6 year old soiling

[MarkJ31]

Hi,

We have a 6 year old boy who has had constipation issues - wouldn't pass anything for ages. He was prescribed Movical and that seemed to do the trick, we had him sitting on the toilet in the morning and evening and actually having a poo which was like Christmas come early.

However he has since stopped doing it on the toilet and we now have a soiling issue instead. He must have some control as he's fine at school, it's when he gets home that the accidents happen. We sit him on the toilet after meals and after the accidents but he won't do anything on the toilet, but will then often soil himself again later.

He still has Movicol so I'm not sure if this could be linked to that or too busy doing other stuff / laziness maybe. It doesn't seem like he tries when he is sat on the toilet, though I guess it is hard to know how much effort is actually going on. He's a bit behind with his development so maybe that could be playing a part.

Looking for any thoughts or suggestions really as we are a bit lost! It is so frustrating thinking you are there with the toileting problem and then another crops up!

Thanks!

[Yaleamanda]

You need to disimpact him and include a stimulant such as senna into the regime.

[MarkJ31 in reply to Yaleamanda]

Thank you, we will talk with the doctor and get a stimulant laxative.

[Helen36]

Hiya,

First of all, you are doing all the right things, so well done! But it is also so normal for there to be a backwards step in the constipation journey.

It’s hard to know for certain what’s going on but I have a few thoughts for you to think about….

- it’s possible he’s getting backed up again and is scared it’s going to hurt and so is witholding. When he soils, what does he do? Do you see any red face, knees pulling up?

- Or, does he seem completely oblivious? A child’s bowel wall is not as rigid as an adults and so constipation can make it lose structure. This can mean they find it hard to push and can’t feel the poo coming when it does. As you said he doesn’t seem to be trying on the loo and he went a long time without going, my hunch is that this is possible. It’s odd he’s not soiling at school, but it may be he’s just more worried about it there and it doing a better job of stopping any little bits get out - impossible to sustain 24/7.

So … in terms of what to try (and the above 2 options could both be true!). First of all, always assume they are getting backed up when they soil and up the movicol dose ASAP. If you can bear it, I’d suggest doing a disimpaction to ensure he is cleared out, as if there if is any blockage in there, anything else you do won’t help until that is gone. (If you need more info on what a disimpaction is, just ask and I’ll explain/ give you some links). It’s not fun, but definitely preferable to do in the school hols if you have some time off.

Secondly, when he does his toilet sits, reward the sit (whether there is poo or not). Ask him to take deep breaths in and then long blows out. (I get my daughter to try and waft my hair from where she is sat). This blowing engages the muscles in the bowels and weirdly helps the ‘urge’ to push come.

I’d also suggest speaking to the doctor to get a ‘stimulant’ laxative added in (for after the disimpaction). They typically start you off on sennakot but there are lots of others. This stimulates the wall of the bowels which helps it recover the muscle tone over time. It generally also helps give everything a bit of ‘oomph’ so helps stop the poo backing up again if the wall has gone a bit floppy.

Hope that helps and good luck x x

[MarkJ31 in reply to Helen36]

Thank you for the reply,

I don't think it is option 1 - there is no red face or knees pulling up. Option 2, oblivious, certainly fits the bill although amazed (and grateful) that the school day can pass with no incidents!

We will up the movicol dosage and speak with the doctor to see about a stimulant laxative and will try your suggestions.

Thank you so much for your help!

[Bambie83]

In addition to what Helen36 said - while on the toilet we’ve tried blowing into things so balloons, bubbles and our favourite a water bottle (one with a straw in). We pretend she’s blowing up balloons and it lightens the mood and helps they muscles at the same time.

[MarkJ31 in reply to Bambie83]

Thank you, we will give this a try!

[emknelson]

Is he having a poo at school? Some (most?) children don't use the school toilets for that, so he may be holding it in and this then causes urgency at home (and confuses the brain/bowel signals, perhaps, if he withholds when he has an urge). School can offer the use of a private toilet, and especially if you contact your county council's "School Nurse" service directly, you can consult the nurse independently and s/he will empower you and assist you to set up a toileting plan at school. If your child is autistic, this may be a feature of his autism, too, so have a look at the National Autistic Society website for advice. We didn't know our son was autistic and his bowel problems intensified at school in Year 1, which is when all the sensory/play is set aside for an environment that is unintentionally hostile to sensory and play needs. If you suspect or know that your child is autistic, he needs more support than a school nurse, as they often don't know much about autism and he/you will need better support than medicine and poo plans.

[MarkJ31 in reply to emknelson]

No not having a poo (only very very rarely an accident) at school. The school have been great and he has a toileting plan and the staff are on top of it as far as we know!

We have seen a consultant regarding autism and they decided that there wasn't enough evidence to support it.

His year 1 has seen a big improvement for his toileting. During the reception year we had plenty of wetting and soiling accidents whilst this year they have been few and far between.