Poo withholding 6 year old

[CCBaxter28]

First post here. Have had some support from ERIC for my son who has had a severe issue with stool withholding for over 2 years.

My son developed what can only be described as a full on phobia of pooing just before his 4th birthday. He's now 6. Usually we get 1 poo every 7 days on average. The most recent gap was 10 days!

Every visit to the toilet for a poo is hugely traumatic for him (screaming, crying, avoidance, pain) and for us as parents to try and reassure him. All logical explanations we can give for him don't seem to get through. The immediate days after a poo are fine, but as the days progress he gets visibly more uncomfortable and lethargic. When he eventually goes...the first poo is huge, followed by lots of smaller softer poos! Almost always accompanied by some blood. We've been assured it's a fissure because his poo is hard and there's lots of it. Makes sense, but no less alarming when I wipe him and all we get is blood.

Doctor has given is Laxido/Movicol so he gets around 2 sachets a day. More if he's not been for a few days. We've also had regular appointments with CAMHS. Mental Health service. We're assured the methods we use are correct and to keep going with what we are doing. Of course we will, but really not making any progress!

Food - our son has had relentless bouts of tonsillitis since he was a baby and got them removed in Sep 2021. Over this time the range of food he eats has got more and more limited...likely due to how often he has been sick. It's like he has a phobia of some foods. So trying to get a variety of food with fibre is nigh on impossible. He eats NO vegetables. Limited fruit - strawberries sometimes and banana (the latter is no good for constipation)! This has been a really integral part of our struggle. I know all kids can be fussy eaters...but this seems extreme to us. He doesn't even like sweets and juice...so we know we're in a rare situation!

So all of the above compounds the issue with poo. Illness aside this is the most stressful issue as parents we've ever had to deal with. It stops us doing things when he's not gone for days, we cancel plans so we can be near home. We worry constantly that he'll have poo accidents in school...which has happened. Kids remember these things. Too much of the movicol leads to soiling, too little has no impact!

I don't have a question unless someone out there has a magic solution, i dream of a phrase that just unlocks this anxiety for him. Just sharing for catharsis.

Thank you for reading.

[Mintchoc]

Hi We are going through something similar with our five and a half year old. We are now on day 11. I don’t think I have answers but just to say you’re not alone. He passes a mega poo that regularly blocks toilets. He has six sachets movicol a week.

We are planning another full disempaction treatment with loads of movicol in the school holidays to try and achieve a reset. But soiling is a near daily/multiple times daily occurrence. And I hope to get to see a paediatric gastroenterologist when the appointment comes through.

Our son seems to have decided that toileting is just less important than whatever else he seems to be doing. We are trying a reward system/lots of praise/bribery to persuade him but he is absolutely defiant at times.

I am really hoping that he and your son grow out of this phase very soon…

Our son won’t eat anything green and dislikes foods mixed together or with sauce. He eats cereal for breakfast so that’s a bit of fibre. Only occasional apple, red peppers and slices of cucumber (round not lengthways!) His fussy eating drives me crazy but I just keep trying different things and he will at least try things. I understand he eats a bit better at school but I suspect they’re just not paying attention! Too many kids to track what everyone is eating surely? Sorry for the rambling response but if you do have any tips that make a difference, please post on here! Thanks

[CCBaxter28 in reply to Mintchoc]

Thanks for your response. Definitely feeling your pain. Defiance is a major issue for us. The blatant refusal to admit he needs a poo. It's a split between chronic constipation and a superhuman ability to tense up down there to stop anything from happening. It's not his fault...but such an ingrained habit that we can't break, 2 years on.

We use reward techniques as best we can. But it costs us. We're at the stage where a poo = a star on his chart. 5 stars = a present (£10 limit!!)

But even when we're 1 star away from a reward he still refuses to even try.

The temptation after the relief of a poo is to take the foot off the gas and then start the movicol a couple of days later. Starting movicol straight away leads to soiling. Which unfortunately seems to be a necessary evil to allow for softer stools. Our discipline wavers a lot too I have to admit. Sometimes just easier to relax everything after he finally goes. But it does no favours so it needs to be a relentless daily struggle.

Any progress we get, any tips I can think of that work...I'll post here. Good luck!

[CCBaxter28 in reply to Mintchoc]

...also I hear what you're saying about school. Sometimes the report we get back from teachers about his habits, eating, general behaviours seems at odds with the boy we have at home. He's a great kid, very funny and very sensitive. So hopefully the school are paying close attention. We've told them about his toilet issue but they don't seem to have noticed anything. We got called to school for a soiling issue once so I suspect that will continue to happen on occasion. We're using the school holidays to hopefully try and crack this. So far...no change.

[Mintchoc in reply to CCBaxter28]

Have been thinking about a few things that seem to help a little bit. My son is not good at staying hydrated so I give him the water challenge where he has to finish his whole water bottle by the end of the school day. At the very least it helps the movicol work! And positioning on the toilet to help go - the advice I read online spoke about having a stool to rest their feet on gives a better squatting position but my son couldn’t get on with that but found it loads easier (and thinks it’s funny) to stand on the toilet seat and squat! Worked fast! Decent balance required!

