Urgent help please

[Arshieahmed]

Hi iv been on here before for advice on my 4 year old who constantly soiling his underwear. It’s a big concern now he refuses to go to the toilet. He will just soil his underwear whilst standing up. We’ve been to the doctors and they’ve said he’s got no bowel issues. Please mums could you give me some advice or help. Much appreciated.

[squizita]

It sounds very much like "witholding" (enopraxis) which is basically that the child has had a bad experience (constipation or an acidic/nasty poo), got scared and held in, then the next poo was dry and hard to pass ... and it gets into a vicious cycle with no medical cause except that they've managed to train their body to hold on. And of course, it's got to come out sometimes - so there is either leakage where some soft poo from behind the hard poo leaks out or (ironically the luckier case - as with my daughter) eventually the hard pellets pop out into the pants by weight/pressure. Of course this feels nasty and starts the cycle again.

The ERIC website and the book "the ins and outs of poop" both give good advice regarding treatment - in line with NHS recommendations. Arm yourself with the print outs and take the child back to the GP.

A strong macrogol (stool softener) is given - at first a high dose to make all the clogged up poo liquid and move it out, then for months - or even a few years - a low dose to 100% ensure poo is always soft and comfortable. Meanwhile you reward and praise attempts to push out poo daily. Give prizes for deliberate pooing - you sometimes have to teach them how to poo (min had forgotten - the Ins And Outs Of Poop has instructions!).

Very gradually they will do more and more poos on the toilet, stop being scared and thus poo their pants less. However even if they learn quickly sometimes the bum is not used to processing the signals, or might be distended inside so again it's a slow journey.

On these forums, some kids have it really badly and others less so. My daughter started treatment in April and now goes 6-10 days without an accident, and accidents are usually small when they occur (I put a Tena Lady in the back of her pants and the tiny bead of poo goes on that, so often we just change that - it used to be HUGE dry logs!).

Hope that helps and gives you some encouragement.