Fully emptying bowel and toilet training

[Sam2020]

Hi,

I would be so grateful to anyone with any advice on the below. My son is 3 years 3 months old. He suffers from multiple food allergies and about 3 months ago we finally got his issue diagnosed of stool withholding. I kept thinking it was his diet but his stools were often soft. He definitely suffered from constipation when he was younger though and this lasted for a few years. He’s on one sachet of laxido a day, and two every other day unless he starts passing lots of stools and keeps trying to go. We also put in a teaspoon of flaxseed oil. He’s doing much better now in that he’s passing stools much more regularly. Mostly every day or every other day. However I can’t tell if he’s fully emptying his bowel. For instance he could go 3 times a day and then the following day do a really large one. What size should his daily stool be? He is very tall for his age but also very thin and I think this has had an issue on him not gaining weight. I’ve heard you can try feeding them sweet corn to see how long it takes to pass through him but he won’t eat the stuff!! Any ideas on how I can tell if he’s not fully emptying bowel or the dosage is too high?

We’ve also just started toilet training. This was massively led by him. He wanted to do it!! He’s fantastic at weeing on potty or toilet and is sometimes dry overnight and wakes to go in the night. However while he’ll sit and wait on potty he seems unable to poo. He pooes on all fours or standing up and can still do a slight dance. How do you encourage them to poo in a sitting position. He did a giant poo in his pants today. Should I actively put nappy on or how should I tackle it?

Thanks for any help.

[Helen36]

Hello - just spotted your post hasn’t had any replies. My daughter’s five now but we were in a similar place at your boy’s age, albeit with lots of wetting problems that still continue now ... which is why I am still on here!

On the subject of poo size, can you tell us a bit more what it looks like? The continence nurses tend to worry more about girth and colour than actual size. The holy grail is a smooth, slim, pale sausage. More frankfurter than Tesco’s finest if you know what I mean! However, your laxido might mean they are more of a cow pat, which is fine too. Any dark brown poo or cracked surface on a sausage can be a sign of constipation so that is what you really need to have your eyes peeled for. There’s something called the Bristol stool chart for children and it’s worth tracking your child’s poo against this as this will be the best guide as to whether there is any underlying constipation. Do you think you could sneak some beetroot into his food? This can be used for a transit time test too I think but maybe have a google for other alternatives that might fit with his allergies.

For my little girl, we kept her poos really soft (cow pat like) for a long time after we recognised that she was withholding. They remember the pain for AGES afterwards and I think it’s worth erring on the too-loose side to help them. His bowel might be a bit stretched from the constipation and keeping it too soft will help it get back to normal. I’d also suggest trying to be really consistent with the laxido, maybe one and half every day rather than upping the dose on output. Consistency is really what helps them learn.

Also, how’s his drinking? My little girl was terrible at drinking, but if you can, get as much fluid (preferably water) down him as you can. At least 5-6 cups a day. Invent whatever silly games you can to get him to drink.

So, moving on to the actual pooing. You have dry days and some dry nights!!! This is completely amazing and you need to bank this success now and keep going! I think poos will probably be a long road for you, but that seems to be totally normal for a lot of kids out there. Bulk buy pants from primark because there will be some pants that are just not worth trying to save! When he needs a poo, offer him a nappy. Encourage him to go to the bathroom if possible to do it, and always offer him the potty as well. But other than that, just go with the flow, and tell him, when he wants to try the potty he can. Just say ‘maybe next time you might like to’. Poos are scary to him, so just let him take it at his speed. Don’t get cross with him if he soils, just say ‘let’s get you cleaned up and remember, next time you need a poo you need to tell mummy’. Have a big reward ready for when that day comes that he does do a poo on the potty. My daughter had a pair of winter Spider-Man pyjamas she wanted that we waved in front of we said her every day for about six months that she could have when she did one on the potty. It was summer by the time she got them, but it was worth it as far as she was concerned!!

However, the main thing you can do to help move things along is try to get him to sit on the potty about 20 minutes after each meal. There is a reflex we all have that means this is when we are most likely to get the urge. Just sit him on there and get him to try and blow a balloon or blow on a musical toy as this encourages the urge. The knees up position of the potty should help. Do whatever will get him to sit there, even for 30 seconds (like ‘you can look at my phone’) just to form the habit. Don’t ask him, just say ‘potty time’. Don’t say it’s to try for a poo, just say it’s potty time.

Final tip is that there is a great book on amazon called ‘meet the poos’ that is designed to take some of the fear out of poos. My daughter is five now, we’ve long passed the book to a friend but we still use the language in there if she’s feeling nervous about doing a poo. It’s about £8 I think.

