt at the time that it would always be a massive problem but thankfully now it's only a small problem.

Good luck with your meeting at school x

[squizita in reply to Luella19]

Yes I read about this in the "ins and outs of poop" - they explain to the kid it's as if there is a balloon full of mush - once it's full the un-knotted end leaks!

[caz205]

Thanks both that's great information, I understand it more now. Ive just bought that book so i'll read it tonight thanks. Im really sad because school have suggested she take a day off tomorrow as the school nurse has spoken to our continence advisor who said she needs a movicol clearout. I'm happy to try it but not convinced its the answer.

School have said they can't cope with 6 accidents a day and asked if this was her normal, i said no but to be honest I don't really know what her normal is. I cant see how she will be able to poo at school ever, and how we can give her the right dose of movicol to keep her pooing so she can't withhold but doesn't soil her pants as she can't control it! Is there no medication that we can try that makes her poo an hour later for example?

Luella19, did the problem become easier as your daughter got older? I don't think mine can understand when we try to explain things, I was wondering if it's easier as they mature?

All this is making me feel like a failure and i feel like i'm at the bottom of a pit and there's no way out!!

[squizita in reply to caz205]

We went to our specialist this week who suggested looking at WHEN you give the meds. So if you give it 1st thing in the morning see if this encourages a poo then, or ditto at night time. We are trying tea time as our Dr thinks it might mean out child gets a big push urge after dinner.

[Luella19]

Please don't feel a failure, you are not, it's just one of those things. I am the same mum to both my daughters and one had poo issues and the other not.

Yes age helped massively, the older they get the more they can understand their bodies and signals and social awareness.

I felt totally in that pit too, I really did. We initially did clear out with sodium picosulphate and then 1 per day movicol for couple of years. When 4/5 the soiling was quite regular sometimes at school, sometimes at home, when out etc. But she still pooed in potty and toilet too, it was very weird. Never really understood. Went through clean periods of a few months then a months of occasional soiling. The consultant last year prescribed daily senokot alongside movicol and that really helped but also the consultant talked to her about her new toilet routine and what he needed her to do, sit on toilet for 10 minutes each evening after dinner and try and poo (he was such a lovely man) because he told her she did it. We used to talk about the doctor each evening on the loo and how we would tell him about how clever she was etc.

The problem is still there but only ever at school or holiday camp, basically anywhere away from family. No problems at home.

The worst bit for me was thinking it would never get better, but please hold onto the fact that it can. I would say we are 90% there now.

That ins and outs of poop book is great too, I read that. The author has a good website too I seem to remember with some good q and a sessions x

[squizita in reply to Luella19]

Yes and there's a book called "stool witholding" by S Furgason who is a UK based psychologist - it's on amazon and very similar to the ins and outs of poop.

Our Paediatrician also suggested tweaking doses and sits to the evening. Logic being if the child is susceptible to deliberate pushing/holding becoming unconscious reflex, use that to help! Make their body crave a poo about 6 or 7pm between tea and bedtime. Early days with us but fingers crossed.

[Hidden]

School is a very stressful time for young children and regressive toilet behaviors can be expected. She may need to be asked privately or taken to the toilet. When the mind is active with new experiences it's easy to lose track of bodily sensations and needs. Is she being given enough fruit in her diet? stewed plums every day with yogurt for breakfast still works.

[caz205]

Thanks everyone for your help!

I spoke to poo nurse on Friday and she is referring her to a psychologist although I'm really not sure that will help, but like you say Luella19, if someone else like dr tells them to do it they are more inclined!

I have got that book stool withholding thanks, just need to refresh my memory and read it again, such a long chronic problem I forget what we tried and I read in the past!

The nurse prescribed dulcolax (picosulphate) on Friday, we used a bit over the weekend along with 8 sachets of movicol per day, im a bit worried about this one, has anyone got any experience with using this type of laxative? She did say on Sunday that she needed a poo so I thought it may have given her back the feeling to push? Not sure if she's only supposed to be on it for a few days or long term?

If she could cut down on the soiling at school and approached them to say when she needs a poo it would be like winning the lottery to me! Im really worried because they are talking about going part time if the soiling is still so often!