The other thing that’s helpful just for me to remember is that he genuinely can’t feel when he needs to go because the bowel is stretched so it’s not his fault. And young kids get sort of used to their own smell so don’t realise they’re stinky to those around them when soiled hence the denial of needing to go when you can blatantly tell!

He gets really embarrassed talking about it so I try and reassure him we’ve all been there and everyone needs to poo every day. It’s normal to go to the loo. His teacher has been quite helpful to.

Nothing very earth-breaking but thought I’d mention it.

It’s every day - keep going!

[CCBaxter28 in reply to Mintchoc]

Thank you. Appreciate this. We have a wee stool he rests his feet on. But will try and make a game out of it...get him to hover.

Yeah the bowel stretch thing makes a lot of sense. He still runs about on day 10 sometimes. And you feel it cannot be possible!!

Onwards and upwards hopefully for us all.

[14crosstitch14]

Hi i had/ have same issues and found things like sorren and theirs plenty flavours. Chia seeds in ceareal or can go in anything and plenty of different types of fluids ice lollies will work for this weather. Plenty exercise too just miving and sqats make it all fun. I played a toiket game and used dolls/ bears to pretend they use potty. Sd is a lot better now and dosen't hold on as much. I think the anziety dosen't help when she's back and forth between homes. She's doing so goid though. Very proud after the last 2 years. Good fibre bars at aldi they think its just cake. Chia seeds and prunes put in cake. They know no diffrrent. Lots of fluids milk shake straws for milk always a good 1 to try.

[CCBaxter28 in reply to 14crosstitch14]

Thank you so much for your reply. I'll try as much of this as I can! Some of the foods...even cereal get rejected. Hope we have similar success that you have.

[Calla_Lilly]

This is us with our 4 yr old daughter. Have you explored underlying medical issues like allergies, digestive conditions, thyroid function? We’ve also been given senna to try and activate bowel movements. She starts school in September and we’ve already had issues with the head telling us she needs an EHCP, full time 1:1 and for her own toilet to be built! They wanted us to defer entry. We’ve now moved schools to a more inclusive one but we are worried….

[CCBaxter28 in reply to Calla_Lilly]

We have an appointment this week to look at underlying issues. School has certainly been a worry for us too. Sending him to school when we know he's not pooped in 7,8,9 days is really nerve wracking. But most of the time we get him home and he's not been. He had an accident once and soiled a little. We got called to the school...we just changed him.and sent him back in! If they can function with that much poop inside we just don't want to deprive him of school time. Would feel like we were admitting defeat if we kept him at home.

Good luck when school starts.

[Helen36]

Hello. First of all just lots of sympathy for what you are going through. I know how hard it is and how it totally takes over your life and relationship with your child but is sounds like you are getting so much right and I promise you will get there with this in the end

So, some tips….

1. You need much more movicol. I would recommend a full disimpaction first (let me know if you need more info on how to do this and I will send a link) and then you need to have him on a dose where his poos are as soft as mr whippy ice cream and keep it at that stage so it is not sore for him. Getting him to drink it will be the battle so good luck with that but this is the absolute key to getting him to poo more often and feel less scared of what is happening. call it his ‘poo softener’ drink to help him understand why he has it

2. Play lots of drinking games. Don’t judge me but I used to give my daughter a shot glass of water and then we would play all my old drinking games from when I was at uni (!) with water in the shot glass. We also used to do a game where I would tell her not to drink it, and then turn my back - and guess what - she drank it! I’d then pretend to be really cross and do a big dinosaur roar. The sillier the better with all of this and the little 50ml glasses add up. It also used to work with fruit and veg (a bit). I’d ask her to keep her eye out for the food fairy whilst I had a pretend nap, and ask her to make sure the fairy didn’t eat her cucumber / apple etc whilst I slept. This might not work for you, but is good fun if he will engage with it

3. Get a proper kids toilet seat and high step so his knees are above his hips on the loo and he feels really safe. At six they still need this if they have any poo fear and the knees above the hips will make it easier for him.

4. Reward a five minute sit on the loo about 20 minutes after every meal but you might need to build up to that length of time. When he’s on the loo get him to blow something. (I used to get my daughter to try and make my fringe move with her blows but you can use little windmills or something like that). This encourages the right muscles for a poo and around 20 minutes after a meal there is a reflex that means the bowel is more ready to open.

4. You are the poo midwife. When he is pooing get him to blow out, hold his hands look him in the eye and reassure him. Say, I know it hurts, keep blowing, well done, you’re nearly there’ - all the stuff you read in pregnancy books. Help him talk about how he feels after a poo and how he feels before one and acknowledge and validate everything he says. ‘You say it hurts and you don’t like it. That must be really scary. I am going to help you as best I can. We will work on this as a team together’

Try not to get too frustrated by him avoiding the toilet. I know it is hard but when you see those signs help him understand what is happening. ‘I see a boy putting his knees up and clenching his jaw. I know that means he might be feeling scared that a poo wants to come out and that might hurt. Can I hold your hand / hug you so you feel less scared’ - when he trusts you on this you can broach moving to the toilet. Now my daughter is older she can explain that she really feels she can’t move in those moments. We now wait for it to pass and then go to the loo. The breathing and blowing usually helps the poo then come.