Sorry, didn’t mean to write an essay... good luck and celebrate those wees in the right place. He will get there in the end with poos too 👍

[Sam2020 in reply to Helen36]

Thank you so much for your reply. I’m very grateful you have responded and for your advice. My son’s stools are always very soft like a cow pat. They vary in size. Last night he finally did two poos in his pants, one very small one (soft) and then another one probably the size of a small apple. They are brown in colour - he drinks Neocate Junior due to allergies so his poo may be slightly different colour to others. What puzzles me is he’s really keen to do the poo on the potty and sits there but doesn’t seem to know how to empty his bowel if that makes sense. He will push a wee out. He then ends up not going at all. Thankfully the laxido is keeping things moving. He only manages to get one out when he’s on all fours with one leg in air and does a kind of jiggle. I do think his bowel is stretched as we had an x-ray earlier in year and it was huge and full of soft poo. I don’t think he’s frightened of pooing anymore but it’s like he’s never fully learnt how to empty bowel. Do I up the laxido or just hang in there and be patient...

[Helen36]

Hiya - given that they sound soft and cow pat like I think stick with the laxido dose you’re on. I’m slightly unsure about this too. Maybe try a week of a higher dose to see how that helps?? You could always do half a sachet or a quarter of a sachet, or even a few teaspoons. I always think it’s better to be too soft to help him get it out but I realise I am probably just confusing you more now! Or you could try a bit of prune juice or dried apricots as they are a bit of a laxative (which will help push) rather than just a stool softener (that just holds water in the bowel) like laxido. Does that make sense?

Great to hear he had one last night. An Apple size sounds ok. I have a 2.5 year old with no problems pooing and she does some enormous ones and some this sort of size so hopefully that reassures you that it is normal to have variation.

In colour terms, the darker the poo the longer it’s been in the bowel so just monitor it to get to know what it looks like for him with his neonate and, gross as it sounds, maybe do the same for your own so you get to learn how to observe how these things vary naturally.

In terms of helping him learn to empty, the regular sitting after meals and blowing on something (a little windmill or bubbles) is the best way to teach this as the blowing action engages the right muscles. (Think antenatal classes for pushing a baby out!) You can also ask him to try and do a trump and see if he can get it to make a noise to help him work out what to do (and is brilliant fun of course!). Also, get him to watch you do a poo and get him to put his hands on your tummy as you do it so he can feel the way you engage your stomach muscles as you go. Then you can ask him to copy what you do. Sorry, there’s no dignity on this forum! Anyone else he can watch like other children, siblings or cousins of a similar age can be really helpful too. It’s great that he will sit on the potty, that is half the battle. If he wants to carry on actually doing his poos on all fours, let him carry on with that for now, but just encourage the after meal sits and blowing to help him learn the sensations. It sounds like such a pointless exercise but it’s amazing how this can work for them and the potty position is his best chance of fully emptying the bowel.

There’s no quick process with this unfortunately but have faith that he’ll get there. Just keep the stools nice and soft so they keep coming and don’t get sore for him.

Have you found the ERIC website? Lots of information on there too and their Helpline is great if you want to talk to a professional directly. X

[Sam2020 in reply to Helen36]

This is all really helpful advice and I’m going to try it all! I’ve upped the laxido to two every day and will see how it goes. He’s just done another on all fours this morning. I’m going to try order a trumpet online and we have lots of bubbles. He asked to poo on potty last night and happily sat for a long time but in the end said ‘I can’t poo mummy’. I’ll try some of those foods to see if that stimulates things. My only thought is his bowel has got very stretched or he doesn’t know how to fully relax so poo comes out, he seems to cautiously let small bits out at a time so it’s a sensation thing. Hopefully upping laxido for a bit will help.

On a separate note we have an open appointment for paediatrician about this for 6 months before they discharge us. Any advice on what to ask? Last time she just said read ERIC website but that was it. Is there anything I should get her to check? I’ll post let you know how we get on. Thank you very much for the advice.

[Helen36]

Hiya - I’ve been mulling this since I replied and I think upping the laxido is the right thing to do. We kept my daughter’s super soft for ages at his age and every time we tried to reduce it she started going less often. You’re almost certainly right that his bowel is stretched and so keeping it moving through fast is the best way to help it shrink. I’m not too sure about the sensation side of things but I’ve always felt my daughter actually finds it easier to ‘feel’ the sensation when she has more Movicol in her.

In terms of the paediatric appointment, it’s great that you have some specialist advice. The first thing to ask is if you can see them again! Just plead not to be discharged or ask for a referral on to your local paediatric continence team if your area has one. These teams of amazing ‘wee and poo nurses’ usually don’t take children before the age of 4 but have long waiting lists so if the paediatrician can refer on now at least your son will be in the queue for it. It can take months for a bowel to get back to normal and the main thing is to make sure you don’t drop out of the system so you can talk to someone who understands his history and can give you the best advice. GPs can be very well meaning but most of us on this forum find we know more about childhood continence than they do...

