Strategies to stop withholding

[Le15]

My son is 4 1/2 and due to start school in a few weeks’ time. He has had toileting issues ever since we potty trained just before he turned 3. It started with a slight fear of using the toilet - nothing too major (or so we thought). There have been times in the last 18months where he has been fine and we’ve felt that we’ve cracked the issue and then it turns into a nightmare again.

About 3 months ago he started having lots of leaky urine accidents in his pants so I just knew the constipation was back. If we clear the blockage, the wee accidents stop… and it worked. However, the poo in the pants issue hasn’t stopped.

We have done 3 movicol clear outs in the last 6 weeks. The first time, we didn’t get to brown water. The second we did (it was a VERY messy weekend with lots of showers) and he seemed to improve, now the poo accidents are back again and we have just done a 3rd clear out. In the meantime he still takes one movicol sachet in the morning and one in the evening.

So he’s still withholding and that’s the bit I can’t seem to crack. We can physically stop him holding in his poo using laxatives - but how can you get a child to stop withholding themselves? How can we fix the psychological issue because at this point I’m not even sure he is aware he is withholding.

We do ‘toilet time’ after each meal and get him to push a bit (this rarely produces a result) - he does poo daily despite this - just never in the toilet - and never shows any fear or concern about what is going on. Can this all be a front? Surely he does care really?! That’s the hardest thing about all of this - staying calm when my son acts like he’s not bothered. We’ve also backed off the issue completely - no toilet chat WHATSOEVER and that really seems to have helped. I just say ‘one day when you feel like doing it in the toilet, I know you can, it’s up to you’ so we’ve really tried to make this not about power or control in any way.

So we will keep going with the laxatives and good diet, trying to get the balance right every day. But should we start having play therapy? Have anyone used a therapist that has helped? He has an X-ray booked in that we’ve had to fight for a pay privately but I think it will put my mind at rest that all the poo has gone. I just can’t cope with him starting school in this position. It’s heartbreaking.

Any thoughts on strategies to help with withholding are welcome! TIA

[LB1234]

Hi, I've had similar with my daughter. We have found that we weren't giving her long enough on the toilet after meals. It often takes her a good 15mins or more to pass something. We take toys/books and have a good chat/laugh about general life to pass the time and she will generally have a bowel movement once, sometimes twice a day doing this.

It's not fully resolved the soiling here right enough but she is at least going regularly and passing a decent amount so hoping it will start to break the habit of witholding as she gets more used to doing it in the toilet.

Sorry I don't have any other advice. Hope you find something that works!

[Le15 in reply to LB1234]

This has help so much! Thank you! We’ve got a new set up in the toilet - a stool that lifts his legs a bit higher and the iPad on it so he has to lean forward a bit to get in the optimum position. We also downloaded a few new games (reading eggs) to keep him entertained. He sits there for around 20-25 minutes now on his own accord / no pressure from us after every meal for now and produces a result! Im hoping if all the poo comes out before / after school we can retrain him to stop withholding overtime without having loads of accidents at school. Photos for anyone this could help!

Toilet set up for constipated child

[LB1234 in reply to Le15]

Excellent, glad you've got some progress and he's comfortable. Looks like an excellent set up! We're going for the same approach here with hoping that the regular emptying will help overall. We've had about 4 days with no wee or poo accidents so hoping we're starting to get there - back to nursery tomorrow though after a week and a half off so will wee how that goes!

[Loufrom]

Hiya, I’ve seen your post and it could have been myself writing this about my little boy! He’s 4 and he’s doing exactly the same. He has just started wet accidents in the last week which he hasn’t had in such a long time. He’s always some soiling since potty training, I thought he had cracked it but he hadn’t. It is like he struggles to go, and a lot of mess in pants. And sometimes it is like stuck in his bum and it won’t come out. It’s also like he’s not bothered and I really don’t know what to do.

[Le15 in reply to Loufrom]

Oh I really feel for you! It’s so hard isn’t it. It sounds like you are where we were 6-8 weeks ago. We took our son to the DR and started the process of disimpacting using movicol and it worked wonders at getting him regular. I don’t want to give medical advice but I think that could be the answer - just make sure you really go for it with the movicol over a 4 day period and then keep on a maintenance dose. It’s massively inconvenient but I wish I had done it months ago. My son is starting school next week and it’s causing so much stress. We’ve done 3 clear outs so far so be prepared that a relapse is likely! Best of luck x

[CheshireMama]

If you add a stimulant, senna for example, to your routine that should help as it makes them feel when to go. Along with the praise, reward charts, regular seats etc, it will improve again x

[Le15 in reply to CheshireMama]

Thank you we will try that

[lil21lucky]

Hi, my daughter was the same a year ago. It never bothered her that she would have poo in her pants she’d just shrug it off. We had good days and bad days, 2 sachets she was on. The school were good and would help change her. In May she had a gastro paediatrician check her over. Nothing wrong very common she will get there eventually. She recommended disimpactation, we got to 8/9 sachets for the day. We then reduced but still had the accidents, looking back now I’d say because the dosage was too high. We focussed on get the poo to be soft and I was going to deal with the accidents afterwards. But with the poo being right the accidents stopped. We are now two sachets with dinner.

[Le15]

Thank you. We’ve found getting the right maintenance dose to be so challenging - thus having 3 separate disimpactation/clear outs! We are also on 2 a day now and it seems to be the right level for now. It’s a constant balancing act