Stool withholding - 2 years of desperate training

[yellowdino]

Hi, I'm seeking for any further advice on how to help our 4 year old with really terrible stool withholding. He was first prescribed laxatives when he was 6 months old and had suffered from constipation regularly until he was about 2 years old when it finally became more manageable with higher dose. He no longer suffers from constipation only this has left us with a permanent state of stool withholding and constant soiling. We go through 5-6 sometimes 10 underpants a day.

Whilst potty trained for a wee - he now started to wee himself as he strains / presses his bladder whilst trying to withhold the stool.

He starts school in September and we're at a breaking point emotionally as this is a constant, every 30 minute condition regardless of when he consumes food/drink. Going out has become near impossible as he'd have to hide under a table in a restaurant every 20-30 minutes and he's fully aware this is embarrassing him.

As parents, we're really desperate now. We've tried all of the below over the course of 3 years but the recent 6 months have been really difficult - we can see him suffer not just physically but emotionally too as he constantly apologises and gets upset about something he's not in control of. We tried:

- apps

- books

- songs, stories, etc various resources explaining what needs to happen, both playful and educational

- routine sit downs on toilets / potty

- prolonged sit downs with funny books

- encouraging to use a toilet after a meal or when cramping occurs

- talking about his fears and explaining

- not doing anything at all and let nature take its course in the hope we stop bothering him and he stops worrying

- offering a nappy when he thinks he might need to go so he just goes without worrying

- letting him soil himself to see if this bothers him

- softening the stool with laxatives so he cannot physically withhold

- offering and explaining we can visit a doctor's who might help

- asking pre-school staff to routinely do all of the above for consistency

- rewarding when we make a small progress

As you can see, none of this has worked and I just don't know what to do anymore. The other day I witnessed a group of children laugh at him as he stood upset- this has broken my heart; I cannot have this carry on.

Thank you in advance for any support or direction one could offer.

[Yaleamanda]

Disimpact him again and use a stimulant laxative alongside the stool softener, keep him on both once you have successfully disimpacted for maintenance dose. The stool softener will only serve to soften the stools you also need a stimulant such as senna to help stop the witholding of poos. Keep on doing what you are doing. It takes time and lots and lots of patience. Speak to the school about getting a care plan in place for when he starts school.

[14crosstitch14 in reply to Yaleamanda]

We'v tried all sorts and found she dose more useing the toilet for us than at her mum's because we have her exerciseing playing out and walking. Not relying on a car to go everywere. Drinking plenty and exercise will help and regular toileting after tea. Explaining that the sooner their done the sooner their back to doing what their doing the less messing we have to do with them.

[Shellbags]

Also following this post. My daughter is exactly the same. She is a little younger and luckily school for her is next year, but otherwise I could be writing this post. We also have tried everything and I am emotionally drained from it and so worried about other children laughing at her. Like you, we can have up to 10 accidents a day. If we can get her to do any on loo, they are tiny bits. It's like she has no clue how to push. We found a whistle on the loo helps her a bit to push. It's so frustrating and worrying isn't it? I try to be positive but it's not always easy! I've spoken to a few reception teachers and they say it's very common in reception. Have you found your GP useless with support? Apparently at 5, they can be referred to a specialist for support. X

[yellowdino in reply to Shellbags]

GP are way too relaxed for my liking - all I’ve heard in the last 3.5 years is give more laxative. He’s not constipated - it’s (sorry TMI) of peanut butter consistency - he simply refuses to go. And when he soils, he gets upsets saying he promises next time will be better and 10 minutes later he’s doing exact same thing. We’re now exploring a private psychologist because I just don’t see how after years of persistent training we’re not getting better. I know he won’t be a 16 year old soiling himself in a pub but he will be deeply traumatised by the bullying of his peers in the run up to that which will cause a whole lot of different issues..

[Hidden in reply to yellowdino]

I don’t know if you already have a psychologist in mind but if you don’t, I can recommend the private psychologist we saw. We have a different path to problems as you but I had got myself into such a mess right before my daughter started school, and she was really helpful at getting things on track if not immediately resolved. Best thing was feeling that my own anxiety was contained.

If you’re interested please DM me (assuming one can do this here…?)

[Hulahoops]

Are you using stimulant as well as a softener?

[Toes11]

Hello. I just want to say we were in this position with my daughter for a number of years, from age about 2 to 6, and it is very, very tough, so I have massive sympathy and, as much as it will sound like a platitude and difficult to believe, I think the only thing you can do is keep trying and trust it will get better.

We think our daughter's problem started with constipation and moved onto withholding, which she became adept at disguising, and which it took us a very long time to cotton on to.

Apart from one traumatic incident in public (thankfully not too public) after many days of withholding, which did seem to change her behaviour for the better, I wouldn't say we had any single breakthrough, but a number of things together, over time, did help.

You haven't mentioned anything specific about diet in your post, and I know the effect of different foodstuffs on individuals are highly variable, but we found regular fruit (fresh and/or dried) and limiting the amount of bready foods we gave her helped somewhat. I think drinking water was also helpful. I must say, in retrospect, I think we didn't focus enough on her diet, which sounds crazy now, but there you go.

For the after-meal routine, we used to set a timer for 15-20 minutes, when she would go to sit on the loo. I think we tried that because she often refused when we asked her to go ourselves, whereas it sounds like your little boy acknowledges it is a problem, so it may not be relevant in your case.

We moved from senna to sodium picosulphate, which definitely made a difference (took a little bit of practice to get the dose right).

Last summer we also paid for a few calls with a child psychologist (over Zoom). Those weren't cheap, and frankly we were desperate, but the Dr did seem to establish a rapport and that was when things began to turn around.

I've just asked my daughter what she would recommend (she's still 6, and not completely out of the woods, but so much better than she was). She mentioned the timer, fruit, and 'reminding, but not nagging'.

Keep going. Good luck.

[yellowdino in reply to Toes11]

Thank you so much. I actually agree - I nag. It’s difficult not to after 3 years of every day nagging - that’s about 1000 days now.This is very helpful, I’ll try more fruit. He actually attends a full time nursery with a very well balanced diet and he only drinks water (very rarely milk).

[Rosieabc]

I totally agree with Yaleamanda. You need specialist advice and a stimulant such as senna. Senna has been a route out for us.