Advice/tips for 3.5yo stool withholding?

[teaandtoast28]

Hi, I'm new here and am desperately looking for some advice/tips regarding my 3.5yo son.

He was only recently diagnosed with constipation/stool withholding after daily daytime wetting. He has been out of diapers for 9 months and all of a sudden started wetting himself. Toilet training for bowel movements had always been difficult for us and I am feeling so bad that we made so many mistakes along the way, including forcing him to sit on the toilet after supper until he had a bowel movement (which could be up to 45 minutes).

After starting him on laxatives which is indeed allowing him to have regular bowel movements, he has thankfully stopped wetting himself, but he is incredibly anxious when he feels a poo is coming; he will cross his legs, bring his legs to his chest, face will get red and will absolutely say "no no no" when i ask him to go to the toilet. He then soils his pants and is very upset about it, and only then will go to the toilet.

I've tried showing him videos/read books about why you need to poo, how everyone poos, etc and he understands why he needs to poo, but at that moment in time when the poo is coming, he just holds it in.

Any advice?

Thank you in advance.

[Helen36]

I’m afraid that time and patience is the best medicine here. Keep up the laxatives to keep the poo soft and reassure him as much as you can that you know he is frightened but that the best way to make sure poo doesn’t hurt is to let it come out. Tell him you will help him and that you understand. Never be cross with the soiling and keep telling him you know he is trying his best. Keep up the books / videos - they will help in time.

In the meantime, sit him on the potty or toilet 15-20 minutes after every meal. There is a reflex that naturally makes the bowel contract after a meal so this is the time that a poo will come most easily. It’s such a simple piece of advice and will probably feel futile to begin with, but it really can work.

If on the toilet he needs a proper child seat and a high step so his knees are level with his hips or higher. Tell him all you want him to do is big deep breaths and blows. You can give him blowing toy or get him to see if he can blow hard enough to waft your hair. This action engages the right muscles to let a poo out. Also ask him to try and pop/fart and have giggles with that to make it fun. Make this your routine and reward him for trying, whether there is a poo or not. Just do it for 5 minutes max, or however long you can keep him there to begin with.

If he realises a poo is coming, hold his hands and gently encourage him to focus on the breathing. Our job as mum is to be the midwife for every poo! And if a poo comes then celebrate with chocolate and mega excitement. Keep up it up, be patient and it will give you the best chance of helping him through this in time xxxx

[teaandtoast28 in reply to Helen36]

Thank you so much for your reply. I'm seeing minimal improvements now that we're on maintenance dosing and his stool is slightly more formed. But also when I look back, I think this may have started when he went into full time daycare (was previously doing mornings only). I have a feeling that he withholds in daycare (embarrassed? doesn't want to miss out? doesn't like the toilet there?) Other than talking to his teacher when school resumes, any other tips so that it doesn't worsen?

[Umapurman in reply to teaandtoast28]

Just wondering if you saw any improvement as this sounds like our girl right now xx

[teaandtoast28 in reply to Umapurman]

Hi! Things are a lot better now (still not perfect) but he still remains on a daily maintenance dose. As I’m still really concerned about him soiling at school (he hasn’t), I make him sit on the toilet in the morning (urge or not) and he usually produces a BM without much effort. During the rest of the day if he has to do another BM, he still seems to hold it when there’s a sensation but then he goes shortly afterwards. He hasn’t soiled his underwear in over 5 months and has only had maybe a handful of urine accidents.

Things will get better for you I’m sure!

I suspect my son will be on this laxative for at least a year.

[Umapurman]

Thanks so much for replying. Really glad things have got better for you. I’ve just got to find a way to encourage the toilet sit. She happily goes for her wees on there, but only if she requests - if ever I encourage a toilet sit outside of that, she gets so angry and agitated. We’re having a Christmas break and then hoping to get back to it with a renewed sense of calm. X

[teaandtoast28 in reply to Umapurman]

I just read your post and it seems your little one is younger. My son is now 4 and what has helped us is that he really does try to be more independent (he wipes his own bum, flushes the toilet etc) so when I can tell that he needs to go, we gently remind him that big boys go to the toilet themselves and then he runs to the toilet himself. He does get into moods where he says he doesn’t want to go, even when he clearly needs to but it’s just reminders about being a “big boy”.

Things that didn’t work for us: reward system, reverting back to pull ups, everyone else getting involved (extended family).

I know easier said than done, but try to not talk about it too much or make every conversation about poo.

There’s no harm in daily movicol (I researched extensively and got lots of reassurance from multiple doctors) and it’s just about finding the right maintenance dose.

Good luck!