Hope this helps… and good luck.

[CCBaxter28 in reply to Helen36]

Thank you so much for this brilliant response. A lot of it familiar. We use bubbles...I'll reply properly when I have more time. Thank you.

[CCBaxter28 in reply to Helen36]

Thanks again for your response. The drinking game idea is excellent! Zero judgement here. If it works, it works!! We've done a lot of what you have said. And the movicol is the best way to go. 6 is our limit really because he puts up a fight everytime he has to drink it. Using something to disguise the taste won't work. He only likes milk or water. Will definitely call it the poo softener from now on.

We were told to try and get him to blow bubbles so that's a technique we keep going with. Distraction when he's on the loo is another. We do a full on comedy sketch with soft toys to make him laugh. It usually takes a good while for anything to happen so we use so much energy. Sometimes we have to give up. You can tell if a poo is imminent and to keep going and you can tell when he just can't feel it.

We've tried hot baths most nights. Again some success but nothing regular. Interestingly we nearly had a terrible accident at a swimming pool. Going from the cool water of the slides to the warm water in the pool activated everything. I had to get him out of there and on the pan really quickly!!

[Natsqualez78 in reply to Helen36]

Thank you so, so much. I'm ccbaxters wife and mum to our wee boy. This is such a valuable detailed response and the suggestions you have given are truly brilliant. Can't thank you enough for the time you've taken to write this. Amazing support, and you have absolutely given us other things to consider for sure. I love the drinking games. That is so happening. And being a poo midwife just makes so, so much sense.

What a great community this is. We will absolutely try everything here. You've even given other ways of thinking about the language we use.

Honestly fabulous. Thanks so much.

😊😊😊

[Flor62]

One of our fosters was very similar. Having 6 sachets of laxido daily! Which as you say can lead to soiling. We would keep her off school on days when we thought we were in for a big bout. Then we ordered Hydro C from the US. It shoots a large dose of vit C straight through to the colon. No side effects. Worked a treat for us.

[CCBaxter28 in reply to Flor62]

Thank you for replying. I'll definitely look into hydro c!!

[Suzeski]

Hi, we had something very similar with our 6 year old and he is very fussy with food. We did a full disimpactionin the Easter holidays and are on 2 maintenance doses of movical and now there is no pain at all when pooing. I would highly recommend the full disimpaction. Talk to your doctor/ health visitor about it.

[CCBaxter28 in reply to Suzeski]

Thank you, we definitely will try the full disimpaction.

[Retiredyear7teacher]

As an adult, I have had colon problems. One problem I have had is that a treatment whatever it is works for a while, then problems come back and I try something else for a while. Start googling treatments for children and see if some other treatment is out there. Be sure that there is not an impaction that remains after a bowel movement. You will never get good results if soft poo is going around an impaction that is the source of the problem.

Try to get your child to have a bm every day. Don't wait five or more days to try to have a bm.

You might need to visit with another doctor. He or she might come up with a different treatment that will work for you. Best of luck.

[CCBaxter28 in reply to Retiredyear7teacher]

Thank you for responding. ☺️

[CheshireMama]

Oh this sounds so hard on you all! Mommy now 4.5 yr old has been on Movicol for 1.5 years and until we “cracked it” it was so tough.

Some thing that helped us. Finding our maintenance dosage of movicol. Trial and error but finding the amount that doesn’t make her have quick loose stools, but means she can’t hold her poo as well (for us it was 1.5, then 1 & now 0.5 a day). We also got her to sit on the toilet with the iPad for 20-30 mins after each meal. We also gave senna in an evening if she hadn’t had a poo.

I don’t think it’s right for you all to just have this as your normal - a good doctor should be helping you find your way to your son no longer being chronically constipated.

If you haven’t got it already can you ask for senna as a stimulant to help him go?

As a side note, the movicol doesn’t cause soiling - that will be the overflow of poo from the constipation, so upping the dosage might be your solution.

Just for light at the end of the tunnel - my daughter has daily poos (or misses the odd day & goes 5/6 times a week). She has half a movicol a day & mainly will take herself for a poo, but we still have to tell her to go and try as her default is to say no & hold - but a forceful reminder and iPad bribe sorts it.

Good luck

[CCBaxter28 in reply to CheshireMama]

Hi. Thank you for your response. I think you're absolutely right about a maintenance dose of movicol. Usually 2 a day for our son. We saw another doctor yesterday who has prescribed us something for emergencies...e.g. he's not been in 9 days and there's a party the next day so we'd really.love him to go. Can't remember the name. Will post when we get it.

Apart from that, tablet and 20 mins is a good way of establishing routine.

Thanks!!