I’d also suggest asking the paediatrician about Senna/senakot. I don’t know what age they prescribe this from (he might be too little still) but sometimes they give this to children with stretched bowels to stimulate bowel movements rather than just soften and help keep it clear to shrink.

You could also ask for an ultrasound to check for any remaining impactions in the bowel (blockages) and the have the bowel measured. At least this will give you a data point for the future if problems persist. We had this done at the bladder and bowel clinic my daughter goes to at the Evelina in London and I wish I knew what it was back when she was first constipated so I could at least tell whether it was getting better!

On a happier note, the fact he asked to poo on the potty makes me think you are not that far away from it happening - he clearly wants to and is really trying for you. I think it will all come together soon and the penny will drop for him on how to make it happen. Just try to remain calm, supportive and gentle with him and he’ll get there. I want an update when it happens!! 😆🎉

One final idea I had, is whether he might like sitting on the toilet? The general rule is that kids don’t like this when they are very little but with a decent kids seat and asking him to put his feet on the seat so his knees are right up might work for him. Worth asking him if he’d like to try it if you haven’t already x

[Sam2020 in reply to Helen36]

Hi Helen, thank you again for your advice and sorry for my slow response. I’ve booked appointment for follow up. They can’t see us for a few months but I can keep calling for cancellations. We’ve regressed quite a bit in that he started withholding with the toilet training. He got distressed at peeing when he poos in his pant so we’re on pull up pants all the time now. He withholds at Nursery although did go once there this week. He’s been pooing now all weekend, several times a day. When we try potty or toilet he just says it hasn’t come. I had a slight success with him infront of iPad on potty but it’s like he doesn’t know how to relax and release the poo. He started physically jumping up and down to keep it in. He’s now sticking bun in air and wriggling legs and then pooing. I’m just relieved he’s pooing again now.

Your advice about measuring bowel is great. It would be good to compare size. He’s had one x-ray so I wonder if they can compare from that? He’s seen for allergies at Evelina and they’re amazing but not seen there for bowel issues.

Thank you so much for the advice - I will definitely let you know the day we manage a poo on the potty. When did your daughter manage a poo on potty/toilet?

[Helen36]

Hello again and sorry for my slow reply in return!!

Very sorry to hear not more positive news of progression. ☹️ That’s the trouble with bladders and bowels, it always seems to be one step forward, two steps back. I think going back to pull ups if he is scared is the right thing to do. It will help him feel in control of everything and keep him pooing which is the priority. I know it’s disheartening to go back to pull ups but please have faith he will get there in the end.

There’s a good book called ‘constipation, withholding and your child’ written by a paediatrician that you might find useful to read. (It’s on amazon) One of the things that helped me is that it says in there that children who withhold are technically potty trained because they are acting on the sensation of needing to go, they just need to change what they do! I think it took us a good 6 months+ to get a poo in the potty and it wasn’t all plain sailing after that. A big turning point for us was the ‘meet the poos’ book i mentioned a couple of replies ago. I would literally tip the poo out of the nappy in the loo and wave goodbye to it (which makes sense when you have read the book!). I think it just helped make it more fun and take some of the fear away for her.

The tricky thing for you though is knowing whether he can feel how to go without doing his wiggling. I wondered whether you might be able to say to him to take deep breaths and blow outwards when he’s doing this just to try and calm him and to mimic the practise after meals on the potty, and just have the potty next to him when he’s going in his pull up so if he wants to choose to sit on it, he can.

Will he still do a sit on the potty after meals even now he’s back in pull ups? This routine is really key if you can persuade him. And if the iPad got success, I’d say keep using it.

Hope you get your appointment soon but try not to be disheartened. X

[Sam2020 in reply to Helen36]

Hi Helen,

Thanks for the tips and all the advice. Been using the poo story you’ve mentioned for a while. He does talk about it so it must help explain things eg. He says his weed and poos go to wee or poo land. He’s fine with us putting the poo down the loo. He also is happy to sit on the loo. He’ll sit there for an hour but I think he sits and holds. He’s so disappointed when he stands up though and nothing is there. When we up the laxido it’s quite distressing though as he literally will be trying to poo 10 or more times a day. Not sure what to do. I’m sure he’ll get there in the end. I did try the deep breathing and iPad again but no joy. I might try get a soft toilet seat and a trumpet!

[Misty10]

Hi aslong he is going every day it doesn't matter on size they like it to be firm and soft .